Wednesday, December 14, 2016

Syphilis: resistance and epidemiolgy

Instapundit linked to this article on the resistance of syphillis to antibiotics... i.e. Zithromax/azithromycin.

The advantage of Zithromax is that it is a few pills, whereas Penicillin means a shot (and if you have ever seen an allergy to penicillin you know why the pills are preferred). And Zithromax will also cure Gonorrhea and Chlamydia, which often are also present in these patients but may not show up in tests or give symptoms.

But the article wonders what is behind this:

They found that the two current clades (categories) of syphilis infections had a common ancestor in approximately the 18th century. One of these clades, called SS14, has a particular strain (SS14-Ω) that seems to have split from the others sometime in the middle of the twentieth century. (italics mine)....
It’s not clear why SS14-Ω is so successful. There could be a biological explanation, like it having an increased transmission rate, says Arora. But it could also be social or demographic reasons: “Perhaps there’s a strain type that circulates among networks of people more easily.” Isolates of both strains show up with resistance to azithromycin, but resistance is far more prevalent in SS14

 middle of the 20th century? As in "time of the sexual revolution"? Or a bit later, as in after the Gay liberation movement stopped all attempts to close disease spreading bathhouses and bars:?

People with hundreds of sexual contact are more likely to catch HIV and other STD's than a monogamous person, but to say that out loud will get you accused of homophobia or rigidity/moralism.

and since syphilis is more common in HIV positive white men practicing MSM, could the problem be that Azithromycin, which only discourages and doesn't kill the germ, might not be killed by the body's defenses?

Zithromax belongs to a class of antibiotics called macrolides, which are bacteriostatic – meaning they treat infections by preventing bacteria from multiplying and producing the proteins that are essential for their growth. Eventually, the remaining bacteria die or are killed by the immune system, not by the drug itself. This is in contrast to bactericidal antibiotics, which kill bacteria.

we saw a lot of syphilis, including neonatal syphilis, when I worked in Africa. Men worked in town but were forced by company policies and tribal customs (where if you don't have someone working your land, it will be deeded to someone else) to let their wives in the country to tend the farm. Prostitutes spread various STD's and we saw cases after each holiday.

I always wondered why the mines didn't bother to check the local gals and treat their STD's (as the US Army usually did to stop STD's in the good old days).

and don't say: "condoms"... they aren't used in Africa, mainly due to tribal custom, but also the heat and humidity mean that the latex deteriorates so may be useless.

the presence of "male dormitories" at mines and factories in South Africa etc. is one of the big reasons for the spread of heterosexual HIV, along with no circumcision. And it is probably one of the reasons for South Africa's problem with drug resistant TB.

and in Asia, including China, Iran, and parts of Russia, most of the HIV was related to to injection of heroin etc.

But as a whole, in the West, it is same sex male sexual practiccs that spread Syphilis, HIV and other STD's.


The HIV/AIDS epidemic in the 1980s was associated with general declines in the rates of syphilis among the general population in the US and Western Europe, including MSM [1, 8, 9]. The decline continued into the early 1990s and was concurrent with the adoption of safer sex behaviors and the effectiveness of sexual education and HIV/AIDS prevention programs [10, 11].
However, around 1999, intermittent outbreaks of syphilis were reported in many urban areas in the US and Western Europe [8–13]. These outbreaks occurred almost exclusively among MSM and were attributed to increases in risky sexual behaviors such as condomless anal sex (CAS), exchange sex, illicit drug use before sex, multiple sexual partners, and high-risk anonymous sexual contacts [14].
Syphilis outbreaks continue to occur sporadically in the US and Western Europe [3]. Given the continued risk of syphilis transmission, its close association with HIV infection, and the disproportionate disease burden among MSM in the US and Western Europe, there is a need to examine and understand syphilis trends among MSM in both geographic areas.

to check why, you need an x rated investigation, This article is a good place to start, but is probably quite shocking to the general population.

but we docs already know what is going on: not just drug use, and not just a very large number of different sexual partners, but a lot of practices that a normal woman or an ethical prostitute would reject.

read this and weep..

and then tell the damn Pope that his going along with this "who am I to judge" and condemnation of rigid/moral ideas rather than the condemnation of sin is a major reason that this epidemic spreads.

Yes, in the good old days, we had gays sneaking out once in awhile to have sex, but at least we could use shame and fear (of hell, of disease, or being picked up by the cops) to limit their disease spreading behavior.

being judgment free only means they refuse to recognize the reality behind all those rigid moralisms was not hatred of women/ hatred of sex, or  homophobia, but based on experience.

Warniing people of danger is not hatred, but a form of love...

Tuesday, December 13, 2016

Orange Babies and blue men

I had written a previous post about the Rose Madder herb being fed to horses to make their hooves pink.

That is not the only dye/foodstuff that can change the colour of skin or nails:

Wholesome baby food website discusses the question: Why is my baby orange.

Image: keeleymorris on Twitter

Carotenemia is a medical term for a condition that causes the skin to turn orange-ish due to increased blood carotene levels. In the vast majority of cases seen, it is associated with large consumption of carotene in the diet; as in too many carrots or sweet potatoes. Read more at

more at Wikipedia 

we see this a lot in kids, and the way you can tell it's not jaundice is that their eyes are not yellow. The treatment is to reassure the parents.

I've only seen it once in an adult: It she admitted that she had a craving for carrots.

People who are anemic often have similar cravings: although ice eating and starch/clay eating are more common. (The technical term for this is pica).

I tested her, and sure enough, she was anemic and low in iron.

but carrots are not the only food that can cause problems: tomatoes can do it also, from the lycopene in them.

argyria is from silver in the skin (benign). One of the problems for "preppers" who use AgNO3 for medical problems.

and Iron overload (from a genetic defect, hemochromatosis or from being given too much iron for severe anemias,) can also discolor the skin.

It's not hemochromatosis per se, but there is a well known problem of dark black skin in Bantus in Africa.

We saw a lot of very dark skin in our heavy native-beer drinkers in Africa: it is because the local beer is brewed in iron kettles, but also because some people carry a gene that makes them vulnerable to the condition.


Dietary iron overload is the consumption of large amount of home-brewed beer with high amount of iron content in it. Preparing beer in iron pots or drums results in high iron content. The iron content in home-brewed beer is around 46–82 mg/l compared to 0.5 mg/l in commercial beer

we didn't treat it as such (often these patients also had cirrhosis from alcohol, and/or viatmin B deficiency, so mainly we would feed them up and tell them to stop drinking).

The Wikipedia article also suggests this might be behind the high rate of liver cancer in Africa, but I have also read that mold in certain foods might be another reason for this, or maybe Hepatitis C.

finally, there was a book of medical mysteries that included a story about 11 blue men.

usually when patients are blue, it is due to lack of oxygen from heart or lung problems.

For example: we docs separate lung disease in smokers into pink puffers (pure emphyesema) and blue bloaters (Chronic Bronchitis...Bloaters is British slang for a person who coughs up lots of phelgm). Because the mucus causes CO2 retention, they tend to have a high CO2 level and tend to be a bit cyanotic.(blue)

But the classic story "11 Blue Men", this was due  someone accidentally putting sodium nitrate into salt shaker.

Full story HERE

quite a few medicines can cause methhemoglobinemia, but most of these medicines are used in doses too small to cause problems unless you overdose, or unless have a genetic problem. this long medical article discusses the problem.

and then there is a rare congenital form of methhemoglobinemia that runs in families... one example is the Blue Fugates of Kentucky.

------a shorter version is on my FKCLINIC blog.

Friday, December 9, 2016

Zika and microcephaly

Long report on the CDC website about cases in Colombia.

The rate of microcephaly in women who were diagnosed with Zika was 4 times that of those without the virus.

But the "natural" rate is low so that means the actual number of case was low.

. Peak prevalence of microcephaly was registered in July 2016, when the prevalence was ninefold higher than in July 2015 (PR = 9.0). In 2016, among all microcephaly cases, 432 (91%) occurred in live born infants, and 44 (9%) occurred among pregnancy losses; in 2015, among 110 reported cases of microcephaly, 90 (82%) occurred in live born infants, and 20 (18%) occurred among pregnancy losses.

So all the hysteria was about a couple hundred cases of microcephaly out of tens of thousands of births.

Although the microcephaly prevalence in 2016 among infants likely exposed to Zika virus in utero (9.6 per 10,000 live births) in Colombia was not much higher than the median of microcephaly prevalence (6.6 per 10,000 live births) reported by passive surveillance in 17 U.S. states during 2009–2013 (4), the comparison with 2015 Colombia data indicates the magnitude of the increase.
Tranlation: chance of microcephaly was low, and higher among those affected but still the risk was low (6 out of ten thousand).

now, the question Why was the risk higher in Brazil than in Colombia?

In 2015, microcephaly prevalence in Brazil was 5.5 per 10,000 live births, representing an approximate ninefold increase over the average prevalence during the previous 14 years (5,6). 
In Colombia, the relative increase has been smaller (fourfold); however, the baseline microcephaly prevalence was 2.1 per 10,000 live births in 2015, at least three times higher than Brazil’s reported baseline.
Ah, so even the baseline was different. So does this mean that microcephaly was being missed in Brazil before the epidemic, making the statistics higher? or did altitude have something to do with it (Colombianos live mainly in the high plateaus).

 There are several possible reasons for differences between the reported baseline microcephaly prevalences in Brazil and Colombia, as well as the differences in increases of microcephaly in the context of the Zika virus outbreaks in the two countries. 
First, 50%–75% of the population of Colombia reside at altitudes above 2,000 meters, in areas without active, vectorborne Zika virus transmission (7). 

or maybe the difference is how the measurement is done

Second, microcephaly is a difficult birth defect to monitor because there are inconsistent definitions, obtaining accurate measurements is challenging, and terminology is inconsistent. Because of these challenges, prevalence estimates vary widely among countries and among surveillance systems within the United States (4). 

finally, how many women were frightened by the kerfuffle and either postponed pregnancy or aborted their babies in fear?

Third, the reports of microcephaly from Brazil might have served as an early warning. As evidence was emerging about the link between Zika virus infection and microcephaly, the Colombian Ministry of Health issued a recommendation in February 2016 advising women to consider delaying pregnancy for 6 months, which might have affected subsequent birth rates.§ The number of live births in Colombia during epidemiologic weeks 5–45 decreased by approximately 18,000 from 2015 to 2016.

and the dirty little secret: not all the cases of microcephaly were from Zika. Other viruses etc were also to blame: 476 cases, 306 tested for Zika but only half of them had blood tests positive for Zika. Toxoplasmosis was found in one fifth, and CMG, herpes simplex and syphillis were found in other cases.

Among the 476 infants and fetuses with microcephaly reported during epidemiologic weeks 5–45 in 2016, a total of 306 (64%) were tested for Zika virus infection; 147 (48%) had laboratory evidence of Zika virus infection by RT-PCR or immunohistochemistry on any placental, fetal, or infant specimen, and five of six tested had serologic evidence of infection by MAC-ELISA. Among 121 infants tested for other pathogens, 26 (21%) had evidence of infection with other pathogens, including toxoplasmosis (15 infants), herpes simplex (six), cytomegalovirus (four) and syphilis (one); among these 26 infants, 17 (65%) had evidence of coinfection with Zika virus (14 of 15 with toxoplasmosis, two of six with herpes, and one of four with cytomegalovirus). Neuroimaging results were available for 32% of all microcephaly cases. Among 476 infants or fetuses with microcephaly, mothers of 164 (34%) reported having symptoms compatible with Zika virus infection during pregnancy.

I am not saying this is not a serious disease: What I am saying is that the risk of malformation is low, compared to women infected with other diseases e.g. rubella in the first trimester.which is associated with an 80 percent chance of one of several devesstating problems.

Rubella infection in pregnant women may cause fetal death or congenital defects known as congenital rubella syndrome (CRS). Worldwide, over 100 000 babies are born with CRS every year. There is no specific treatment for rubella but the disease is preventable by vaccination.

usually rubella vaccine is given with measles and mumps vaccine as the MMR.

So compare the hysteria on Zika and the outcry to rush to get a vaccine, while everyone is ignoring the 100 thousand cases of fetal rubella syndrome, where there actually is a vaccine that will prevent babies from being born deaf, blind and/or retarded.

my sarcasm is twofold:

One, because the outbreak occured shortly before the Olympics, there was a chance that rich American yuppies might catch it, so hysteria.

Two: Zika can be used to push the abortion/population control agenda on poor women.

Is Smallpox a new disease?

tech times:

new analysis of smallpox DNA from the 17th century suggests smallpox might have recently evolved and does not date into prehistory as many had thought.

The disease had long been believed to have emerged among humans thousands of years ago, afflicting people in India, Egypt, and China. Some historical accounts even suggest the Egyptian pharaoh Ramses V, who passed away in 1145 B.C., had been struck by smallpox.

For the study that involved the genetic analysis of the viral DNA taken from the partially mummified remains of a child dating back from the 17th century, researchers found that the smallpox could be just some hundreds of years old.

measles is considered to be a "new" disease also, so questions if ancient plagues were measles are also at question. Measles evolved from the animal disease Rinerpest in the 11th century.

so what caused earlier plagues?

One problem is that diseases sort of change with time.

Often they are very virulent when they first hit humans, then because killing one's host is not very beneficial for your evolution, the variation of the germ that doesn't kill quickly (and hence, spreads to more people) wins the evolutionary battle.

DNA has helped to identify ancient diseases: there is some evidence that Justinian plague was actually Bubonic plague, and some studies of the plague of Athens suggest it might have been typhoid.

and they are still debating what caused the Antonine plague (which weakened the Roman Empire and killed Marcus Aurelius, the emperor in Gladiator). Since the soldiers caught it from "Parthia", a dry climate, one suspects it could be bubonic plague or a similar zoonosis.

but it also does mention the Chinese in 1000 AD devised innoculation with smallpox scabs to stop the disease from spreading (other stories insist it was Africans or the Arabs who did this. A lot of the Africans brought to the Americas were from Muslim areas and the Arabs were in touch with China so maybe the idea spread? The English started to use it from the Ottoman empire contacts.

on the other hand,

Until the 18th century, inoculation was a practice largely confined to China, India, Turkey, and other eastern countries. 
Lady Mary Montagu, an aristocrat and the wife of England’s ambassador to Turkey, is credited as being the first to bring attention to the practice in the Western world. In 1715, Montagu had gone through her own bout of smallpox, and had been disfigured as a result. After learning about inoculation during her time in Turkey, she was determined to protect her six-year-old son from the disease through inoculation.

One possible reason for the confusion is that there are two variations of smallpox: One with a very high mortality, and one with a lower mortality.

the latest case that suggested a recent evolution of the virus ignores non DNA evidence from the past

So is smallpox old or new, or something that just pops up now and then?  LINK and LINK (these are long MEGO type articles that I will have to read in detail later).

but this is one puzzle:

As variola virus lacks a known non-human animal reservoir, its origin as a human pathogen has been concealed under a veil of mystery. The evolutionary history of this virus can be dated based on either the assumed dates of variola virus subtypes diverging from the ancestors, or the dates of isolated samples that contain variola virus.
the problem with the smallpox family of viruses is that they mutate quickly, and humans can catch pox viruses from animals: The most famous example of this is Jenner's observation that milkmaids who caught cowpox never caught smallpox, and devised vaccination.

but other animal pox could cause problems: in recent years, there have been reported cases of monkeypox in humans.

and then there is camelpox:

Phylogenetic reconstructions suggest that camelpox virus, taterapox virus and variola virus emerged from a common progenitor almost simultaneously. Additionally, these viruses are strictly specific for their hosts, and both variola virus and camelpox virus cause diseases with high case fatality rates.

However, the real puzzle about human smallpox is that so far they haven't discovered an animal who carries it, i.e. a reservoir where it hides.

sow what does this mean?

It means a new outbreak could pop up from animals, mutate and kill thousands of people

Recent oubreaks of "new" diseases like SARS (in China), MERS (in the Middle East) and cases of avian flu in humans so far haven't killed millions mainly due to old fashioned ways of stopping the spread of the virus, e.g. washing hands, isolation, and stopping travelers.

 and of course outbreaks of known diseases like Zika and Ebola are also a worry.
But small pox? Spread via the air to people nearby, long incubatio perios, and no one except some of the military and first responders who have had immunity suggest a problem.

But at least with smallpox, there is a vaccine.

And the real worry: What if a newer variation, such as weaponized monkeypox or camelpox that evolves ?

again, the bad old days of quarrentine will return.

Plague in the news: Here, kitty kitty kitty

CDC report of domestic cats in Idaho who were diagnosed with the plague.

Cat-associated human plague cases, including fatalities, have been reported in the western United States since 1977 (3). Compared with dogs, cats are highly susceptible to plague illness and can transmit disease to humans directly through exposure to respiratory droplets and infectious body fluids associated with bites or scratches (1). Cats could also carry infected fleas into households.

no human cases, but it can be spread to humans so the pet owners are being put on alert.


related item: Plague carrying squirrels.

PJMedia has an article remembering how children were urged to kill plague carrying squirrels during World War I... \

George H. Hecke, commissioner of California's State Horticulture Commission, created what would be known as the "Squirrel Army." The effort was presented as an extension of the United States' declaration of war on Germany, which was made the previous year.
“We have enemies here at home more destructive, perhaps, than some of the enemies our boys are fighting in the trenches," said Hecke. By organizing “a company of soldiers" in their classes or in schools, children were encouraged to help annihilate their ultimate foe—the ground squirrel.
The rodents were a source of bubonic plague back then, and the cause of an estimated $30 million in crop devastation. That's equivalent to $480 million today. Hecke called for "Squirrel Week," which ended up being seven days of murder and mayhem.


Wednesday, November 30, 2016

CRISPR and hemophilia

could the CRISPR technique splice in a gene to counteract the missing gene for some types of hemophilia?


Most single-gene diseases, such as hemophilia, are caused by different mutations scattered in a specific gene rather than a single predominant mutation, so the team needed to develop a vector that would be applicable for patients with any mutations. The study is a preclinical proof of concept using a universal CRISPR/Cas9 gene targeting approach that could be applied to majority of the patients with a specific disease, in this case hemophilia B. According to the Centers for Disease Control and Prevention, hemophilia in general occurs in approximately 1 in 5,000 live births and there are about 20,000 people with hemophilia in the United States.

good news if it works out

Wednesday, November 23, 2016

Just ignore the happiness of the children you don't want

David Warren writes that this film has been banned from French TV because it might upset some people...

At the centre of the controversy is that smile — that distinctly Down syndrome smile, more haunting than the smile on the Mona Lisa. To those who happen to have eyes to see, it is in itself a moral, and a mystical revelation. I have dreamt, towards Christmas, of the Child in the manger: surely Jesus smiled upon his mother like that.

he also wrote:

as I know from first hand (my younger son is Down’s), they are an extraordinary gift, to those parents and to any siblings, or others, who are brought into contact with a love, a fidelity, an emotional attentiveness, a kindliness, a joy, an innocence, an orb of communicable experience and perception that enlarges and deepens us.


related item: Pearl Buck and her retarded daughter.

Her daughter had PKU, which now is screened for and the retardation prevented with a strict diet.

when I first studied in medical school, doctors recommended all such children be institutionalized. Thanks to the Kennedy family, that has changed, and most are now cared for at home or in home style care homes.

but Down's syndrome is a chromosomal abnormality (they have an extra chromosome). Some wonder if genetic manipulation like CRISPR could "cure" or treat their deficiencies or other genetic causes of disabilities.

JohnsHopkins article discussion.

Nature also discusses the possibility and the ethics of genetically manipulating children.

one problem is that manipulating genes in embryos or growing fetuses is essentially "experimenting" on someone who cannot give their consent.

For minor things, like beauty genes or high IQ, this would be immoral, because if the experiment didn't work, the embryos would be discarded or left to die.

But the dirty little secret is that in today's world that stresses perfection, that most children with Down's syndrome are aborted. Changing their genes at time of diagnosis might give more mothers the courage to oppose the pressure on them to abort and give their baby a chance to live.


additional note: people with Down's syndrome have higher incidence of some disease like Leukemia and Hypothyroidism, and may develop Alzheimer's disease in middle age. All these things are from immune changes from the chromosome. One reason that in the past (i.e. check out any textbooks from the 1940's) was that they tended to die of infections before they reached puberty. Antibiotics changed this.

there is also an increased chance of certain congenital heart defects. In the 1960's they discussed if these children merited open heart surgery, which at the time was rare and risky. Now few would deny the children such treatment.

I remember one major magazine had an article about a woman whose child had Down's syndrome and heart problems, and was disappointed the child lived. She said she planned to become an activist for euthanizing such children.

Well, she had her wish: Not euthanasia, although Singer and other professional bioethicists would recommend infanticide, and of course, most of the Down's syndrome children are aborted  so no one has to actually confront the face of the child you killed.

But of course, as European progressive nations have proven: Just wait a decade  or two and infanticide and murder of children under the guise of compassion will be promoted.

Sometimes these stories makes one hope that the pro life Muslims will take over the place. .. although as this BBC link suggests, the PC are working on modern "religious" experts to change this.

A similar pro life bias is found among most Africans and AmerIndians, seeing abortion as the same as taking a life, although some tribes do allow early abortion for grave reasons, and of course, taking herbs to bring on one's period is seen as contraception, not abortion.

hence the push for "abortion pills": out of sight, out of mind...

Yet, as the banning of the "SMILE" film suggests, even these mothers remember:

“Can a mother forget the baby at her breast    and have no compassion on the child she has borne?Though she may forget,    I will not forget you!16 See, I have engraved you on the palms of my hands;

But with Down's and genetic abortion, you don' t have that option.

I ran across a comedy about a one night stand with an acquaintance, where the woman got pregnant, and the dude went with her to the doctor's... and they did an ultrasound and saw the beating heart of their tiny old baby...

the dude was speechless and the mother could only cry with mixed emotions.

Nowadays, a blood test will diagnose a lot of Down's syndreme kids early ,so if you want to abort early you can. Of course, the chance of a false positive is there... even if the newest fancy test claims a 0.1% of false positive, you still have lab error, mosaic chromosomes and other problems.

The lab error problems are especially big when testing in populations with a low risk of a problem. LINK

Seattle news article discusses the problem here.

... often after the 16 week ultrasound, where abortion is quite risky and you have to pull out fetal parts to kill the kid. Some delay even longer, hence the use of fetal poison to kill the kid or decompressing the skull of a partially born child (AKA partial birth abortion).

Pearl Buck was told her child would never be normal, so put her into an institution and forget about her. But as the article points out, you never do forget...

Friday, November 18, 2016

latest medical headlines

CDC report on the use of vaccines around the world. For later reading since it is ocmplicated.

the use of DPT vaccines has lagged at 85 percent, and countries with internal wars are especially at risk for not getting their kids vaccinated.

another problem: not all the kids got all their shots, so could get the disease.
The good news is that one shot will give you some immunity and since you are now older and healthier (most of the deaths from DPT and measles and HIB etc are in toddlers) but it will wear off. We saw this with measles vaccine, where we had an epidemic in our high school and not all the younger doctors had ever seen a case.

all the anti vax people in the US seem to think vaccines are a NWO plot to kill people to keep down the population. Actually it is the opposite: It cuts down the number of poor children dying in the third world.

Of course, when the moms realize they no longer have to give birth to 5 kids to make sure they have one or two survive to adulthood, they are willing to use contraception etc. to limit their families.

another note: LATIMES article saying the WHO has called off the Zika emergency.

You know, the "R" in the MMR vaccine is rubella, which causes a lot more brain damage to the fetuse in pregnant women than Zika.

But then I'm old enough to remember the last rubella epidemic in the US, where so many women faced giving birth to a retarded child (and in the UK,, thalidomide cases) that it led to more support for legalized abortion...


CDC reports that if you overdose on immodium, you might get a heart irregularity.

Don't worry about taking one or two for diarrhea however, the dosages are higher here...

. Serum loperamide concentrations were obtained from four patients and ranged from 77–210 ng/mL, representing 25–875 times the therapeutic range of 0.24–3.1 ng/mL (6).

 people use it to get a cheap high, or to decrease withdrawal symptoms from opioids.

we grow organic rice, and it is healthier but the dirty little secret is that if we all ate organic rice grown in the traditional ways, there would be millions of people starving to death.

GM food hysteria kills.

LATIMES has an article on a GM crop that increases the food produced by making photosynthesis more efficient

GM is a technique, that allows the manipulation of crops and animals faster than by breeding/ choosing crops with positive traits.

Like any technique, it is morally neutral, and can be good or bad.

and chimeras with one human gene are not the problem: but too many genes and you could get a scenerio like Cordwainer Smith's underpeople...

Improbable research: Death by selfies.

Saturday, November 12, 2016

Rat fever

nope. Never heard of it in medical school outside a single lecture in animal related disease

Nor did I treat any cases when I worked in Africa (probably because I worked in a  rural area, but also no floods when I worked in Liberia).

Of course, since every fever was given penicillin, I might have cured some cases that never had been diagnosed. But I never saw the liver involvement and severe syndrome either.

The disease is easily treated early with antibiotics; the bad news is that often it is fast, so you wade in water, and then after a few days get a fever (big deal) and then voila the complete syndrome and you die.

 But here in the Philippines, we get deaths after every typhoon, from people wading in ankle deep/knee deep water in the street.

Science Daily has an article about a newer treatment for the severe cases....

While rare in the United States, leptospirosis remains an important health threat for impoverished populations in developing countries, causing more than one million illnesses and 60,000 deaths annually..... 

 The reasons why leptospirosis causes life-threatening manifestations, such as pulmonary hemorrhage and acute kidney failure, have been poorly understood. ...

Patients who died from leptospirosis had a defect in the expression of the gene encoding an antimicrobial peptide, cathelicidin, which is capable of killing bacteria, the researchers found. In contrast, survivors were able to mount a vigorous response to the infection as exemplified by the expression of genes that encode cathelicidin as well as those that play a role in adaptive immunity such as antigen presentation and immunoglobulin production.

e-nurse care plan

Thursday, November 10, 2016

Viking stuff

Did the high incidence of alpha 1 antitrypsin help the Vikings survive the fact that they carried a lot of parasites?

This can cause emphesema and liver disease.

 Last year, Danish scientists studying the remains of a Viking privy found that the ancient Norse and their domestic animals were infested with a variety of intestinal parasites. These parasites release enzymes called proteases that cause disease. The immune system also creates proteases that can cause inflammation and damage, but the body has natural defenses against those, including a molecule called alpha-1-antitrypsin (A1AT).
Because they were more or less constantly infected, Vikings evolved to produce “deviant” forms of A1AT that were specifically useful against worm-related proteases instead of the body’s own.
In the absence of normal A1AT, the immune system’s own proteases are free to damage tissue, including in the lungs and liver. At the time, the benefits of this genetic mutation outweighed the risks. Not so today.

 Science has an article about the lost Viking settlement in Greenland.

The story goes that they were farmers, but when the Little Ice Age came, they kept farming and slowly starved to death because they were just too rigid to learn to hunt seals etc from the local Inuit.

But now some question that since the prescence of seal bones in the garbage heaps suggest they did hunt a lot.

For later reading.

Sunday, November 6, 2016

eating placentas and spirit cooking and the taxidriver rule

My previous blogpost was about yuppies eating placentas because dogs do it, and hey, there are reports that a couple of tribes might have done it once in a while.

But now the latest kerfuffle is about Spirit cooking.

The usual idiots saw a reference to it on an email of John Podesta's brother, and now are claiming Hillary is into devil worship.

Shhes. She's a Pelagian liberal Christian, where her zeal at pushing "good deeds" as a SJW trumps all her bad deeds, like taking 100 thousand dollars a speech at Goldman Sachs.

So what "spirit cooking" are they referring to in the email?

Snopes has the details.

"Spirit Cooking" was an art project Abramovic created in 1996. Although Abramovic's cookbook does reference recipes containing bodily fluids such as semen and breast milk, Abramovic told ArtNews that her home cooking events don't actually feature these items.

so it was a dinner hosted by an artist whose modern performance art uses pig blood and who has published a cookbook using bodily fluids.

Spirit Cooking, Abramovic explained, was a performance she staged at a number of museums around the world in the ‘90s, painting graffiti with pigs’ blood. She also made a limited-edition book, which contains various recipes. That book is in the collection of the Museum of Modern Art in New York, among other places.
and although the book and recipes and bloody art work have nothing to do with Satan, it does have to do with "spirituality".

And the Satanism charge? “Anybody who wants can read my memoirs and find out that [my work] is far away from Satanism,” she said. (The book was just released this week, she noted, and it’s doing well on Amazon.) “My work is really more about spirituality and not anything else,”

not noted: Which spirit is she involved with?

TheOtherMcCain is full of blogposts about the mental twistedness of modern feminism, and the travails of modern feminists who seem to need a psychiatrist, but since I always worked with the poor, I am not familiar with the decadence of modern colleges and since I avoid "feminist ideology" blogs, I will have to take their word for it.

why did I put this on my medical blog? well, it's too R rated for my ordinary blog, and this artist seems to have a mental illness that needs treatment.

Pigs blood can spread disease when eaten in traditional Asian dishes that are undercooked ...

and we had an Ebola Reston epidemic in pigs that did manage to infect a few of those in contact with "pig products"... (who luckily only got a mild flu like illness). it isn't clear from the article if they had just cleaned up the muck,  (finger/feces route) had contact with blood or lung tissue during butchering, or had inhaled the virus from the muck or animal, which would be a more dangerous scenerio (airborn Ebola Reston was noted in monkeys in the book the Hot Zone).

lbut pig carry other diseases: Trichinosis from eating uncooked meat is the most famous but I ran across one article stating that a lot of AmerIndians died from after DeSoto went through what is now the Southern USA, and a lot of epidemiologists blame it on the fact that the Spanish traveled with pigs as a source of fresh meat, and they spread infectious disease, either Hepatitis or swine flu.

None of these diseases would be a danger to those who view the creations of this artist, although she might be at risk.

And ditto for "bodily fluids". Does she wear gloves and take precautions as per OSCA regulations? Uh, Zika and HIV and various forms of hepatitis are spread via body fluids for example.

However, what is this about bodily fluids in her recipes? This seems to be done out of sheer desire for being yucky... a sign of decadence, to shock. It is only art because modern art has morphed into a way to shock ordinary people.

So about once a year we read about modern art work being thrown out in the trash by a clueless janitor who thinks it is trash.

In psychiatry, we were told of a "Taxidriver rule": if an average taxi driver thought that the person's behavior or ideas sounded crazy, then maybe they were crazy.

Sounds like some of Hillary's close associates hung out with such a crazy person, and didn't recognize they were crazy, what does that say of her ability to pick staff?

Saturday, November 5, 2016

fake science fad found phfishy

Science Daily:

No, you don't get a lot of iron if you eat your placenta.

no, this is not something I had run across in my cross cultural experience: I have no doubt that there is a tribe somewhere that does this, (Wikipedia article) but I haven't worked with any of the tribes mentioned, and indeed, it is hard from the Wikipedia article to tell if this was a common practice or just sometimes done.

 In Africa, one of the important jobs of the midwife was to bury the placenta, so it would not be eaten by dogs or hyenas (and would not be unearthed and used for witchcraft spells).

so guess what? It is a fad of the affluent.

Placentophagy is an increasingly popular trend in industrialized countries throughout Europe, in Australia and in the U.S.. Proponents of the practice often reference placentophagy's common occurrence among nearly all mammals in nature, and they suggest it offers numerous benefits to human mothers too, including increased energy, improved mood, and more rapid postpartum recovery.
YUM! Chocolate covered Placentas!

not noted: The reason that animals eat the placenta is to keep the nest clean of odors. They also eat their babies' feces and probably their urine because they lick those areas to encourage the small ones to do their thing.

I should also note that our dogs eat their dead babies too, if they are stillborn. Once I had to remove one from our dog Sophie/s throat because she couldn't swallow it.

Fart Fire

There is a story going around the internet where a woman receiving laser surgery for a cervical lesion farted (not unusual by the way) and caused a fire.

Was this real, or just made up for the internet?

My first question was if the laser was properly grounded, so it wouldn't cause sparks. I have heard of cautery fires from the alcohol used to clean the skin area, or (in the good old days) from ether explosions.

In the good old days, we wore special "surgical shoes" that had a metal spike in the sole of the shoe... the inside of the shoe was constructed to collect static electricity from the body (from your clothing rubbing on itself when you walked)... in those days, the surgical gowns were all cotton cloth.

Later, plastic disposable shoe covers were used, with a strip that went across the bottom of the shoe and then went into a ribbon that you put inside your shoe. This was a big help, since it was often hard to clean all the blood off of the leather shoes, and although this was before the days of HIV, blood was a protein that could grow germs so it was an infectious hazard.

They also switched to disposable gowns and hats about that time (1970).

I have no practice with lasers, but Improbable research has a report on an experiment to check if the story could be true.

read the whole thing...

and check out their videos.

one tiny error in the experiment: Smoke is particulate matter, so has a different dispersal pattern than gases. (i.e. the methane and hydrogen sulfite gases in farts).

They also equated the slow emission of smoke from a tube as the same as the (usually fast) emission of gas that would have taken place in this scenerio. However, since methane is lighter than air, the possibility that it went upward into the surgical field is quite probable.

Wednesday, October 26, 2016

it' wasn't patient x

That flight attendent who had sex with half of the original cases of HIV was not the cause of the epidemic.

the virus was already here.

The study came from the HepB epidemic information in gay men: Most folks don't know that the valuable vaccine was made from investigating the HepB epidemic. Before these easily found cases were used, Hep B was called "serum hepatitis" and was mainly found in those who got blood, or in medical personnel.

Thursday, September 29, 2016

Alberta opposes eugenics

they kill Indigenous people, don't they?

Metis (and ex MP) Mrs Gay Caswell (and the Catholic bishops of Alberta) are pointing out the legal irregularities of the Suicide bill in Canada mandated by their courts and then rammed through the Parliament with little discussion by Baby Trudeau....

she points out that the public was told the court decision was final, but as an MP she knows there is a clause that lets parliament overturn decisions that go against (section 31 of the Canadian Charter).

Hmm... maybe the US should have a similar way to stop the court system from making law, which is after all supposed to be done by the people's elected representatives...

The Indigenous people of Alberta were victims of the Eugenics movement in the 1920's, so like the Black Americans who remember the Tuskegee project, they tend to be suspicious....
and if you think this is about personal freedom, well, follow the money.


speaking of medical problems: CDC on poor coverage by influenza vaccine.

Ironically, it is not a strong vaccine, so giving it to adults, caretakers, and children would do more to stop the elderly from catching it than actually giving the vaccine to those whose immune system might be too weak to develop immunity.

CDC reports 12 percent of working age Americans have at least one disability.

Wednesday, September 21, 2016

Polio like Enterovirus

The WAPO article about cases of polio like paralysis from an enterovirus.

Just a couple dozen cases a year, but a recent upspike in cases has people worried.

I am old enough to remember the polio epidemics in the 1950's, when we couldn't go to the local swimming pool in August because of the outbreak. Two of my friends caught polio, and in later years I met two doctors who had caught the disease caring for folks (one who ended up in a wheelchair).

Polio is an "enterovirus": The virus causes stomach flu/diarrhea. Only one strain of the polio virus causes paralysis.

But we also learned that other enteroviruses could cause paralysis, but that these cases were rare. But when we had outbreaks of some types, we also would see viral meningitis or encephalitis.

So this is not a puzzle, but I will report more when I see the actual CDC or medical articles on the virus.

Friday, September 9, 2016

Medical news: Hillary Polio and EColi

LINK Hillary has lost TedRall, a Bernie supporter:

Access should be, has to be in a democracy, determined solely by meritocratic criteria. Political leaders like Hillary Clinton need to be meeting with people who can offer them the best advice and who need the most help -- not those who bought their way in. Anyone who doesn't understand that access always equals corruption, even when access doesn't result in favors, doesn't deserve to hold political office.

about the Clinton foundation's appearance of ethical problems. Give money for a good cause, get a visit with the secretary of state. Results are not guaranteed so it's not bribery.

of course, in Mrs Clinton's case, there are also questions about getting huge sums for corportate speeches.

and the meme that 80 percent of the Clinton Foundation money goes to "overhead" is wrong, as Polifact explains:

While measuring charitable endeavors by the amount of grants awarded may be appropriate for many private foundations, it is not for an organization that acts as a direct service provider like the Clinton Foundation."
They name three such grass roots initiatives, which would require only small grants if they had outsourced it. They go on to say that actually if you include the many foundations that exist under the Clinton foundation umbrella, that over 85 percent of their funding goes to "program services".

And then Polifact insists:

While measuring charitable endeavors by the amount of grants awarded may be appropriate for many private foundations, it is not for an organization that acts as a direct service provider like the Clinton Foundation."
they then bring up that they got cheap generics for poor HIV patients in Africa.

Heh. I wrote about that last week: That they got them from a company who was fined for faking their quality control data. And since substandard, fake and counterfeit medicine is a major problem in the third world, getting a bargain generic is not always a good thing.

From the right wing WashingtonExaminier:

Clinton denied on Sunday that she participated in any foundation activities while she served as secretary of state, employing a new defense of its operations by highlighting the negotiated healthcare deals.But under her leadership, at least a handful of the State Department's global health efforts relied on drug companies that were also major Clinton Foundation donors in arrangements that raise questions about the distance Clinton kept from her family's philanthropy

So where does the money go? InsidePhilanthropy notes that the organization is so complicated that few can actually follow the money.

I'll have to read it later.

but the UKMail has an article on Jerome Corsi's book, and he was on C2C recently about the problem. VideoLink. He's a nut case, of course, and I would put an article from the MSM to refute this, but all their articles seem to be (correctly) pointing out that this guy is a cospiracy theorist, but not actually discussing his accusations. Sigh. Ad hominem attacks before facts. And the question is if the generic medicines didn't work, and if as Corsi claims that many of those getting the medicines died.

Glenn Greenwald interview here includes some stuff about the Clinton Foundation

I have a personal interest in this: the hospital I worked at in Africa and some of the nuns I worked with run HIV medicine programs... and one African sister just lost her 19 year old niece from HIV related causes even though she was on anti virals. Did the medicines stop working or were they substandard, I wonder...

Having cheap generic medicines is literally lifesaving for people in the third world, not just for HIV but for malaria and ordinary infections. People die because they can't afford the medicine, or they take a smaller dose or stop it too soon because of the cost.

But unless you realize the problem of substandard, fake and counterfeit drugs, you are fooling yourself.

PEPFAR works with the FDA to insure HIV medicines are okay.

I couldn't find any articles to back Corsi yet, but this PLOS article on Thailand HIV drugs says only a small percentage are inferior. (3%).

Annals of Internal Medicine worried about the problem: Economic savings vs Health Loses. and this article on generic anti virals

but the WHO defended the use of generics.

Translation: Problems that people are trying to stop

and as a cynical doc, remember: Lots of money could be made by stealing/diverting the real pills and selling them on the side. not just by patients but also by Pharmacists, import businesses and bypeople who transport
And how many people remember to take their pills?


Speaking of Hillary: That National Enquirer story on her health is just rehashing the here-say. No hard facts...And a lot of it is absurd. (she might have congenital Muscular dystrophy? give me a break.)

What is behind this hysteria?
She needs help going up stairs? Looks like quadriceps are weak....Lower back problems or knee problems from arthritis, diabetic neuropathy, or it could be muscle weakness from hypothyroidism or post stroke weakness on one side.

The real question is: what are her cognitive abilities? Were these affected by her strokes?

They are either printing this nonsense to make money or to suck up to Trump.


Bad superbug has reached Massachusetts.

Colisten resistant E Coli.

The mcr-1 gene was first reported in 2015 in food, animal, and patient isolates from China (1) and is notable for being the first plasmid-mediated colistin resistance mechanism to be identified. Plasmids can be transferred between bacteria, potentially spreading the resistance gene to other bacterial species. Since its discovery, the mcr-1 gene has been reported from Africa, Asia, Europe, South America, and North America (2,3), including the United States...

apparently, it was from antibiotics being given to farm animals in China.

But the real danger is overusing antibiotics in chicken and pigs farms.

scientificAmerican story.

and the bad news: The gene can be spread to cousin bacteria.

the good news: no links, but my "chicken business" email newsletter has a lot of articles about using probiotics or other ways to keep the chickens safe without filling them with antibiotics.

the "free range" and people thinking a backyard chicken is the answer need to realize that these birds are more likely to catch bird flu from passing migrating birds than those brought up en masse in chicken houses.

And of course, without "chicken farms", the poor in the mega cities would have little or no cheap sources of protein in their diet.

 a spoonful of sugar no more.

The problem of the rare mutation of the weakened polio virus becoming strong again and causing mini epidemics has led to using the old fashioned shot that uses the dead virus.

it is being phased out. Technical report:
CDC report here.

a shorter version of this is on my regular blog

Thursday, September 8, 2016

The Plague! the Plague!

BBC reports that the London Plague epidemic of 1665 was indeed caused by the YPestis bacteria, aka Bubonic plague

supposedly, in between plagues the bacteria merely infected rodents: which is why we get occasional cases in the Navajo area each year.

But is the plague still alive in European rodents?

"We don't know why the Great Plague of London was the last major outbreak of plague in the UK and whether there were genetic differences in the past, those strains that were circulating in Europe to those circulating today; these are all things we're trying to address by assembling more genetic information from ancient organisms."

The rumor is that the massacres and famine deaths from Genghis Khan's army conquering the Middle East were the source of the Plague, but this hasn't been proven.

related factoid: When I googled for the disease, I used the older term, Pasteurella Pestis, but apparently they change the name.

Yup, it used to be named after good old Louis, who not only invented Rabies vaccine and pasteurization but proved that "spontaneous generation" was nonsense.

but apparantly, YPestis was not discovered by Pasteur, but by a scientist working from his Institute.

Y. pestis was discovered in 1894 by Alexandre Yersin, a Swiss/French physician and bacteriologist from the Pasteur Institute, during an epidemic of the plague in Hong Kong.

 However, Pasteur did discover another animal disease so has that family of germs named after him 

The genus is named after the French chemist and microbiologist, Louis Pasteur, who first identified the bacteria now known as Pasteurella multocida as the agent of chicken cholera.

the disease still pops up on and off in the Southwest (most docs working for the IHS in the Navajo area know to keep an eye out for the symptoms) but also pops up now and then in VietNam and/or in the deserts of China... and Gerbils on the Steppes were probably the source of the epidemics of the middle ages.

The Black rat fleas were supposed to be the reason it spread, but now these rats have pretty well been replaced by the Brown rat in Europe. is this why we don't see more epidemics originating there? The reoccuring outbreaks of plague in Europe suggest a vector that allowed the disease to pop up again and again, then it stopped...So where was the source animal?

Camus' book The Plague was based on an epidemic in French colony of North Africa (in Oran in 1944). He used the reaction of the locals as an analogy on how the French people reacted to the Nazi takeover.

And it still is hiding there somewhere: LINK to the 2003 outbreak

Epidemiologic and biomolecular findings strongly suggested the existence of a local animal reservoir during this period, but its origin (resurgence or re-importation) could not be determined.

so why worry?
This sudden and unexpected reemergence of plague, close to an important commercial seaport, is a textbook illustration of a public health event of international importance. It also demonstrates that the danger of plague reoccurrence is not limited to the currently indexed natural foci.
ah, and could terrorists get hold of the plague and spread it?

This 2009 outbreak in an terrorist camp in Algeria worried a lot of people. But apparently they were just dirty (body lice and lack of hygiene) not trying to develop it as a WMD...

But of course, some smart bozo could theoretically find some and spread it again. Luckily bathing and pest control and antibiotics would stop the epidemic.

nor was this the only recent epidemic:

The last reported serious outbreak was in 2006 in the Democratic Republic of the Congo in Central Africa, when at least 50 people died.


and the "ideology before reality" items on Zika:

Related item: Florida green types want to stop spraying for mosquitoes that carry Zika virus.

Hmm... wonder if they know about the Yellow fever epidemic in Angola, which could be spread by the same bug?

and the Zika funding bill was blocked  by Democrats in Congress because it did not include Planned parenthood funding. 

uh, a separate bill could have restored the PP funding, but never mind.

Related item: The fall of the Roman empire has many causes, but there is a good argument that Justinian could have revived much of the empire in Europe except for the Justinian plague...
which was found to be caused by YPestis.

and of course, the plague weakened the eastern Roman Empire and opened the area for conquest by Mohammed's armies.

  NIH link.

The epidemic plague significantly contributed to the weakening of the Eastern Roman Empire, and the rapid decline of the Persian Empire, while during the early expansion phases of Islam, it indirectly favoured the nomadic Arab tribes which, moving on desert or semi-desert territories, succeeded in escaping the contagion more easily.


Ottoman History podcast on how that empire handled the plague

Friday, September 2, 2016

Mad Cows or mad deer?

make sure you don't contaminate your venison with spinal cord or thymus, or maybe you could get a variation of mad cow disease.

cross posted from my main blog

A lot of hysteria a couple years back about mad cow disease on the talk show circuits.

But that sort of disappeared when they started to butcher cows more meticulously.

Ah but are you aware of mad deer, mad moose, and mad elk disease?

PhysOrg: white tail Deer population decline from CWD...

"Chronic wasting disease has likely been present in southeast Wyoming deer and elk populations for approximately 50 years," Edmunds says. "It has been steadily increasing to the point that some hunt areas are seeing populations with as many as 30 percent to almost 50 percent of harvested deer testing positive for this disease."

ah but can it spread to humans? CDC report say no, or maybe in rare cases.... but since most cases take years to develop, the number of cases might be underestimated.

So they advise you to be careful while butchering the meat and wear gloves.

 Hunters should avoid eating meat from deer and elk that look sick or test positive for CWD. They should wear gloves when field-dressing carcasses, bone-out the meat from the animal, and minimize handling of brain and spinal cord tissues. As a precaution, hunters should avoid eating deer and elk tissues known to harbor the CWD agent (e.g., brain, spinal cord, eyes, spleen, tonsils, lymph nodes) from areas where CWD has been identified.

CDC map identifying areas with infected deer etc.

Sunday, August 28, 2016

HIV, counterfeit medicines and the Clinton Foundation

did the Clinton's highly praised program to fund HIV treatment by using counterfeit medicine which was cheaper?

The counterfeit/inferior drug problem, mainly from China and India, probably kills more people than heroin.

I just listened to a C2C program (I listen to it via internet radio in the afternoon but it is here on youtube)

 where the Clinton Foundation was accused of using inferior and cheaper generic medicines for HIV patients in Africa that didn't work. The source of the medicine was from India.

Right wing site WND has the story. read the whole story for the links if you don't believe their reporting

Ira Magaziner, the chief executive officer and vice chairman of the Clinton Health Aids Initiative, known as CHAI, approached the Indian company, Ranbaxy, in 2002 to negotiate a deal. It allowed CHAI to assume a controlling position to administer the airline-ticket levy program through UNITAID, a program of the U.N.’s World Health Organization in Geneva. CHAI proposed to Ranbaxy that “they could put the developing countries together to form a sort of ‘buying club’ that could “ramp up economies of scale and lower cost,” according to Professors Ethan B. Kapstein of Arizona State University and Joshua W. Busby of the University of Texas at Austin in their Cambridge University Press 2013 book “AIDS Drugs for All.” ....
 A Kaiser Health News “Morning Briefing” dated Nov. 21, 2003, reported former President Bill Clinton “visited Indian generic drug Ranbaxy Laboratories’ pharmaceutical plant in Gurgaon, India, to show support for Indian companies that have agreed to manufacture low-cost generic antiretroviral drugs for nationwide HIV/AIDS treatment plans in four African and more than 12 Caribbean countries.” 

So getting cheaper generics so you can buy more medicine and treat more people. What could go wrong?

BMJ article on the problem of substandard medicines lists a lot of things that can go wrong.

Uh, just ask anyone who lives outside the elite bubble in third world countries: A lot of the cheap stuff (not just medicine) is shoddy, poorly made, or doesn't work very well.

Ironically, a couple years ago, the "Green" type anti big pharm types were blasting major drug companies for overpricing these drugs, insisting that the HIV programs should buy cheaper generics, either made locally or generics, as was done here.

The Clinton founation website brags:

When the Clinton Health Access Initiative (CHAI) was founded in 2002, only 200,000 people were receiving treatment for HIV/AIDS in low and middle income countries, with medicines that cost over $10,000 per person per year. Over a decade later, more than eight million people are receiving treatment and CHAI has helped reduce the cost of medicines to around $100 to $200 per person per year in many countries. Countries have repeatedly proven that it is possible to rapidly scale up treatment services. For the first time, there is real promise that we can turn the tide against HIV/AIDS.

The Atlantic pushes this meme saying they "made a deal" with the companies and the high price was the middle men making lots of profit.

2006 The NYTimes article said Clinton was playing catch up on the issue of HIV in Africa and again is full of praise

But: Uh Oh: US Justice dept report: the Indian company Ranbaxy got a 350 million dollar fine for their fraud. 2013

They were faking a lot of their data in quality control.

The conservative think tank AEI report on the problem here. A lot of it is about Ranbaxy being licensed to sell the cholesterol lowering medicine Lipetor, in the US. But the report includes this snippet:

It was surprising that the FDA was prepared to overlook Ranbaxy’s drug quality problems. In 2005, whistleblowers from Ranbaxy alerted the FDA that members of Ranbaxy’s staff were deliberately cutting corners in producing HIV medication to be bought with US taxpayer funds. The FDA and US Department of Justice identified two questionable Ranbaxy plants and 30 suspect medications, yet only restricted their US-bound sales in 2010. 

Fortune magazine on the Great Valentine's day raid on the company and an expose on the company. 2013

in Gurgaon, as Thakur’s project managers gathered data and interviewed company scientists and executives, he says, they stumbled onto Ranbaxy’s open secret: The company manipulated almost every aspect of its manufacturing process to quickly produce impressive-looking data that would bolster its bottom line.
“This was not something that was concealed,” Thakur says. It was “common knowledge among senior managers of the company, heads of research and development, people responsible for formulation to the clinical people.”

India Times story on how their companies make drugs cheap (patent infringement is admitted in the article)

NIH report 2015 on the danger of counterfeit medicine
Poor quality medicines are a real and urgent threat that could undermine decades of successful efforts to combat HIV/AIDS, malaria and tuberculosis, according to the editors of a collection of journal articles published today. Scientists report up to 41 percent of specimens failed to meet quality standards in global studies of about 17,000 drug samples. Among the collection is an article describing the discovery of falsified and substandard malaria drugs that caused an estimated 122,350 deaths in African children in 2013. Other studies identified poor quality antibiotics, which may harm health and increase antimicrobial resistance. 
full report HERE.

the problem is worse, because substandard drugs (i.e. where the medicine is in the pill, but either is in too low a dose or in a form that the body can't absorb) increases the mutation of antibiotic/ anti malaria resistance.

The Zimbabwe Herald notes that drug resistance to HIV is becoming more common, and attributes that to poor compliance in taking medicine.

more about their program HERE. which is run by USAID PEPFAR and the UN. No mention of the Clintons.

Ironically, it notes that often the blood levels of the drugs are higher in Africans (probably due to lack of body fat or because the liver metabolism is slower) Presumably that fact comes from a single study in Malawi. but it would mean that mildly substandard medicine might work.

AHO report: various studies mention: one, in 2005, the HIV medicine problem was tiny 2%  in comparison to 10 to 37 percent in Malaria medicine.

But you know, there are very few articles about African patients and their response to treatment.

Australian reporter MichaelSmith has a long article about the HIV medicine problem.
including the Clinton Foundation using HIV meds from Ranbaxy for people in Papua New Guinea.

This article lists Australian taxpayer money going to the foundation, and notes a small problem: Bill Clinton signed a lot of papers when he was not officially head of the Clinton Foundation and did not have the legal standing to do this.... and notes other irregularities having to do with money.

Australia gave 70 million dollars.

His sidebar also has lots of links about fraud on his sidebar, including Clinton fraud for a hospital that never was in Papua New Guinea.

and the most WTF article on the money trail:

Trump and family donated 100 thousand to the Clintons (2015).

finally, no discussion of HIV in Africa could be complete without noting a lot of quackery is out there

when HIV epidemic started, a lot of people went to native healers because one: western medicine didn't help and two: the symptoms of HIV (getting thinner and thinner) was a known symptom of witchcraft associated illness (no quite superstition: Think Slow poison by an enemy).

But with Presidentw  Bush's program, hope arrived. Not much in the US press about this because of their political bias of course.

but this might be behind the Clinton's wish to be seen as do gooders: Envy.

Whatever. I don't care if they do it for the wrong reasons, my question is if the money is actually going to the ones it is supposed to help.

And no, I don't give to many charities: But I do send school fees to a friend in Zimabwe for her nephews and nieces who were made fatherless by HIV before anyone was aware of the problem.

not well organized but I started posting this to my other blog and it sort of grew..