Tuesday, December 23, 2014

politicizing the blood supply (X rated)

The decision to "allow" gay and "bisexuals" to donate blood was a purely political decision.

True, they might be HIV positive, but the testing will find that out. And the one year prohibition should catch the danger of spreading HIV before the screening test turned positive.

The problem? People lie....

But it's not the sexual orientation that is the problem: It's the anal sex.

This survey of people in "high risk" areas for HIV of "heterosexuals" suggest that anal sex is a major problem in the spread of HIV: And 30 percent of both men and women admit to anal sex...

but the main danger is drug use: 50 percent admit to using drugs (not necessarily IV, mostly oral).

and I found this interesting:

blacks or African Americans (hereafter referred to as blacks) and Hispanics/Latinos are disproportionately affected by HIV. Estimated rates of diagnosed HIV infection in 2011 were 9 times as high for blacks and 3 times as high for Hispanics or Latinos compared with the rate for whites.

in Latin cultures, sodomy is a way of humiliating women.

But the "high risk" areas apparently included a lot more African Americans than other groups.

Participant Characteristics

Approximately half (58%) of participants were aged 40–60 years. The majority of participants reported black race (72%) or Hispanic/Latino ethnicity (21%); the sample was evenly distributed by sex (Table 1). The majority of participants (64%) had never married and were not cohabiting. Most participants reported no more than a high school education (men: 86%; women: 83%) and very low incomes. For instance, most participants (87%) reported annual incomes of <$20,000, which is lower than the federal poverty guidelines for a family of four; approximately one in three (36%) reported annual incomes of <$5,000. Nearly three out of four (men: 72%; women: 73%) reported both income at or below poverty and no more than a high school education (data not shown). Approximately one third (31%) of participants were currently or had been homeless in the 12 months before the interview, and nearly half (46%) were uninsured.
With the exception of homelessness and health insurance, the demographic characteristics were similar for male and female participants. Approximately one third of male (35%) and female (27%) participants had been homeless at some time in the 12 months before the interview.  

and they tried to exclude high risk behaviors, but found some participants had done these things more than 12 months earlier

Although the analysis sample excluded data from participants who reported they had recently (within 12 months of interview) injected drugs or had male-male sex, 14% of male participants reported that they had injected drugs or had sex with another man >12 months before the interview; 5% of female participants had injected drugs >12 months before the interview (data not shown). Each participating area contributed an average of 442 interviews (range: 131–565) to this analysis. 

the number of average sexual partners was low: 3 for men, 2 for women.
And then you come to this:

A total of 4,467 (90%) female participants reported having vaginal sex without a condom with a male partner in the 12 months before the interview, and 1,420 (29%) reported having anal sex without a condom with a male partner (Table 3). The percentages of women who had vaginal sex without a condom were similar among women in all categories of education and income. Anal sex without a condom was more common among those with lower levels of income. 

anal sex requires a stronger better lubricated condom than vaginal intercourse.

and unprotected vaginal and  anal sex was more common when it was with a casual contact, and by white men.

 Vaginal or anal sex and vaginal or anal sex without a condom with female casual partners were less common among male participants who were married or cohabiting and among those with higher incomes and were more common among white men. 

another variable was lack of health insurance.

yet 70 plus percent had been tested for HIV, about 30 percent within the past year and most in community clinics or health centers.

much of the rest of the survey is about routine (one third got free condoms) (remember that some people overreport good behavior and underreport bad behavior).

the reason I bring up anal sex is that the passive partner is more likely to catch HIV, and in Africa, non vaginal intercourse was used during lactation to prevent pregnancy in some tribes (although in south Africa, intercrural intercourse was traditional to keep the girls virgins).

a broader cdc population survey suggested that 35 percent of women admit to having anal intercourse, and the average number of sexual partners lifetime was 4 for women and 6 for men. No link: A pdf that crashed my browser.

this estimate of anal sex is a lot higher than that found by Kinsey's survey, which was mainly in teens.

No, I'm not an expert on anal sex, mainly because it was not that common among the groups I worked with.

But one wonders why there is no outreach to people about this risky form of intercourse.

Finally, this caught my eye:

 Use of crack cocaine has been associated with HIV infection among heterosexuals in the United States (7,10,42). These results highlight opportunities for drug use prevention efforts among low-income urban populations. 

I've read anecdotes about homeless women trading sex for crack cocaine, and wonder how many traded anal sex for this (note the lower rate of anal sex with regular partner suggests it might be more common in those trading sex for money etc.).

So what does this have to do with the blood supply?

Well, if you don't want to offend the "gay" activists, just continue asking about anal sex for everyone. And ask about the past year.

But remember, the type who do such things often lie about it.

Sunday, December 21, 2014

Ebola update

Sheryl Atkinson at Fox news says that new cases of Ebola are no longer being reported in the news, or on the CDC news for political reasons.

The CDC has put out (finally) videos how to put out suits and protective gear, but no recent news of cases except in local papers.

So how many possible cases are there? 1400 are being monitored they told her.

MMWR homepage here. The Ebola page has mainly reports in Africa for the last two months.

so this should be in the monthly report of reportable diseases, yet their link gives a 2012 report. Huh?

my rss feed gives me the latest here.

but you have to find it in the footnotes:

There were no cases of viral hemorrhagic fever reported during the current week. In addition to the 4 cases of Ebola diagnosed in the United States to date in 2014, six residents of the
US have been medically evacuated to the US for care after developing Ebola in West Africa. Ten of the 11 VHF cases reported for 2014 are confirmed as Ebola and one as Lassa Fever. See Table II for dengue hemorrhagic fever.
So most cases being monitored haven't developed the disease, yet.

Friday, December 19, 2014



HIV protease inhibitors might work against Malaria

According to Parikh, there is more to the story than the direct antimalarial effects of the HIV drugs. His team has also found that a major reason for the significant anti-malarial protection in HIV patients is due to a beneficial “drug-drug interaction,” between the protease inhibitors and the antimalarial drug, artemether-lumefantrine, the most widely used treatment for malaria in the world.

the article includes this factoid:

Eighty-two percent of the world’s 198 million cases of malaria are in Africa, a WHO report states. Further, according to amfAR, 91 percent of the world’s HIV-infected children live in Africa.

this is important since malaria is becoming more resistant to antibiotics: SciAmerican  blames it on "overuse" but I suspect giving substandard doses because often the medicines are counterfeit (i.e. substandard, fake, or diluted so the dose is lower than the lablel)  might be behind the problem. This article points to drugs from India, but the counterfeits from China are a big problem, especially in SE Asia...

In total, 10.9 percent of the products collected failed an assessment of their active ingredients, 7 percent of which were considered substandard. The rest that failed were falsified, meaning they didn’t contain any active ingredient and were likely counterfeits from China, the researchers said.
they are discussing Cipro treatment in the article, and includes the factoid the Cipro is chemically related to Chloroquin, something I didn't know.

When I came down with a mild case of Falciparum Malaria while taking Chloroquin 35 years ago, I took a sulfa drug mixture. And for cerebral malaria, we used IM or IV Quinine. This is now not used due to resistance.

Friday, December 5, 2014

Shakespeare and the Great Pox

I'm busy listening to the medical history podcasts from Gresham College (UK). LINK

Syphilis was a bit more severe and easier to catch in those days (i.e. kissing could spread it if you kissed a cheek with an open wound).

it was syphilis that initially caused the most widespread suffering and death. However, by the mid-sixteenth century, observers were beginning to note that it was declining sharply in virulence. As Frascatoro noted in 1546, ‘although this pestilential disease is at present still fully active, it is no longer the same as it was at first.’ Pustules, he reported, were ‘now only to be found on a very small number of patients, and the pains are negligible or very slight…The sickness is in decline.’ Either people had developed some resistance to the most extreme symptoms, or the disease itself had mutated into a less virulent form. Whatever the reason, by the 1540s it settled into the form, or forms it has more or less persisted in taking up to the present day.

The change in the way a disease acts is not unknown in history...In the last week, news reports say the HIV is getting less virulent in recent years too, and often diseases of history are hard to identify because they differed from the modern versions.

So anyway, the disease is mentioned in a lot of plays by Shakespeare, making some speculate that he might have had it. And he even might have been cured of it: Because back then they treated it with very hot baths

From Shakespearenet:

I never definitively state that Shakespeare had syphilis, rather that he may have received treatment for syphilis, and may have suffered untoward side effects. Gonorrhea and syphilis were not differentiated clinically until the eighteenth century, and the Elizabethans regarded them as a single disease entity. This is because co-infection with more than one type of venereal disease is a common phenomenon, then as now. If Shakespeare had only a less dangerous venereal disease, such as gonorrhea, he likely still would have underwent conventional therapy for syphilis, namely, "the powdering tub of infamy." The unfortunate "scalded chickens" and "boiled stuff" were immersed in hot baths, and exposed to mercury vapor, in the form of volatilized cinnabar. The toxicity of mercury is dose-dependent. The inorganic mercury once used to treat syphilis is not highly toxic in low doses, but modern experience has shown that the symptoms of mild mercury poisoning may become manifest as the nervous system ages.

I don't think Shakespeare died of syphilis, or that it affected his cognitive and creative abilities. The Elizabethan treatment for syphilis was probably surprisingly effective, for those that could afford it. Treponema pallidum lacks heat shock proteins, and is thus susceptible to thermal lysis. The German psychiatrist Julius Wagner-Jauregg won the Nobel Prize for Medicine in 1927 for his use of deliberate malaria infection as a treatment for neurosyphilis. (The high fevers provoked by malaria killed off the spirochetes, but killed about 9% of patients.) Dissatisfaction with the toxicity of malaria therapy and arsenic therapy led to the revival of the Elizabethan hot bath treatment in the 1940s, just prior to the phenomenal success of penicillin.

a journal article from JMVH has more on treatment in the good old days:

 Beck (1997)  describes a typical mercury treatment :
“A patient undergoing the treatment was secluded in a hot, stuffy room, and rubbed vigorously with the mercury ointment several times a day.  The massaging was done near a hot fire, which the sufferer was then left next to in order to sweat.  This process went on for a week to a month or more, and would later be repeated if the disease persisted.  Other toxic substances, such as vitriol and arsenic, were also employed, but their curative effects were equally in doubt.” [9]
Mercury had terrible side effects causing neuropathies, kidney failure, and severe mouth ulcers and loss of teeth, and many patients died of mercurial poisoning rather than from the disease itself.  Treatment would typically go on for years and gave rise to the saying,
“A night with Venus, and a lifetime with mercury” [8]
the hot baths were part of the treatment with mercury, and ironically maybe the very hot bath was more efficient...

Herbs were also used, but not felt to be as successful.

all of which makes one wonder about "sweat baths" popularity in some AmerIndian traditions.

In Minnesota, it was a way to clean oneself and get some relief from arthritis and other ills, especially in the 8 months of cold weather, similar to the saunas of the Scandanavians or the Turkish baths.

NewWorldEncyclopedia article HERE.
I am impressed that when they noted the deaths of some white folks in a newage type sweat, they didn't get a pseudo Indian to comment, but asked Arvol LookingHorse of the Sioux, who is a true medicine man.

a discussion of the traditional Mexican sweat bath is found here.

a description of the sweat lodge of North American tribes can be found here.

As for baths: Yes, medieval people did take baths.

sometime they only did a "full body bath" twice a year, but they washed in between. Many dark age and medieval tales discuss the lady of the house getting a bath ready for the visiting knights.

Cracked has a list of myths about the middle ages...

...not only was it common for medieval folk to wash their hands before and after eating, it was also customary to offer to bathe with guests when they entered your home, something The Man has repeatedly reminded us is no longer acceptable in modern society. Medieval demand for soap (usually made from animal fats, with a variety of oils and salts added) was so great that by the 13th century, soap was being made on an almost industrial scale in Britain, Italy, Spain, and France.
So why do we picture everyone as wallowing in their own filth back then? Well, things changed all at once. If only an act of God could change Europe's epic bathing culture, they got one -- in the mid-14th century, the Black Death strolled up and kicked Europe right in the teeth with its pestilence boot. Suddenly, smart people were telling the previously washed masses that bathing was a surefire way to open your body's pores and invite in all the bad spirits or gremlins or whatever (they weren't too savvy on what caused illness back then).

Read more: http://www.cracked.com/article_20186_6-ridiculous-myths-about-middle-ages-everyone-believes.html#ixzz3L6FbRUty

Wednesday, December 3, 2014

HIV evolving?


a similar weakening in the lethality of Syphillis was seen in the 1500s, and the Strep germ has increased and decreased in lethality several times since the 1950's, when rheumatic fever and sepsis were common....in recent years, there have been sporadic outbreaks of this lethal strain, the most famous case being the death of Jim Henson of muppet fame, who was diagnosed with "flu" when he actually had strep sepsis with shock.

Thursday, November 27, 2014

Arsenic poisoning by accident

I was listening to the lecture at Grescham college about arsenic. I fell asleep after they started talking about the massive but accidental poisoning of Bengladesh, caused by ground water in deep wells which has a high arsenic level. (the deep wells were dug to stop the high death rate of dysentary in children, and they did solve this problem).

But I also ran across this item: Ancient mummies in Chile also show arsenic poisoning.

People of numerous pre-Columbian civilizations in northern Chile, including the Incas and the Chinchorro culture, suffered from chronic arsenic poisoning due to their consumption of contaminated water, new research suggests.

Friday, November 14, 2014

peacekeeper sick

one of the Filipino peacekeepers who came back from Liberia is running a fever and was put into isolation at a local hospital. LINk

update: After I posted this, the Manila Bulletin headline proclaimed: It's only Malaria.

so far we have no cases, but when my husband went to the local Emergency room, I spotted an Ebola suit on the shelf...and the newspapers said that Phil Health will cover treatment.

Counterfeit drugs

apparently, some of those deaths at a sterilization camp in India may have been from counterfeit/substandard antibiotics.

Reuters/GMANews says that not only did 13 of the women die, but 2 others died from drugs manufactures at a local plant.

Some estimate one third of India's medicines are either fake or substandard.

and it's not just India: China has a similar problem.

And these pills are often sent to other third world countries, including here in the Philippines. Which is why we often insist on getting name brands.

The problem? Most US/European pharmacies are manufacturing in China too...

This is deliberate. True, sometimes accidents happen, or manufacturers are careless, but often the drugs are diluted to make a profit, or a less expensive chemical that imitates the expensive one is added instead.

One notorious case was adding propylene glycol to cough medicine (anti freeze) because it is cheaper than sucrose. Heh. Law And Order just did a show on that one: Where teenagers drank mouth wash to get drunk, and died of multisystem failure.

The mouthwash is supposed to contain ethanol, and even our retarded patients found it made them high, so they'd steel it and drink it.

and accidentally spilled anti freeze is a common cause of dogs being poisoned, since they lap it up.

Monday, October 13, 2014


for all the hysteria about Ebola, the dirty little secret is that more folks in Africa die of simple diarrhea and malaria. But never mind.

There are complaints that budget cutbacks in the NIH stopped or slowed Ebola research, but given the money spent on "social problems" that are not really medical but political agenda, this sounds like nonsense.

The dirty little secret is that infectious diseases have caused a headup in the military since Charles VIII's army was destroyed by syphilis, thanks to the friendly ladies of Naples who had caught it originally from some sailors who caught it from some friendly Americans during Columbus' visit there.

Disease kills more soldiers than bullets, which is why the sanitation is so important, and why the military was on top of most epidemics before the ordinary folks recognized it. I mean, I heard about a venereal disease that killed everyone from one of our unit medics who learned about it in a conference a year or two before it was recognized as HIV...and yes, I later attended HIV classes to give classes to our units. So when people talk about gay marriage, I just ignore the elephant in the room, i.e. a high rate of promiscuity that astounded our good old boys.

Well, anyway, military docs ususally checked the women and forbad men to man sex which spreads STD's a lot more efficiently, and if you want pictures why, well, this is an R rated blog, not an X rated one...

well, anyway, since the NIH is busy spinning their incompetence to bash Republican budget cuts, and keeps sending out confusing bulletins, maybe you need to go to the military sites.


Ebola infographic

lots of the information are in PDF files, to download and read later.

bmj says that the very political MSF organization insists the military has to help, which is ironic since they hate the US. And just ignore that most of the medical work in these countries is done either by locals or by missionaries.

but the BMJ does note:

FeatureEbolaOnly the military can get the Ebola epidemic under control: MSF head
BMJ 2014349 doi: http://dx.doi.org/10.1136/bmj.g6151 (Published 10 October 2014)Cite this as: BMJ 2014;349:g6151
  1. Sophie Arie, freelance journalist, London, UK
  1. sarie@bmj.com
Sophie Arie talks to MSF’s president, Joanne Liu, about her frustrations at the slow international response to the Ebola epidemic
Médecins Sans Frontières (MSF), the humanitarian medical charity, has been on the front lines of the Ebola epidemic since it began. It has had a major role in the international effort to control the outbreak, caring for two thirds of the 8000 people in Guinea, Sierra Leone, and Liberia who have been infected. But in early September, after six months of battling Ebola in vain, and with the death toll mounting exponentially, MSF effectively admitted defeat and said that it would take major military mobilisation by wealthy countries with biohazard expertise, not just international aid, to stop the disease. The charity had doubled its staff, MSF’s president, Joanne Liu, told the UN members, but it still was overwhelmed.
Liu, a Canadian paediatrician who has worked for MSF in war zones and natural disasters for the past 18 years, called upon UN members to dispatch their disaster response teams, backed by the full weight of your logistical capabilities. “Without this deployment, we will never get the epidemic under control,” she said.1Peter Piot, director of the London School of Tropical Medicine and Hygiene and the microbiologist who first identified the Ebola virus in 1976, also called in September for a “quasi military intervention.” He suggested that a major UN peacekeeping force should be deployed to Sierra Leone and Liberia, with huge donations of beds, ambulances, and trucks as well as an army of clinicians, doctors, and nurses.
The message came as the numbers of deaths from Ebola began to spiral, particularly in Liberia. There have been over 3800 reported deaths in the region, according to the latest World Health Organization figures, 40% of which have been recorded since September.2 WHO has estimated that there could be 20 000 infections before the outbreak is brought under control, and the US Centers for Disease Control has predicted that, in a worst case scenario, as many as 1.4 million may be infected by the end of January.3 As the economies and health infrastructures of the three countries, home to over 22 million people, risk total collapse, the UN Security Council declared the outbreak was a threat to international peace and security.
Limited response
Yet a month after the first calls for military deployment, forces are only now starting to be mobilised in any numbers. The US, UK, Germany, and France have responded, although not exactly as Liu had hoped they would. The US has said it will send 4000 troops to build new isolation units and treatment facilities in Liberia, a country created by US citizens as a colony for former African American slaves. But President Obama has made it clear that US troops will not be staffing those units and coming into contact with Ebola patients. The UK has pledged to send 750 troops to establish new Ebola treatment centres in Sierra Leone, its former colony, and a training academy for those working in treatment centres. Around 5000 German troops have volunteered to work in west Africa but they have not yet been deployed, and the government has now admitted that it would not have the resources to fly any troops home for treatment should they become infected.
So far no other countries have offered their armed forces, and President Obama warned in early October, if most countries choose to remain on the sidelines and watch the US do the bulk of the military work, the outbreak will continue to be a global threat.4Liu says she is exasperated at the slow, hands-off response. “Countries are approaching this with the mindset of going to war,” she says. “Zero risk. Zero casualties.”
Liu describes the current military efforts as the equivalent, in public health terms, of airstrikes without boots on the ground. Pledges of equipment and logistical support are helpful—“The military are the only body that can be deployed in the numbers needed now and that can organise things fast.” But there is still a massive shortage of qualified and trained medical staff on the ground. “You need to send people not stuff and get hands on, not try to do this remotely,” Liu says, “Local doctors have been extremely brave, but we are running out of staff and that is why we are asking for a major workforce to deploy.”
Since the 9/11 attack on New York’s twin towers, Western countries have developed military and civilian biohazard teams to protect their populations against a possible bioterrorist attack. Liu had hoped that these could be deployed to west Africa. “I think with the massive investment and knowing how much they are afraid of bioterrorism, they have some knowhow about highly contagious diseases.”

if I am sarcastic about the headline grabbing medics without borders, it is because they grab the headlines from those who are working there before and after them....including many locals and church or mosque funded charities who pay for physicians. But as a recent article complained, missionaries have no right to go there and preach (never mind that Liberia and SierraLeone are both highly Christian nations, or that Muslim charities often go to Musim areas.)

For example, in Monrovia there is not only the government hospital that has ties with the US, but also a Catholic hospital that treats people LINK In small local clinics, sometimes entire staffs of eight or 10 people were killed within days. The Catholic church’s biggest hospital in the capital of Monrovia, which employs over 185 staff, was forced to close after nine of their top doctors and administrators died of the virus.
According to World Health Organization statistics from Oct. 3, there have been 7,492 Ebola cases and 3,439 deaths in the current outbreaks. Liberia has been the hardest hit, accounting for 3,834 cases of Ebola and 2,069 death

Sunday, October 12, 2014

exciting new medical treatment


frozen poop pills.

c.difficile is a nasty disease, so this might make the treatment more palatable. The idea is to replace the normal bowel flora after treatment.

Sunday, October 5, 2014

let the kid die?

Jahi declared dead, mom takes her home against doctor's orders.

Jahi is now alive and showing signs of life. What's worse, he brainstem is damaged but her cortex is alive on tests.

Expect a major lawsuit against the hospitals, and as a doc I wonder if the rush to diagnose her was because if she lived, it would be an expensive and dirty lawsuit against the hospital.

And one wonders if racism was behind the rush to declare her dead. No, I don't think so (doctors are now being trained to see the mentally handicapped of all races as useless eaters). But one wonders if the family thinks racism might be behind it, or if the black community is taking note of the case. It's an open secret that Blacks and other minorities won't sign "living wills" because of distrust of the medical establishment, and given how our Native American patients were treated in "liberal" Minnesota, I suspect they have a point. Where is Al Sharpton when we need him?

Yes, I am joking, but I suspect Jahi's mom didn't go along with the doctors because of this mistrust (the black community still remembers Tuskeegee experiment).

One wonders if she was a thin blond child, not a fat black girl, if the docs would be so fast to diganose brain dead when there were still drugs and brain swelling going on.

But of course, a white kid's family would have agreed with the docs (especially if the parents were educated) and let them remove the tubes keeping her alive.

the doctor involved in the case, Dr Shewman, once wrote a detailed analysis in 1990 why anencephalic babies should not be declared brain dead. It's a really scary read, but didn't stop the AMA experts a few years later declaring these babies should be sacrificed for organs (public outcry stopped them and they changed their mind...one wonders if it would get the same reception now).


but the most disturbing part of all of this is the comments riduculing those who see her as a human being...essentially is saying hey she's dead because they think so (not because of any scientific reason) or worse, she's better off dead...

Friday, October 3, 2014

patient zero ebola


Sunday, September 28, 2014

for later reading

unsafe contraception in Africa?

Statement made by Kwame Fosu:
We all believe that women should have access to safe contraception.  However, in Melinda Gates’ 2020 Family Planning Initiative, she is using Sayana Press or Depo Proveraas one of the central contraceptives being targeted to African women. Depo Provera has serious side effects.  Bill Gates’ own researcher Dr. Renee Heffron came up with research in October of 2011, which stated that Depo Provera and injectables significantly increased risk of transmitting and acquiring HIV/AIDS. Not only that, but Depo Provera also doubles the risk of breast cancer and causes [excessive] bleeding.  So my question is this: in countries where HIV is a significant problem, where we don’t have access to good healthcare, why would we be using the most dangerous contraceptives for African women, when in countries like Holland, they all use very safe low-dose contraceptives.
Fosu’s statement was made in a meeting co-sponsored by IPPF, Denmark and Liberia which was meant to attract high level ministers in New York for the General Assembly.
Fosu included a reference to Holland because, as public health policy, long-term progesterone contraceptives such as Depo Provera and Norplant are rarely used by women in European countries.

several reasons we used this before the HIV problem was known: First, unlike the pill, it does not decrease breast milk, so less malnutrition in babies.
Second; You could give it out at baby clinics, without worrying that the pills wouldn't be taken correctly or lost or deteriorate from the heat.
third: the HIV problem might be demographic (in urban promiscuous populatons vs the rural women who use non vaginal intercourse when breast feeding).

in the US, the drop of teen aged pregnancies is from using depo instead of the pill...theoretically the pill has a 1 to 2 percent pregnancy rate, but in teenaged girls it is ten percent or higher, since they tend to foget the pill...

Friday, September 26, 2014

antibodies against ebola


I knew a nurse whose blood was used to treat Marburg or a similar disease 30 years ago...and gamma globulin used to be used a l.ot more in the good old days

so the WHO is devising guidelines to use this for Ebola victims.

 For later reading

vaccine nonsense

Except for smallpox, I have seen and treated patients with most of the diseases now prevented by routine vaccinations. So I have little patience with the hollywood types who eschew getting their kids vaccinations.

In Africa, often "childhood" diseases such as measles killed many.

But in the affluent west, the rare side effects are megaphoned via the internet to make the side effect seem worse than the disease.

Gresham College has a lot of lectures on various subjects that are great to listen to, and they have a series of lectures on vaccines and problems. list here.

Good, Bad and Ugly: The History of Polio Vaccines
... or crippled millions of people, but successful polio vaccines were developed during the mid-1950s which have spared millions from ... polio to the verge of extinction. The development of polio vaccines is more than a great medical success; this is a gripping story that ...
Something old, something new, something borrowed, something blue: The true story of Gulf War Syndrome
... not use them. The protection against biological comes from vaccines. The armed forces are routinely vaccinated before any major overseas ... what is the increased risk associated with receiving these vaccines on your subsequent health? We have a slight problem, which is that ...
The Tragedy of Easy Problems
... therapy to clean water programs, mosquito nets, and vaccines, we can make more of an impact than we have. Yet in the uproar of ... much of the solution is obvious. There are effective vaccines for rotavirus and measles; efforts to make sure every child can get ...
Modelling the Spread of Infectious Diseases
... it was only in the last century that safe and cheap vaccines could be produced in large quantities. The aim of vaccination is to ... the symptoms of infection.   In simple terms vaccines work by stimulating the immune system to produce antibodies but ...
The life and legacy of Dr Edward Jenner FRS, pioneer of vaccination
... the principles established that led to the discovery of vaccines to other infectious diseases.  Dr Wallington describes the ... was the main source of vaccine lymph in Britain until a vaccines produced in calf’s skin became available in 1861. During this ...
Danish Fairy Tales? From Andersen and the Copenhagen consensus towards a theory of commerce
... demonstrated electro-magnetism. Louis Pasteur developed vaccines. Marie and Pierre Curie worked on radioactivity. Charles Darwin ...
Hygeia and Panacea: Is prevention better than cure?
... prevention, through his International Finance Facility for vaccines and sanitation. “The rates of return from upfront investment in ... 1954, cover of Time magazine, featuring Jonas Salk. Polio vaccines were developed in the 1950s, chiefly by Jonas Salk and Albert Sabin. ...
A is for Autism
... Equally, there’s no evidence that vaccines are contributing to the increase in autism but rather like the ...
Conquest and Disease or Colonialism and Health?
... diseses. This knowledge led to the development of drugs, vaccines and methods of insect control and the colonial powers wholeheartedly ... by deploying the latest discoveries in medicine such as vaccines and drugs, some of which like quinine which were manufactured locally, ...
Unwelcome Guests: Human Diseases
... crowding, better and more varied nutrition. More recently vaccines have reduced still further the risk of many viral and some bacterial ...

The Times of Our Lives: A history of longevity
... health (sanitation) and microbiology (diagnostics, drugs, vaccines). The direct effects were powerful partly because they relieved a ... may not be the principal limiting factor; good drugs and vaccines can only partly compensate for other deficiencies. Specific health ...
The First World War: Disease, The Only Victor
... all their troops against typhoid. By 1914 there were also vaccines against cholera, anthrax, rabies, typhoid and plague but they appear ... inadequate sewage disposal and the fact that there were vaccines were available but their use was not compulsory.   ...
Barnard’s Inn Hall
... Good, Bad and Ugly: The History of Polio Vaccines Dr Johnson's ...
Getting a life: Limits to health in the 21st century
... opened the way to developing better drugs, diagnostics and vaccines. 24.  These interventions, especially the first two acted, ...
Pathogens and parasites; plagues and pandemics
... a few, cheap interventions – a mixture of antibiotics, vaccines, and sanitary and hygiene measures.   To ...
Return of the Microbes: How infections are once more taking over
... In fact, by the time we are developing very good vaccines, we have plateaued out and changed the causes of what people are dying ...
Lessons from the Past, Warnings for the Future
... its real triumph, with the development of effective vaccines first by Jonas Salk at the University of Pittsburgh in 1954 then by ...
How to get ahead in commerce: The sure-fire ways to make money
... machinery to electricity to magnetism to railways to vaccines to plastics to atoms to computers to designer drugs to ...
The Great Pox
... continued to favour mercury treatment, and the various vaccines that were developed did more harm than good. In an increasingly ...

I have listened to quite a few, but have bookmarked them to listen again (I usually play podcasts in the background when I sleep...I was listening to the one on polio vaccine, but missed a lot of it due to background noise from the pump and then falling asleep).

Monday, September 22, 2014

The WTF articles of the day

This was noticed awhile back but now is in the LATimes:

Dry roasting process might lead to more peanut allergies.

In a statement, he said that the researchers are looking for ways to “eliminate” the chemical changes that seem to make dry-roasted peanuts more likely to trigger allergic reactions.

my question: Is it the dry roasting causing chemicals that cause allergies, or the fact that this means more peanut particles float around and get breathed in when you eat them?

Regular peanuts are greasy, from oil so the grease would hold in the particulate matter but that's not true for dry roasted peanuts.

Breathing in particles means the lung will be exposed to peanuts, and may mount an immune response more vigorously than the stomach etc.

We see this with talc lined latex gloves, where a lot of the latex allergies are from direct skin contact or to small cuts in the skin from vigourous washing, but a lot are thought to be from the particulate matter of latex being breathed in with the floating talc particles.
FDA report on powdered gloves 

Conclusions(1) The major adverse impact of glove powder appears to be its contributing role in natural rubber latex allergies.
(2) Glove powder acts as an airborne carrier of natural latex proteins.
(3) Exposure to airborne natural rubber latex allergens can be most effectively reduced by considering both the level of natural latex proteins and the amount of glove powder on medical gloves.

and it's not just medical folks:

linThe prevalence and severity of latex allergy has increased dramatically in the last 15 years due to exposure to natural rubber products. Although historically this health risk has been elevated in hospital personnel and patients, a recent survey has indicated a significant potential risk for the general population. To obtain a wide-spread source for latex exposure, we have considered tire debris. We have searched for the presence of latex allergens in passenger car and truck tire tread, in debris deposited from the atmosphere near a freeway, and in airborne particulate matter samples representative of the entire year 1993 at two sites in the Los Angeles basin (California)..... A latex cross-reactive material was identified in mountain cedar. In conclusion, the latex allergens or latex cross-reactive material present in sedimented and airborne particulate material, derived from tire debris, and generated by heavy urban vehicle traffic could be important factors in producing latex allergy and asthma symptoms associated with air pollution particles.

Thursday, September 18, 2014

BBC article on cloves, the sins of colonialism, and the clove tree that defied empires.

In 1652, after displacing the Portuguese and Spanish, the Dutch introduced a policy known as extirpatie: extirpation.
All clove trees not controlled by the Voc were uprooted and burned.
Anyone caught growing, stealing or possessing clove plants without authorisation faced the death penalty.
On the Banda Islands, to the south - the world's only source of nutmeg - the Dutch used Japanese mercenaries to slaughter almost the entire male population.
Like Opec today, the Voc also limited supply to keep prices high. Only 800-1,000 tonnes of cloves were exported per year. The rest of the harvest was burned or dumped in the sea.
Somehow, Afo managed to slip through the net. A rogue clove. A guerrilla plant waging a secret war of resistance.
Afo would eventually bring down the Dutch monopoly on cloves.
In 1770, a Frenchman, appropriately named Poivre, stole some of Afo's seedlings.

the article includes this factoid:

A Han dynasty ruler from the 3rd Century BC insisted that anyone addressing him chew cloves to sweeten their breath. 


unrelated item: Meaningful practice. A bit thing on Obamacare, but this explanation doesn't help explain what it is.

Manila needs a new sewer/drainage system, so is in danger of floods as the rain from the last storm comes downstream from the north.

Marikina is partly under sea level, but they managed to build there anyway.


premies at 22 weeks only have a 12.5 percent chance of survival, but the article stresses the negative since many end up with complications.

The results show that the precise survival rates by gestational age were 12..5%; 13.1%; 36.9%; 55.7% and 71.9% at 22, 23, 24, 25 and 26 weeks, respectively.
Survival with no serious intracranial haemorrhage, periventricular leukomalacia (damage to the brain's white matter close to the ventricles), bronchopulmonary dysplasia (chronic lung disease) or retinopathy of prematurity (abnormal development of the blood vessels in the retina) stood at 1.5%; 9.5%; 19.0% and 29.9% at 23, 24, 25 and 26 weeks, respectively.
presumably "experts" will use the data to impose "no treatment" orders on the kids, instead of figuring out ways to increase the survival rate.
The problem is that a large percentage of these kids are weak and don't breathe on their own after birth.
the parents want everything to be done...yet after CPR most of the kids revived only lived a few hours.
I've stopped CPR on a "flat" 22 week baby,who didn't revive after a few minutes of CPR,  so there is a good argument both ways. But that was 20 years ago and in a small rural hospital, where the nearest NICU was 200 miles away...
In Africa, even 3 pound babies usually didn't make it...all we had was an incubator which used 100 watt bulbs to regulate the temperature and a tube feeding in oxygen to the babies.

Thursday, September 4, 2014

Malpractice in plain sight

Joan Rivers died during what appears to be a biopsy of her vocal cord lesion, and it appears no one was monitoring her during her light anesthesia.

 This happens: I have seen deaths or near deaths from tooth extraction and tonsillectomy because of bad anesthesia. And you might want to keep it in mind when liberal judges nix laws that require decent standards of medical care for abortion clinics. I suspect a lot more deaths are occuring than reported? Why? Because I read an article years ago that the NY abortion law was a success, because no one died and there were few complications.

At the time the article was written in the early 1970's, our gyne ward was full of complications from NYCity abortion clinics on poor black women, and I know of at least one patient who died of renal failure because she signed out of the hospital who was monitoring her high risk pregnancy to get an abortion, and promptly died because the renal failure wasn't monitored anymore, and lupus nephropathy often exacerbates after delivery, even when it is done at 28 weeks (it was a viable baby, but never mind. And I suspect the death, which occured three days after the abortion, was never reported as abortion related, even though back then they usually aborted these kids with high salt injections of the amniotic cavity, which would have exacerbated the problem).

This was in the days before dialysis was paid for by medicaid, of course. Poor women died of renal failure back then.

Thursday, August 21, 2014

for later reading


Tuesday, July 29, 2014

de plague de plague

no, not ebola that is trying to spread around the world (uh, ever hear of Quarantine?)

but the medieval one.

For later reading (via Medievalnet)

the treatment of the plague by Arab physicians.of moorish Spain.

full report here.

for later reading.

Most reports on the black plague are about Europe or England: Somewhere I heard a lecture however about how the drop in population meant that the irrigation system of Egypt collapsed causing more deaths.
And of course, the latest epidemic of black plague was in 19th century China.

then there is this report on medieval dutch nuns.


again for later reading...seems that the plague was weaker in that part of the world and it notes that in the high middle ages there were more women than men, which explains why all those girls were put into convents for lack of husbands and why there were so many prostitutes.

Friday, July 18, 2014

de plague! de plague!

conspiracy page Newsmax reports that there are three more cases of pneumonic plague in Colorado. wapost article here

Originally there were two cases: A man and his dog, and the dog probably caught it from the fleas.

I should really not call the paranoid right wing Newsmax a "conspiracy site" since their article doesn't attribute the plague to escaped biowarfare stuff. Indeed, recent reports of (HORRORS) ANTHRAX being found in unmarked refrigerators shows how these thing tend to get exaggerated.

Hello: Anthrax is present in half the barnyards of the US middle west. It's spores live in dirt. But unless you eat it (which is why elephants died in Zimbabwe and had conpsiracy theorists blaming the west) or get it into an open cut in your hand, it just isn't that infectious. You have to process the spore to make it small enough to enter the lungs. Which is why a lot of us think the blaming of the anthrax letters on a rogue scientist was a cover up: he did have access to anthrax, but NOT to the machines that would allow him to weaponize the stuff. Nor did he know how to use the machines without killing himself.

as for plague, this is alas found in local prarie dogs in the moutain states. When I worked for the IHS, we had to keep this and hanta virus in the differential diagnosis of our patient, since an Indian who had hunted would come into the ER once or twice a year.

Tony Hillerman even has a mystery thriller on it, although in his book, the plaugue was superplague.

Saturday, July 12, 2014

When quacks attack, take two

Dr OZ is a quack, but no one has gone against him, because the Medical societies are too busy sending us emails about how to figure out the new paperwork requirements of Obamacare, or emails hailing the wonderfulness of the new program.

 But now, a medical student dares to take him on.JB: Was there a particular patient who inspired this crusade against TV quackery?

BM: The patient who inspired the policy I wrote was an older woman in her 60s who had a lot of the classic, chronic health problems we deal with in America. She was overweight, she had diabetes, heart disease. And so the physician I was working with was recommending these oral diabetes medications that are pretty standard fair. She had watched the Dr. Oz Show featuring green coffee-bean supplements—and how it was great to lose weight—and she was convinced this was going to be a huge impact on her weight.
We tried to politely express concerns that this probably wasn't going to be effective because there's no evidence for it. She refused the diabetes medications. The hope she had placed in the green coffee-bean extract was part of that.
JB: What do you think is the impact of Dr. Oz's sometimes dubious health advice? 
BM: I think these things impede the doctor-patient relationship. These doctors are actually doing a great job. But the trust people are placing with Dr. Oz—when their family physicians even nicely try to contradict him—disrupts their relationship.
JB: As a physician, what are you thinking when you hear Dr. Oz say he believes in magic?
BM: The movement in medicine has been toward evidence-based medicine because physicians had done things by their gut and belief for hundreds of years. Most physicians would agree it's only through the scientific process and evidence that we were able to make huge differences in medical care. It's insulting to talk about important medical issues and drugs as if it they were a matter of belief. It degrades all that work that has been done.

Me, I'm still wondering why no one is taking on the new age types infiltrating the profession.

Yes, I told patients to spend time in meditating: but for a Catholic that might mean saying the rosary, or christian it might mean thinking about what the bible says when they read it. For a grandmom, knitting works too. When they push "mindfulness", they not only risk panic attacks and psychotic breaks in a small number of people, but they are introducing Buddhist prayer techniques into a non Buddhist population.