Thursday, September 26, 2013

Bad statistics headline of the day

Long distance runners don't get arthritis of the knees.

maybe because if you have arthritis, you don't run?

and heavy women are probably that way because they have painful knees.

and since most long distance runners are athletically endowed by their gene pool, the rest of us who are klutzes are not runners.

in my case, it is my high arched feet and varicose veins, not my knees, which are fine.

Wednesday, September 25, 2013

hearing loss

UKTelegraph says that French Horn players are at the highest risk for hearing problems.

Scientists have found that those who play the distinctive, curved brass instruments experience some of the loudest noises within an orchestra and have the highest risk of hearing loss.
New findings suggest that up to a third of horn players suffer hearing problems in at least one of their ears, with younger musicians being most at risk.
It is thought that the shape of the instrument, which can direct the sound towards the player's ears and those of their neighbour, is partly responsible for this increased risk compared to other musicians.
and they aren't the only ones:

A recent study published last year by scientists in Slovenia, suggested that violinists were also highly prone to hearing loss due to the proximity of their instrument to their ears.

and here, for your enjoyment, is a song about French Horns:

<iframe width="420" height="315" src="//" frameborder="0" allowfullscreen></iframe>

paperwork paperwork

UKMail reports on a study showing that doctors working for the British health service spend more time on paperwork than on seeing patients.

and a Cornell study showed that US doctors spend four times as much time on paperwork than Canadian doctors.

the article attributes that to the "single pay" system there, but I'm not so sure.

In the USA, billing medicare/medicaid is very complicated, requiring diagnoses and complications/comorbidity with the appropriate numbers,  but when I visited a friend in Canada, he could bill for several patients on a single sheet of paper, with a single diagnosis not a number to justify the cost. That was 20 years ago so maybe things have changed.

Here is one example: you have to sign it, not your nurse/secretary/etc.

Hmm...wonder  if docs could get an automatic pen writing machine to do it...

Tuesday, September 17, 2013

The MERS (coronavirus) can spread person to person

There has been an outbreak of a corona virus in SaudiArabia, with a few people leaving there and dying elsewhere.

WIKIPEDIA article 

It is not yet known if the infections are the result of a single zoonotic event with subsequent human-to-human transmission, or if the multiple geographic sites of infection represent multiple zoonotic events from a common unknown source. Among animal reservoirs, CoV has a large genetic diversity yet the samples from patients suggest a similar genome, and therefore common source, though the data are limited. It has been determined through molecular clock analysis, that viruses from the EMC/2012 and England/Qatar/2012 date to early 2011 suggesting that these cases are descended from a single zoonotic event. It would appear the MERS-CoV has been circulating in the human population for greater than one year without detection and suggests independent transmission from an unknown source
translation: Probably from an animal but no one knows which one.

The problem? If it starts spreading from person to person, we will be faced with another SARS epidemic.

And today's GMA reports one of our Pinay nurses died of the disease in late August (and that another filipina who was a patient at that hospital has since recovered).

A 41-year-old female Filipino nurse died of MERS coronavirus in Saudi Arabia last month, the Department of Foreign Affairs (DFA) said on Tuesday.

The Filipino, whose identity was not disclosed, is the first reported fatality from the Philippines. She died at a hospital in Riyadh last August 29.

A medical report obtained by the Philippine Embassy says the deceased “tested positive for the coronavirus before her death,” Foreign Affairs spokesman Raul Hernandez told a press briefing.

The hospital’s VIP ward supervisor said prior to her death, the Filipina went to the United States for a vacation on July 13. She returned to Riyadh on July 19 and reported for work on July 21.

In mid-August, she complained of fever and coughing and developed respiratory distress. She was put on a ventilator on Aug. 22.

Two days later, she was diagnosed with severe pneumonia and had to be transferred to the hospital’s Intensive Care Unit.

The part about being in the US is a red herring (no SARS here, but it did make the differential diagnosis have MERS patient?

Or were there patients in the area, where air flow could have spread the virus?

(this happened in SARS, where a case in Hong Kong infected his apartment building, and in Germany, where a smallpox case infected those on a different floor of the hospital).

I should note that there are a million Filipinos in Saudi, which has a population of 19 million locals and 8 million foreign workers.

the WHO does not consider it a threat...yet. more HERE.

Monday, September 16, 2013

Defining deviance down

The everyday sadists among us.

yes, thanks to the "Shades of Grey" trilogy, the NYTimes now declares this is normal behavior.

Related item: Nature's Fourth Trimester abortions.

yes, it's "natural" and was "common" in the past, goes the narrative, (implying that we should legalize infanticide).

What is not recognized is that usually such things happened when the families had no choice,  because of severe poverty where another mouth would mean not enough food.

I am reading a book on the Eskimos in Canada, which noted that "infanticide" of girls and the deaths of the weak/crippled elderly stopped as soon as the gov't there started granting family allowances so that familes could survive.

Ditto for twins in Africa: not enough milk for two and so both would die...but with more money and canned milk/formula now an alternative, it is rarely done nowadays.

And it was rarely a free "choice": Pearl Buck tells of Chinese women weeping when they related killing their girl babies during a famine, and in Africa, one older lady mentioned that when she had twins, her husband's mother killed them, and she was so upset that she left that husband (and later married again.)

No, infanticide happened, but not when there were alternatives (hence stories of abandoned babies taken to monasteries, or those abandoned in ancient Rome being saved by those who would bring them up and sell them as slaves, or stories of Christians who saved these babies).

And babies saved include people like Darius and Oedepus...or Paris of Troy...

Medical notes of the week

The "I Don't like Green Food" item of the week:

Broccoli slows arthritis, researchers think.

uh, that says it is their opinion, not a scientific fact, and is based on mice and cell cultures, meaning it is a very very early experiment.

So they now will have folks eat lots and lots of broccoli to see if it's true.

The good news: IF you don't like broccoli, brussel sprouts will do.

and it could be worse: You might be told to eat Hospital food....


Growing human minibrains in the lab? 

The "Yuck" factor here is high, suggesting there are ethical problems with the experiment: Like, why didn't they start with monkey or guinea pigs instead of embryonic cells?

or maybe not: some of the brains didn't come from embryos but from skin?

Prof Paul Matthews, from Imperial College London, told the BBC: "I think it's just mindboggling. The idea that we can take a cell from a skin and turn it into, even though it's only the size of a pea, is starting to look like a brain and starting to show some of the behaviours of a tiny brain, I think is just extraordinary.

Saxon herbs

an article about saxon herbal medicine, linked for later reading

What is interesting is that although this book was written during the mid Anglo-Saxon period when Christianity was well established, it is clear that many beliefs from the earlier pagan religions were still held as well as the new faith. This is shown by these examples of illness caused by dark-elves whom the Saxons believed attacked people during the night or by relations with the devil.
For elf sickness, a leechdom…one must sing over the plants before one takes them and one must place them under an altar.
Make  a salve for the elvish race and nightgoers and the people with whom the devil has intercourse.
Some interesting methods of treatment
For palsy, if the mouth be crooked or deficient, take coriander, crush it into a woman’s milk and put it in the healthy ear. Here they seem to be talking about what we today call Bell’s Palsy which causes paralysis and dropping of the side of the face. Not sure what putting milk in the other ear would do.

The Tolkien professor has a course on Fantasy literature, starting with the Middle Age stories of people being kidnapped by elves, and points out that if a person

Smallpox and sex

Via Instapundit: An article about how the gov't worried there would be a smallpox epidemic after 911...

we were working in a rural IHS (Indian Health service) clinic in Oklahoma, and we actually were alerted with plans on how to vaccinate our area. The vaccinations would be given out in local schools, and it told how to set up the clinic, who to vaccinate first, where to put those with the disease etc. All in detail.

I was tasked to read the paper: when we were in Africa, we had similar plans (never used, thank God) on what to do if cholera broke out in our area: You don't put everyone into a hospital, you treat them in alternative places (schools for example) including the home. This was not done with Ebola epidemics which spread to hospital personnel.

Why worry about it in rural Oklahoma? Well, a "war game" a few years before 911 was called Dark Winter, proposed a release of smallpox at an Oklahoma city truck stop.

The medical report is here.

Smallpox would actually be a lousy weapon for Islamoterrorists: It has a long incubation period, so the chance of it spreading to their own country is high. Even if it started in Oklahoma...(few know that many refugees from Iraq war I were settled there).

In the USA, there would be enough "first responders" and ex military folks with partial immunity or who would be vaccinated more recently.

Ironically, another "realistic" version of what would happen can be found in one of John Ringo's sci fi books. I have to laugh, that one bozo called it "conservative propaganda", but in a world where political correctness keeps one from saying non PC things, it is one way to recognize what is going on.

Here are the PC things I don't dare say for fear of being a racist, even though as a doc I have had to deal with the people suffering because the gov't doesn't want to acknowledge what is going on (which would enable them to use social pressure to stop it)

No one wants to recognize black on black crime is why the murder rate in the US is so high. Nor does the press want to recognize the subtext in the immigration bill is because many black and Mexican gangs are infiltrating and killing in even small American towns, where Metziso hispanics who only want to protect their neighborhood are relabled "white hispanic racists" to fit the narrative,  where Asian high school students in South Philly High who were beaten up by black gangs are themselves punished by being "reeducated" to "understand" black culture so they stopped upsetting the gang members, and where conservatives are considered more of a threat than Muslims who attend mosques with jihadi preachers from Saudi Arabia, one has to wonder when the truth will come out.

Yes, that makes me racist, but not really. Like Ringo, the pompous asses need to recognize that reality tends to bite back.

Ringo's book is on Baen books.

the plague in the book was not a bio attack, but retells the story of SARS, which was covered up in China and ended up killing a lot of folks in Canada.

and, alas, too often those who go into publichealth etc. are rule oriented, and not able to think outside the box, and that part of the satire is also true.

I remember a high up IHS official telling us our job was to treat our patients "within the limits of our budget" or some such thing. I pointed out three times that actually we were to treat our patients under the agreement between the gov't and the tribes, the hell with the budget: she didn't appreciate it since it was HER duty to increase the budget if we needed more money, and that would mean more paperwork for her.

In other words, paperwork and filling out forms was more important than actually treating folks.

Nor is this limited to the Federally funded clinics/hospitals: When I had surgery way back in the 1990's at a big shot Boston hospital, I saw the nurses about four quick visits a day, and the doctor for two minutes. I walked myself up and down the halls, and found the nurses busy at the desk doing paper work (on their new computer sytem). And I spent half of my walk answering question about their disease from other patients, who were clueless and worried because no one talked to them.

Presumably things are worse now.

Related item: The "story" of gay martyrdom just hit the fan too.

Actually, those of us who knew reality were sceptical about this. I mean, what type of gay guy goes to a non-gay bar in rough neighborhoods and flirts with the heterosexual guys? Especially in Wyoming? Especially a guy who has been beaten up at least once in the past for doing so?

Camille Paglia pointed out that most in the gay community knew he enjoyed the "rough trade", i.e. enjoyed this type of thing because of the risk, not despite the risk.

This move "Looking for Mr Goodbar" was about this type of person, but with a woman. Yes, there is a type of woman who always choses losers: which is why there is a subgroup of "rape" victims who have a history of being raped before, and why abused women keep returning to the hospital for their injuries, even after they change partners.

The new book however brings up the meth connection. Meth wasn't a big problem back then, but it was around, as were the white biker gangs who used it... and the writer points out among a subset of the gay community also abused drugs to get high...that I wouldn't know about...most of the gays I saw were "closeted" and I usually treated their wives and ex wives for depression (which is why I back gay marriage).

So I guess that makes me homophobic too, so I'll add this item: A lot of the "homophobia" in Africa is because of male rape and sexual exploitation of kids/workers in colonial times when the "troubled" son often was sent to Africa to make his fortune, and in boarding schools.

Now that Dawkins has acknowledged it was common in his secular boarding school in the UK, maybe someone will notice that such abuse wasn't limited to church boarding schools for Canada's first nations, or to catholic priests. And yes I am angry about the priest problem: but it wasn't just priests who did it, but the fact you trusted priests made it worse for all involved.

The problem with the above is that by not allowing someone to say that a small sub group of a population is doing something wrong, you end up by distorting the truth, and medicine is a reality based science.

The point here is "subgroup". Prejudice is saying all those in a group act the same.

Sociology is saying behavior belongs to subgroups, and public health points out the subgroups so you can treat the problem.

Political correctness denies the problem, and makes it taboo to mention the subgroups, so stands in the way of our recognizing and treating the public health problem.