Friday, April 25, 2014

lead in ancient Rome

One theory on the fall of Rome was that lead from pipes made the people bonkers and killed their kids.  UKGuardian story

But recent studies suggest the level wasn't high enough to do a lot of damage.

The tests on the Tiber sediments were striking. They showed that two kinds of water mixed in the river. The first was natural river water, which carried lead isotopes originally from the Apennines and volcanic rock in the Alban hills south-east of Rome.
The second type was much cleaner drinking water, that had drained into the river, and was contaminated with isotopes of lead not found in Italy. The researchers believe the lead was mined elsewhere, perhaps in Eifel in Germany, or even the English Pennines, and then brought back in ingots to make lead piping.
Further tests on the sediments showed that levels of lead in the Roman tap water varied over time from 14 to 105 times higher than those found in natural spring water,,, Even so, Albar├Ęde believes that any health problems caused by lead piping could not have brought the civilisation to its knees.
"Can you really poison an entire civilisation with lead? I think it would take more than lead piping in Rome to do that," he said.. The findings are reported in the Proceedings of the National Academy of Sciences.
and, of course, the question is if people drank the water...
One comment on the UKG site notes:

in ancient Rome. In his De Architectura, Vitruvius recommended that clay pipes should be used instead of lead for drinking water pipes after he observed illnesses in lead foundry workers.

Wine usually was mixed with water, of course. And there were other sources of lead, such as cosmetics and in medicines.

mentions that Hippocrates first described lead poisoning and that the ancients noted not to graze animals near lead mines...

Saturday, April 19, 2014

what works, what doesn't

The tamiflu kerfuffle is about a drug that works on some strains of influenza but not all of them.

It doesn't stop the flu: it only shortens the length you suffer symptoms...And it only works if you start it right away.

The problem? In your office, you don't know if it will work.
And most people don't see you until day two or three, when it is pretty well useless.

So I rarely used it.

Usually the danger was secondary infections: I told folks take tylenol etc. and if they got worse, to come back because they might have pneumonia etc.

in 1990, we had a nasty strain of the flu...after almost losing 2 folks in our nursing home, and knowing most of the cases were type A influenza, I started them on amantadine...the entire nursing home. Pissed off our (gov't) pharmacy, but no new cases popped up.

And amantadine is maybe why Patrician White Bull work up from a 10 year coma in is also used for Parkinson's disease.

Again about the 1990 flu epidemic: we almost lost two kids from Staph pneumonia...sent them to the university centers where they were pulled through in ICU settings...and I can't remember if this was resistant staph or not, but it was nasty.


Number two drug story: Chinese herb works better for Rheumatoid arthritis.

Yup They compared it to sufasalazine, which is a lousy medicine that doesn't work well (which is why most cases get the anti cancer drug methotrexate to turn off the immune system that is killing their joints).

and not noted: A lot of these "chinese herbal medicines" in the US have been found to contain indomethazone, and there have been cases of aplastic anemia from this.
Also many batches contain cortisone, which "cures" Rheumatoid arthritis, but you end up fat, diabetic, and osteoporotic.

so my question: who made the 'herbal medicine', and did they check what was in it?

Medieval malnutrition

BBC article on plague victims shows a lot of malnutrition:

Skeletons unearthed in London Crossrail excavations are Black Death victims from the great pandemic of the 14th Century, forensic tests indicate.
Their teeth contain DNA from the plague bacteriumYersinia pestis and their graves have been dated to 1348-50.
this is important because some revisionist historians doubted that the plague was the plague.

Analysis of the skeletons' bones and teeth indicates that:
  • Many of the skeletons appear to suffer signs of malnutrition and 16% had rickets.
  • There is a high rate of back damage and strain indicating heavy manual labour.
  • The later skeletons from the 1400s had a high rate of upper body injury consistent with being involved in violent altercations.
  • 13 of the skeletons were male, three female, two children, the gender was undetermined in the other seven skeletons.
  • 40% grew up outside London, possibly as far north as Scotland - showing that 14th Century London attracted people from across Britain just as it does today.

there was climate cooling and famines in the years before the plague, and it was thought that this was why there was so much malnutrition. Of course, many who went to London to work were probably the rural poor who never ate well to begin with.

What is often lacking is the knowledge that the plague also decimated Asia (so much for the church hating pc who blamed the plague on the "fact" that the Catholic church hated cats so allowed rats to flourish, ignoring barn owls and snakes of course, and the fact that the plague is spread via the black rat, not the present day rats of Europe, and that pneumonic plague killed many in crowded cities/houses).

I ran across a lecture about Egypt and the plague: That the depopulation resulted in the collapse of the irrigation system from the Nile, and then more deaths from famine.

But the Eurocentric history ignores such things.

Similarly, the Plague of Justinian was Pestus, and helped destroy post Roman Europe. I am reading a book on that period, and there is archeological evidence that some parts of central Europe was depopulated, allowing the Slavs etc to take over...

And how much of the "fall of Rome" was from the various epidemics? Was the fall of the population of Rome caused by malaria killing many  children? Rome started on a tidal swamp where they made salt, but remained swampy and allowed Egyptian malaria to spread.

Similarly one wonders how much of the "we're going to get malaria from global warming" folks recognize that much of Europe had malaria once, until the monks drained the swamps. That "Green" love of "wet lands" is not good.

One part of England was fatal to newcomers until the swamps were drained. And one wonders if the high mortality of the Anglo Saxon kings etc. was from malaria and other nice diseases...presumably that's why they drank so much beer and wine...

Friday, April 18, 2014

Rice and heavy metals

This article is worrisome: rice, especially brown rice, concentrates heavy metals such as arsenic (a problem in parts of India) and cadmium (a toxic byproduct of heavy industry in China).

But I worry about mercury
We are downstream from our city dump site, and no one properly disposes of the newfangled light bulbs, which contain high levels of mercury.


nytimes heart death panels, as Wesley smith notes LINK

 Apparently, some medical societies are buying into the distrust sowing meme that doctors should give better care to some patients than to others. Why? Duty to society. From the New York Times story:

Saying they can no longer ignore the rising prices of health care, some of the most influential medical groups in the nation are recommending that doctors weigh the costs, not just the effectiveness of treatments, as they make decisions about patient care.
The shift, little noticed outside the medical establishment but already controversial inside it, suggests that doctors are starting to redefine their roles, from being concerned exclusively about individual patients to exerting influence on how health care dollars are spent.

ah but the Hippocratic oath is about the ethical duties to a patient.

By making doctors obey society, they twist the profession into one that obeys the policies of the government.

Leo Alexander has the classical article on this in the NEJM in 1948(Before it became the favorite journal of the culture of death). I don't know if the article is on line because the webpage won't link.
This article has no abstract; the first 100 words appear below.
SCIENCE under dictatorship becomes subordinated to the guiding philosophy of the dictatorship. Irrespective of other ideologic trappings, the guiding philosophic principle of recent dictatorships, including that of the Nazis, has been Hegelian in that what has been considered "rational utility" and corresponding doctrine and planning has replaced moral, ethical and religious values. Nazi propaganda was highly effective in perverting public opinion and public conscience, in a remarkably short time. In the medical profession this expressed itself in a rapid decline in standards of professional ethics. Medical science in Nazi Germany collaborated with this Hegelian trend particularly in the following enterprises: 

 Try this one LINK
Medical science under a dictatorship.

a lot of the "futile care" part is about not treating the brain damaged or senile. But this isn't about expensive treatment, but has migrated into feeding: So you put in a feeding tube because the nursing home nurses are too busy to properly feed someone (or too cheap to do it) and then you pull the feeding tube as "unwanted medical care".

Which is why John Paul II allowed a feeding tube for his Parkinsonian crisis: (where if he hadn't died of infection he might have recovered). To show that you don't just throw away people.

And if you think this idea is limited to those in vegetative state, you are mistaken.

We had a patient with frontal lobe syndrome and quadraplegia , and asked a neurologist the best way to treat her symptoms of excess emotional outbursts that upset the ward (if she saw you, she'd scream and cry in happiness, sounding like she was in pain. It's called paradoxical emotional reaction).

The neurologist spent the hour not examining the patient but talking to the family to try to persuade them to pull her feeding tube (which was in for staff convenience) so she could die. The Native American family was quiet, not because they agreed but because they were angry. On leaving, one cousin, who had enough western education to be disrespectful, said: That is the difference between you white people and we Indians: We respect our elderly.

Wednesday, April 16, 2014

Cross posted from my main blog

the Korean ferry disaster.

 These things happen in the Philippines every couple of years.
But was this an "on/off" ferry, or was there a reef nearby??

 Not mentioned in the articles I read. all sorts of medical items, from the safety issues to hypothermia...the water was 54 degrees, so they wouldn't be alive long in the water.

  StrategyPage has the good news from Afghanistan that you won't read in the paper:


and this critique of women in combat at strategypage notes:
None of these proponents of women in the infantry have ever served in the infantry, but they understand that if they proceed without proof that women can handle the job, that decision could come back to hurt them (not to mention getting a lot of American soldiers and marines killed first). So far the tests, overseen by monitors reporting back to civilian officials in Congress and the White House, have failed to find the needed proof. The main problem the military has is their inability to make these politicians understand how combat operations actually work and what role sheer muscle plays in success, or simply survival... Yet women have often been exposed to a lot of indirect combat. As far back as World War II, 25 percent of all troops in the army found themselves under fire at one time or another, although only about 15 percent of soldiers had a "direct combat" job. In Iraq women made up about 14 percent of the military personnel but only two percent of the casualties (dead and wounded). Most women do not want to be in combat but those who do get the job have proven that they can handle it. Moreover many proponents of female infantry fail to appreciate the fact that all these women in combat incidents was not the same as women in the infantry or special operations.
 it's the physiology, stupid...or maybe the female hormones.

So next step: give them androgens and let them pump iron?

but the dirty little secret of women not being infantry but being on the front lines is one rarely mentioned in history.

The "campfollowers" did the cooking, washing, and nursing (and other comfort measures, hence the name being used to imply that was their main job).

Now the USArmy has had it's own cooks/washing etc. but now adays often subcontracts it out to cheaper folks. Hence the kerfuffle in Gitmo, when the Filipino cooks at the "mess" (kitchen/dining room) decorated it for christmas, and had to remove the decorations for not being PC in the "new" army.

Hepatitis C notes

There is supposed to be a new treatment for HepC, that only take three months and won't make you sicker than a dog.

If so, everyone will get it.

One of the problems was that population studies of WWII vets showed most of the cases were alive and well 40 years later, so why treat?
Other studies suggested ALL cases went on to a fatal cirrhosis. I never did figure it out...presumably there is a study on what's really true. But the reason I never got around to it was that most of the cases we picked up were so unreliable that they never kept the appointments for the liver biopsy to see if they should go on treatment, or take the medicine. So I think we treated 3 or 4 cases in all at our clinic.

A lot of alcoholics who died in their 30's actually had hepatitis b or c or a along with their alcoholic liver disease, which messes up the statistics.Now they have a new HepC test, right in time for the new middle class epidemic of heroin addiction.

A new cohort of young injection drug users acquiring HCV infection has been recognized nationwide, notably in suburban and rural areas 

translation: Now white suburban kids are getting it, not just minorities in the inner city (or in our case, on the reservations)

sounds helpful: but only if the new easier treatment regimen works and is quickly implemented in the community...

WEDNESDAY, Jan. 15, 2014 (HealthDay News) -- Hepatitis C treatment isn't pretty, but the dark days of weekly injections, rough side effects and no guarantee of full recovery from the liver-damaging disease may soon be over, researchers report.
Two studies, both published in the Jan. 16 issue of the New England Journal of Medicine, involved giving various combinations of antiviral pill cocktails to patients with hepatitis C. Some had failed to respond to standard treatments, and some had not received treatment yet. Yet, the cocktails cleared the virus in both studies for between 93 percent and 98 percent of the patients.
These cocktails are game-changers for the illness, said Andrew Muir, director of gastroenterology and hepatology research at the Duke Clinical Research Institute.

Tuesday, April 8, 2014

The Plagues of war

StrategyPage has a report on the collapse of the Syrian health system.

 Three years of war in Syria have left the health care system in a shambles. Over 100,000 children have been unable to receive vaccinations and polio and measles are showing up again. Polio is a particular problem because Pakistani Islamic terrorist rebels have apparently brought polio back to Syria. In 2013 there were over fifty cases of polio in Syria, after having been absent since the late 1990s. In 2013 the vaccination rate for Syrian children fell from 95 percent to under 80 percent and is expected to plunge even more in 2014.
In 2014 thousands of polio causes are expected and there have already been several outbreaks of measles, which is less deadly than polio but also largely absent from Syria for decades. In 2013 there were over 10,000 known cases. Measles, mumps and rubella hits adults as well as children because few adults received booster vaccinations after childhood. Polio can also hit adults who did not receive a booster dose of vaccine. Adults are also liable to get typhus and other rapidly spreading diseases that have not been a problem in Syria for a long time. 

update: Just as the Pakistani polio is being spread to syria by Alqaeda jihadis, so also is Iraq in danger. Also from StrategyPage:

The government is preparing to distribute polio vaccine to 20 million Iraqis. This is in response to the recent (March) confirmation that the first case of polio had been found in Iraq since 2000. This was the result of Pakistani based Islamic terrorists infected by polio (but not crippled by it, which is common with many people exposed to polio or other viruses like influenza) coming from Syria since 2012. Syria had polio outbreaks earlier in 2013 and has been unable to carry out a polio vaccination program because of the violence and the refusal of some rebel groups to cooperate. Polio is a problem because Pakistani Islamic terrorist rebels have apparently brought polio back to Syria. As a result in 2013 there were over fifty cases of polio in Syria, after having been absent since the late 1990s. In the first three months of 2014 there were 27 cases. In Pakistan there were 62 cases of polio in 2013, which was more than all of 2012 (58). In Pakistan polio cases reached a low of 28 in 2005 but then Islamic terrorist opposition to vaccination led to a sharp increase that hit 198 cases in 2011. Since then Pakistani government and religious leaders have sought to deal with resistance to the vaccination campaign. A Pakistani Taliban ban on polio vaccinations has left over 250,000 young children vulnerable to the disease and these are most of the ones getting infected. Years of Islamic radical clerics preaching that polio is un-Islamic has caused a growing number of parents to refuse the vaccinations even when there is no Islamic terrorist threat of retaliation

Sunday, April 6, 2014

locked in not brain dead

AnnAlthouse links to an article about a man listening to doctors discussing taking his organs.

in Sweden, but I suspect there are cases in the USA (or maybe it's just an "urban legend")

But Arthur Caplan, when he moved years ago to Pennsylvania, tells a story of how the driver's license clerk warned him not to check the "organ donor" box "or they'll let you die"...

Thursday, April 3, 2014


StrategyPage article on using drugs to enhance soldiers in war.

and yes, terrorists use them too.

For over a century now one of the more popular fatigue solutions has been amphetamines. However, this drug can impair judgment, making the user more aggressive. Ambien has similar side effects. After September 11, 2001 kinder and gentler alertness medications became available. The most effective of these has been Modafinil (sold as Provigil). This stuff is described as "a mood-brightening and memory-enhancing psychostimulant which enhances wakefulness and vigilance." Tests showed that user performance was degraded 15-30 percent, versus 60-100 percent for those who took nothing at all after 24 hours of being awake.

when I was in medical school, they started cutting hours, but we still had weekends on call, meaning only a few hours sleep. A lot of people claimed we worked just as well, and even used studies to prove it. But I remember several times when I was so tired I couldn't walk let alone function.

It was about money: Interns and residents were cheap help.

What stopped it was when Libby Zion died because the residents didn't notice she was on an MAO inhibitor, and gave her a drug that interacted with that old fashioned anti depressant, so she died, and her father got a good lawyer to sue and change the law.

So, will the latest shooting at Fort Hood slow down the use of polypharmacy?

Actually, these drugs cut down the suicide rate, but alas are being used in place of other, more expensive things like talk therapy or cutting back on combat.

Wednesday, April 2, 2014

Vegetarians less healthy?

Usually the elites laud vegan and vegetarian diets because they are associated with a low risk of heart disease.

Yeah. Not a lot of heart disease in the African bush (although here in the rural Philippines, we see hypertension related heart attacks, also meth induced heart attacks).

Monkeys eat other monkeys and sometimes small animals.

Presumably this is an evolutionary way to get extra protein. Indeed, some evolutionary biologists think that the discovery of using fire by Homo erectus allowed them to cook meat, making it easier to chew and digest, and led to the fairly fast evolution of a thinking brain.

So WesleySmith's blog links to an article saying vegetarians are less healthy.

A new study out of Austria has now cast doubt on a claim often made by vegetarian proselytizers that one should forego meat and animal products for health reasons. From the study:
Overall, vegetarians are in a poorer state of health compared to the other dietary habit groups. Concerning self-reported health, vegetarians differ from each of the other reported groups toward poorer health.
Moreover, these subjects report higher levels of impairment from disorders. Vegetarians additionally report more chronic diseases than those eating a carnivorous diet less rich in meat. Significantly more vegetarians suffer from allergies, cancer, and mental health ailments (anxiety, or depression) than the other dietary habit groups (Table 3).
Subjects who eat a carnivorous diet rich in meat more often report urinary incontinence. No differences between individuals consuming different forms of diet were found regarding their vascular risk.
The study doesn’t claim that vegetarianism causes these poorer outcomes.

one should ask if the vegetarians are pure plant eaters or if they supplement their diets with milk and eggs and fish.

And remember: When you read an article on "healthy" Japanese or Chinese diet, remember those diets are also high in salt and fish...and there is a high rate of hypertension.

Vegetarians of India usually use milk products (hence the "Sacred cow": if you get hungry in a famine and kill your cow, you may die of protein malnutrition...hence the taboo).

As for Africa: yeah. We saw high blood pressure and ASCVD in the educated on "european" type diets, but not in the rural areas 40 years ago...but our rural folks died easily of minor infections. Hence the high mortality in kids of measles etc.

And now, with McDonalds, I suspect the story has changed in many places there also...