Sunday, August 18, 2013


StrategyPage discusses a couple of anthrax cases in humans in Russia

August 6, 2013: In the south (Stavropol) a health emergency has been declared because two people have contracted anthrax. Last year there was an outbreak in southern Siberia. Anthrax is found naturally in both areas and infected animals (who pick up the disease while grazing in areas where the anthrax spores are active) have to be destroyed when there is an outbreak. Anthrax is also found in some parts of the United States and other parts of the world where climate and geographic conditions are right for it. In rural areas of the United States where anthrax is found, people liable to exposure are usually vaccinated against the deadly disease. Animals are also vaccinated, as it is the cattle and sheep that usually spread Anthrax to humans. Vaccination is much less common in Russia but when there is an outbreak people and animals in the area are vaccinated in order to contain the outbreak. During the Cold War Russia devoted a considerable amount of effort to create a “weaponized” version of anthrax for wartime use.

yeah. when the anthrax in the mail scare hit the US, our Oklahoma farmers laughed and said if they wanted anthrax they'd just dig in their barnyards.

Weaponized anthrax is something different: The spores clump, and are too heavy to be weaponize it you have to process it in a way to stop clumping...which is why the scientist who killed himself after harassment probably wasn't the culprit: He knew bacteriology but not the second process....

oh yes: Anthrax is also common in Africa and kills elephants.

Saturday, August 17, 2013

Killing those who help others

Strategy page reports that hospitals and aid groups, including doctors without borders, are being targeted by thugs in Somalia

The departure of Doctors Without Borders comes at a particularly bad time because of a recent polio outbreak. A l Shabaab opposition to polio vaccinations led to this new outbreak of the disease. Some 600,000 children in southern Somalia and refugee camps in northern Kenya have not been vaccinated, mainly because of al Shabaab opposition and general chaos. The first case was detected i n Kenya three months ago when a Somali child in a refugee camp came down with it. Five years ago the UN announced that a ten year effort to eradicate polio (by vaccinating nearly every child under five) had succeeded and that Somalia was free of the paralyzing (and often fatal) disease (which can only survive in humans). But to make that eradication permanent follow-up vaccinations had to be given and al Shabaab interfered with that. So in the last three months over a hundred kids in Somalia and Kenyan refugee camps have come down with polio. Last year there were only 223 cases worldwide.
Polio should have been eliminated entirely by now, 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 and Pakistan). The disease also survives in some very corrupt nations, like Kenya and India, because of the difficulty in getting vaccine to remote areas and tracking down nomad groups. In response to this latest outbreak Kenya will carry out more vaccinations in Kenya and help do the same in dangerous parts of Somalia.

indeed, quite a few Muslim medical workers have been killed in Pakistan/Afghanistan because they were vaccinating against polio.

I'd like to do a blast about the ignorant, but in this case, the "Rumors" about evil polio vaccines started in the UK Press, when someone wrote a story about polio vaccine being associated with the spread of HIV. The core of the rumor was that an early form of one polio vaccine had a virus associated with cancer in monkeys, (Not HIV) but since we haven't seen an epidemic of a similar cancer in humans, and since the vaccine manufacturing methods have changed, the story was like the others about whooping cough vaccine causing brain damage or MMR vaccine causing autism.

The high fever reaction to the old whooping cough vaccine was sometimes thought to be associated with a form of mental retardation (or maybe the kids just happened to get a low grade viral encephalitis and the timing with getting the vaccine was a coincidence) but so many parents refused to let their kids get the shot that it led to 40 thousand cases of that disease in the UK, with a half dozen deaths (and sometimes the kids cough so hard they end up with strokes, but never mind). As for MMR: One of the unsung stories is that giving that delicate vaccine has saved literally millions of lives.

I should note that hitting hospitals and killing docs right now is usually by terrorists inspired by a radical/fascist form of Islam, but when I was a doc, it was the communist insurgents, funded by the very politically correct World Council of churches, who killed quite a few of us. The reason I say "very politically correct" is that in those days, the WCC never condemned Russia or persecution of churches behind the Iron curtain either, but of course, in those days, the US Catholic bishops let their radical leftists write and release a paper suggesting unilateral disarmament of US nuclear weapons....

see no evil, hear no evil by the naive.

One is reminded of the famous essay about the children of light vs the children of Darkness: Jesus said he wished the children of light were half as smart in these things as the children of darkness, and the famous Niebuhr essay laments how good people blithely became allies of evil because they underestimated the strength of selfishness. Heh.

Even that nice liberal writer couldn't say: Look some people just need killing.
and ironically, after a fluffy essay about his influence, someone in wikipedia noted this:

Because of his opinion about factory work, Niebuhr rejected liberal optimism. He wrote in his diary:
We went through one of the big automobile factories to-day. . . . The foundry interested me particularly. The heat was terrific. The men seemed weary. Here manual labour is a drudgery and toil is slavery. The men cannot possibly find any satisfaction in their work. They simply work to make a living. Their sweat and their dull pain are part of the price paid for the fine cars we all run. And most of us run the cars without knowing what price is being paid for them. . . . We are all responsible. We all want the things which the factory produces and none of us is sensitive enough to care how much in human values the efficiency of the modern factory costs.".[32]
The historian Ronald H. Stone thinks that Niebuhr never talked to the assembly line workers (many of his parishioners were skilled craftsmen) but projected feelings onto them after discussions with Rev. Samuel Marquis.[33]

Since my neighbors growing up and most of my patients were blue collar workers, I am happy someone had the nerve to point this out.

Thursday, August 15, 2013

Farmer's markets open in Chicago neighborhoods

Article in the Chicago suntimes about allowing larger community gardens and farmers markets to sell in the inner city neighborhoods.

What is not mentioned: a lot of mom and pop markets close due to crime, and places like Walmart, which has lots of veggies (including ethnic veggies) is not allowed.

but I know one problem is lack of stores: I used to go to a 24 hour market to Boston it was a warehouse type grocery, but elsewhere it was usually the 24 hour Walmart superstores to buy food, including veggies. of course, that shopping was once a week (so fresh veggies often didn't keep that long) but the prices in the small towns were higher and the selection a lot smaller... that is one reason I laugh at those "bring your own bag" types showing an attractive young woman carrying a small tote bag: Uh, even when there was only two of us, we often bought four or five bags of groceries every week...add kids, and double that.

Now, imagine you are on a limited budget, and you see the problem. In Boston, the poor took a cab and filled it with bags and bags of groceries...

Wednesday, August 14, 2013

Vaccination stops meningitis outbreak

NYTimes story here.

At least 16,000 people have been vaccinated; an estimated 30,000 to 100,000 were believed to be at risk. Dr. Varma said the number of vaccinations was probably higher, but doctors are not required to report having given the vaccine, and the data come mainly from large medical practices and organizations like the Gay Men’s Health Crisis.

presumably this was meningococcal meningitis, a disease spread via ordinary ways (coughing, kissing, direct contact including shaking hands)...we usually vaccinate kids who are going to college or into the military to stop epidemics...and the bad news is that a tiny percentage of people are "carriers": in their throats and can spread it.

It is not an STD....I know of two doctor's kids who developed cases, presumably because their fathers had been in contact with a case and brought it home.

Tuesday, August 13, 2013

PTSS and suicide: it's (not) the combat stupid

StrategyPage has a lot of stuff on the prevention and treatment of post traumatic stress syndrome, but today's article is about suicide and combat.

August 13, 2013: Military epidemiologists (experts on medical statistics) have long sought to convince people outside the military that the rise in suicide rates within the military had little to do with the stress of combat and mostly to do with the stresses of military life for all those in uniform during wartime. In other words, the increased suicides were not concentrated among the combat veterans (who make up less than 15 percent of those in the military) but more evenly distributed among all service personnel. For example, 77 percent of suicides were among troops who had never gone overseas.
the stories are not going to examine the evidence, because the stories are written first to prove their point.

These revelations were not well received by the mass media in the United States, which makes much of the rising suicide rate in military (but pays less attention to rising suicide rates among civilians of the same age and education). It was 9 per 100,000 in 2001 and 17.5 last year. This was declared to be a health emergency, and to a certain degree it was. What was missed in all the discussion was the higher suicide rate in the army was far below the rate for civilians of military age (17-60), which was 25 per 100,000 but was catching up.
The fact of the matter is that the military seeks to recruit only people who have an above average ability to deal with stress, especially for the minority headed for combat jobs. It’s not just combat stress the military worries about, because less than 15 percent of troops in the ground forces have combat jobs. The rest are doing civilian type jobs but often under stressful (combat zone) conditions. In fact, most of the military suicides are of men who were never in combat or even overseas. But since the military suicide rate is so much lower than those of comparable civilians, it hardly matters. There are so few actual suicides in the military each year that a few soldiers having family problems can cause the rate to seemingly spike. That’s largely what has been happening.
another "meme" is that suicide/violence is due to drugs used to treat the psychiatric problem, not due to the psychiatric problem itself (suicide, for example, is more common in the recovery phase of severe depression, and this was known before drugs became available...the reason is that if you are very depressed, you are too apathetic to kill yourself, but as you recover, you get the energy back but not the insight that you are getting better, so they act on the plans they had already made).

So what about the drugs?

The danger of suicide led to many PTSD sufferers, or those who might have it, to be given anti-stress medications. Use of these medicines increased 76 percent between 2001 and 2009. By then, some 17 percent of all troops took these drugs, including six percent of those in combat zones. In 2001, the troops used these drugs to about the same degree as the civilian population (ten percent).
what is the real problem: repeated deployments of the same people to a combat zone.

During World War II it was found that, on average, 200 days of combat would bring on a case of PTSD for your average American soldier. After World War II methods were found to delay the onset of PTSD (more breaks from combat, better living conditions in the combat zone, prompt treatment when PTSD was detected). That's why combat troops in Iraq and Afghanistan often slept in air conditioned quarters, had Internet access, a lot of amenities, and a two week vacation (anywhere) in the middle of their combat tour. This extended their useful time in combat, before PTSD set in. No one is yet sure what the new combat days average is, and new screening methods are an attempt to find out. But more troops appear to be hitting, or approaching, the limits.
 they also note that PTSS is common among civilians, and that what the military is learning can be used for civilians too.

Monday, August 12, 2013

Garbage in, Garbage out

WSJ article has a lady investigating advice in pregnancy.

and she didn't notice that the "weight" thing was not really about obesity, but started because of the problem of fluid gain: Weight gain from excess fluid/fluid retention is a sign of pre eclampsia.

and a lot of the "coffee" studies compared clean living Mormon women (who don't drink caffiene) with others. The problem? It only takes a few people in the "coffee drinking" folks to  mess up the statistics.

Another problem: Asking someone if they did something after they have problems with a toddler or  newborn (or develop cancer) brings up more positives than if you ask someone without problems. So if you have a premature baby, you start thinking: maybe it was the coffee, maybe it was because I had sex, maybe it was the cocaine. Whereas if you don't have problems, you probably forgot about that orgie you had when you were two months pregnant...

Freakonomics does an analysis of the problem HERE>

there is a rather large body of literature on the topic of birth month and its relationship to later outcomes. Which is why it’s interesting to see a paper (working version here), just published in The Review of Economics and Statistics, which offers a different angle on all this birth-month conversation. The authors are Kasey S. Buckles and Daniel M. Hungerman:
Season of birth is associated with later outcomes; what drives this association remains unclear. We consider a new explanation: variation in maternal characteristics. We document large changes in maternal characteristics for births throughout the year; winter births are disproportionately realized by teenagers and the unmarried. Family background controls explain nearly half of season-of-birth’s relation to adult outcomes. Seasonality in maternal characteristics is driven by women trying to conceive; we find no seasonality among unwanted births. Prior seasonality-in-fertility research focuses on conditions at conception; here, expected conditions at birth drive variation in maternal characteristics, while conditions at conception are unimportant.

Yup. those summer orgies do tend to make one pregnant...


Another junk science that links autism with inducing or "augmenting" labor.

but we often induce labor for overdate (e.g. when the baby might be overdue and the placenta might not be giving the kids enough nutrition) or when the mom needs to deliver early (e.g. diabetes, pre eclampsia).

and the statistical difference is small:

Of approximately 911,000 babies, Gregory and his colleagues were able to match about 678,000 to their education records, which included a note when a child had been diagnosed with autism.

According to findings published in JAMA Pediatrics, 4,285 boys were diagnosed with autism, compared to 1,363 girls.

Of boys diagnosed with autism, about 14 percent were delivered after an induced labor and about 16 percent were delivered after augmentation. In comparison, 13 percent of boys with typical development were born after induction and 14 percent after augmentation.

Among girls, only augmentation was linked to an increased autism risk. About 16 percent of girls with autism were born after augmentation, compared to 14 percent of those with typical development.

one suggested cause of autism is viral infection causing placenta problems with "small for dates" baby, which might be a reason to induce.

And one reason for "augmenting" labor might be a pooped out mom, from health problems....and a lot of times, the same thing that causes the prolonged labor (large baby, exhausted mom) might be affecting the child. So is it the induced labor, or is it because the kid is brain damaged from prolonged labor?

then there is the problem of diagnosis. How many of these "autistic" children were mentally retarded (or whatever the PC term is for low IQ)? I worked for years with the retarded, and now many "autistic" kids look just like those I worked with. Retarded is not PC, but the name "autistic" is, so I am sceptical about the "autism" diagnosis, especially when I see a retarded child with behavior problems whose mom assures me he is not retarded but merely autistic...

one more thing: We are told that autism is common: In the past, one percent or so of children were retarded, and now we are told that one precent or 88 out of a thousand kids have "autistic spectrum disorder".

yet they found only 5500 kids with autism out of 900000 records...
half of what is the usual number who should have been recognized. or maybe not: They could only track half the kids with their school records.

And how many were chromosome problem, fragile x syndrome, or moms took drugs or had virus infections?

and what about privacy issues? To "track" the  kids school records meant they had the name and birth dates of all these kids. And the "note" on the schools records was noted: NOT if the kids actually had the diagnosis, and no note who made the diagnosis...

Snooping into your records.

Sunday, August 11, 2013

Studies to distrust

a UC Berkeley study links sleep lack with junk food cravings.

first pseudoscience part:
A UC Berkeley has linked sleep deprivation to junk food cravings, finding that high-level brain regions required for complex judgments and decisions become blunted by a lack of sleep, while more primal brain structures that control motivation and desire are amplified.

uh, "high level" brain is the thinking brain, but also does a lot of other things like move your body.

Moreover, he added, “high-calorie foods also became significantly more desirable when participants were sleep-deprived. This combination of altered brain activity and decision-making may help explain why people who sleep less also tend to be overweight or obese.”
Previous studies have linked poor sleep to greater appetites, particularly for sweet and salty foods, but the latest findings provide a specific brain mechanism explaining why food choices change for the worse following a sleepless night, Walker said.

there is another explanation, of course.

That depressed people tend to eat "comfort foods" or food that give them energy, like junk food. Depressed people also have sleep problems. They often have insomnia, and then wake up at 3 am (The medical joke is that there is an alarm clock that goes off at 3 am and wakes all our depressed patients).

you also have population bias; not everyone eats junk food. For example, I might eat "comfort food" but not junk food. This suggests that their obese patients were poor, who routinely eat high protein high fat foods with sugary drinks at the fast food restaurants.

Wonder if they have any depressed upper class gourmets in their population?

a similar study out suggests that kids who watch too much TV have fewer social skills.

The implication is to get all these kids in government day care to train them to act properly.

Yet, one wonders if the children who tend to be shy and/or nerdy prefer to spend time with a tv or computer than to play with kids who routinely ridicule them or tease them.

Saturday, August 10, 2013

The King's midwife

TYWKIWDBI has a photo of a birthing eduation doll used by Madame Coudray

Angélique-Marguerite du Coudray was a famous 18th century midwife and designed this mannequin to teach midwife trainees about delivering babies. Louis XV learned of her expertise and asked her to set up courses throughout France. From 1759-1779 she traveled the country with her mannequin and published her Abrégé de l’Art des accouchements (Abridged Art of Child Delivery)

actually, we used a similar mannequin to teach our midwifry students in Africa...

book about Mrs. Coudray HERE....they used to let you read it on line, and it was interesting but boring...alas, no longer: You have to shell out money to even check it out. This site says you can read it on line, but it's not loading for me.

nowadays, they have big expensive mannequins to teach you how to deliver a baby. LINK...

well, the dirty little secret is that you learn how to deliver a baby by...delivering a baby...see one, do one, teach one...but few women are willing to be "guinea pigs" for half  trained residents nowadays...

and since things like breech births with extended arms or face presentations are rare, maybe the way of the future is training with such birth simulators so you can do it "automatically" when these rare things occur.

Thursday, August 8, 2013

MERS (Arab form of SARS) came from camels?

NYTimes article

The virus, first detected last year in Saudi Arabia, causes Middle East respiratory syndrome, or MERS, which begins with flulike symptoms and can progress to severe pneumonia. Because the virus belongs to a family called coronaviruses, often found in bats, researchers suspect that it originally came from bats. The bats might infect people through droppings or saliva, but they might also infect other animals that could then transmit the virus to humans. But which animals? Researchers have been scrambling to find out.
Now, a scientific team from a dozen universities is reporting that dromedary camels (the kind with one hump) from Oman and the Canary Islands show signs of past infection with the MERS virus or one very much like it.

Lancet article HERE.

We took sera from animals in the Middle East (Oman) and from elsewhere (Spain, Netherlands, Chile)....
Not from Saudi camels?


50 of 50 (100%) sera from Omani camels and 15 of 105 (14%) from Spanish camels had protein-specific antibodies against MERS-CoV spike. Sera from European sheep, goats, cattle, and other camelids had no such antibodies. MERS-CoV neutralising antibody titres varied between 1/320 and 1/2560 for the Omani camel sera and between 1/20 and 1/320 for the Spanish camel sera. There was no evidence for cross-neutralisation by bovine coronavirus antibodies.


MERS-CoV or a related virus has infected camel populations. Both titres and seroprevalences in sera from different locations in Oman suggest widespread infection.

so a virus similar to MERS has infected camels all over in the past. Does this mean we didn't recognize it in the past (probably) or a new mutation that lets it infect men (WAGD !)

Tuesday, August 6, 2013

New data on firearm homicides in US cities


summary: Homicide rate down, suicide rate slightly up.

Linked for later reading.

Fewer fat kids?

Awhile back, when someone was complaining about fat kids, I remember someone showed a study that said kids were still getting fatter, but that the obesity rate in the children raised in upper income family was down.

Now the NYTimes links to a study saying that obesity in lower class kids is falling too.
the question is why:
Tuesday’s report covered the period from 2008 to 2011 and offered what researchers said was the clearest evidence to date that the obesity epidemic may be turning a corner for 2- to 4-year-old children from low-income families. Children from poor families have had some of the highest rates of obesity, which have remained elevated even as rates among more affluent children in some cities have started to drop.
One in eight preschoolers in the United States is obese. Among low-income children it is one in seven.
The cause of the decline remains a mystery, but researchers offered various theories, like an increase in breastfeeding and a drop in calories from sugary drinks. In interviews, parents suggested that they have become more educated in recent years, and so are more aware of the health issues associated with being overweight.

so Michelle's preaching has worked?

the rest of the article says yes, but one naysayer points out that obesity is in the genes, and another points out that the decline is minimal.

but why only in the last few months? I am not in the US, so can't answer. But I know that despite many many educational programs by the IHS hospital and tribe, we couldn't put a dent into the obesity problem on the reservations.

Anyone check if there is a change in the way they manufacture plastic bottles? Some plastics make the metabolic syndrome gene kick in....

Full CDC report here.
and includes these points that might have changed the data:
First, PedNSS is limited to low-income children who participated in federal nutrition programs. These findings might not reflect the obesity prevalence and trends among all low-income U.S. preschool-aged children. In addition, the results might not be reflective of preschool-aged children of higher socioeconomic status who might have experienced more substantial declines in obesity prevalence (12). Second, this study included 43 states/territories that consistently collected PedNSS data during 2008–2011. Trends in other states/territories might differ. Finally, compared with 2008, the number of children in PedNSS was higher in subsequent years (approximately 2.7 million in 2008, 3.0 million in 2009, 3.0 million in 2010, and 2.9 million in 2011). This might have been caused, in part, by the economic downturn, which might have led to previously ineligible families becoming eligible for these nutrition programs.
In other words, the increasesd numbers might have added children from families with healthier genes, or whose nutritional habits were better to begin with and changed the numbers.

And some families might have less money so didn't spend as much on snacks.

there is also an article about surgery overseas. Manila is trying to get into this bonanza. I link but don't quote, since the NYTimes limits me to ten articles a month...

for elective surgery, this makes sense. And Manila has a low HIV rate, although there is always the risk of earthquakes, floods, robbery, and dengue fever (joking....aside from getting things snatched the other things are rare...and considering the number of ex pats and visitors, the number of tourists killed are few).

Monday, August 5, 2013

Legionaire's disease outbreak in the VA hospital of Pittsburgh

I ran across this on the right wing Freeper's website (*while checking  the GGG forum pings such as an article on the Moche (Peru) treasures. I also get pinged when medical stuff is posted)

It seems that there was a bad outbreak of Legionaire's disease in the Pittsburgh VA hospital, but a local newslady is mad because it's been ignored by the press.

another Trib article here.
It's not just Pittsburgh.
Department of Veterans Affairs hospitals across the country failed to follow policies designed to stop the spread of Legionnaires' disease, according to a VA Office of Inspector General's report released on Thursday.
More than one-third of VA hospitals and clinical care facilities did not conduct proper planning and risk assessment required by a 2008 national VA directive to control the Legionella bacteria. If inhaled in water mist, the bacteria can become a potentially deadly form of pneumonia known as Legionnaires' disease.
“The report shows a clear lack of understanding at VA facilities across the country about proper protocol when testing for Legionella,” Sen. Bob Casey Jr., D-Scranton, wrote in an email to the Tribune-Review.

Usually Legionaire's disease is spread when water droplets carrying the germ get sprayed into the air, for example from contaminated water (example, in a shower) or in a humidifier or air conditioning sytem.

It began at a hotel holding an American Legion convention, ergo the name. A lot of men died, many of whom were smokers and died of pneumonias etc. that didn't respond to ordinary antibiotics. They found that erythromycin works, but we don't usually use that for severe pneumonia. I've never treated a case.  It is a weird organism, sort of a "naked bacteria". This caused problems in finding the cause of the illness, since usually we identify bacteria by staining their walls. Also, it means antibiotics in the Penicillin family, which work by making it impossible for them to kill this germ. The antibiotics that kill it work elsewhere: inside the cell where it manufactures it's protein.

Preferred antibiotics include doxycycline, tigecycline, and azithromycin because of their activity and pharmacokinetic properties (eg, better bioavailability, better penetration into macrophages, longer half-life).

the problem is that people with good immune systems usually are healthy enough not to get sick (in contrast, often with food poisoning, everyone who eats the food is sick) so it took awhile to figure out what was causing the American legionaires to get sick. Finally they found it was a bacteria and not a virus (important since bacteria are easier to kill with antibiotics than viruses).by using a silver stain that coated the germ. They now use antibody tests, which are easier and more specific.

CDC article on the VA problems here...when they checked who had been reported sick, they came up with 16 or maybe 21 cases...

and yes, the water systems were contaminated.

Factoid of the day: they have a lot of Legionaire's disease in Pittsburgh, so the public health dept didn't recognize it was an outbreak (Pittsburgh has lot of ex coal miners and steel workers who have lung damage from their occupation or from heavy smoking).

Factoid number two:
a sample from the sand filter of the decorative fountain at the entrance showed growth of the outbreak strain; therefore the fountain cannot be ruled out as a potential source of exposure for some cases.
Translation: they even found Legionaire bacteria in the decorative fountain in the entrance of the hospital.
Well, there goes all your pretty fountains.

factoid number three: The superheating and the silver/copper ions used to keep the water clear for ordinary legionella bacteria didn't work...ditto for Chlorine....a resistant strain had popped up.

Factoid number four: The outbreak started at the time they were doing upgrading/construction. The Legionella bacteria lives in soil, so this might be the source of the germ: it floated from the dust, settled into the water sytems, and voila, a slow spread of germs.

The CDC upgraded the water cleansing system and so far things look clear.

So kudos to the CDC folks, who don't get no respect for protecting our Veterans.