Thursday, January 28, 2016

Veteran suicide: Parsing the numbers

lots of veteran suicides, but most of them are VietNam vets, not from Iraq/Afghanistan.

press release from VA here;

with links to the longer (59 page) report for later reading.

I am not sure what the shorter article meant when referring to 22...the suicide rate is 22 for normal people, but in actuality the number is 13 for women and higher in men.

But for female physicians and for some veterans it is much higher...I don't have the data in front of me, but I seem to remember an "ain't it awful" report smearing all vets as psychos who pointed out a 29 suicide rate in veterans was proof, and then I googled that the suicide rate for female physicians was 29.

At least the VA does prevention...the NEJM, if I remember correctly, suggested a similar intervention for high risk physicians (e.g. women physicians and psychiatrists).

Of course, the NEJM also pushes suicide as a social policy, so they tend to be hypocrites.

headsup TeaAtTrianon

Wednesday, January 27, 2016

Zika virus ahead

Lots of kerfufle about the Zika virus.

The LATimes says the WHO predicts it will hit the USA, but actually it already has.
Although the virus popped up in Africa during the 1950s, and later in the Pacific Islands, including Micronesia, it had not been seen in the Americas until it appeared in Brazil in May. It unclear how it got there. One theory is that the virus entered the country during or around the 2014 World Cup, when hundreds of thousands of people were visiting from around the globe. Weather conditions may be contributing to its spread, some experts have suggested. "Maybe El Niño has something to do with the rapid spread, although we aren't sure," said Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston. The lack of any previous exposure has also increased vulnerability because the populations lack immunity

uh, Weather (i.e. "global warming" or "el nino" only increases or decreases rain. The mosquitos live there all the time).

the bad news?

  • The symptoms of Zika are similar to those of dengue and chikungunya, diseases spread through the same mosquitoes that transmit Zika.

which are:

  • The most common symptoms of Zika are fever, rash, joint pain, or conjunctivitis (red eyes). Other common symptoms include muscle pain and headache. The incubation period (the time from exposure to symptoms) for Zika virus disease is not known, but is likely to be a few days to a week.
  • The illness is usually mild with symptoms lasting for several days to a week.

 the main danger is a birth defect, microcephaly which is devestating to the child.

Me, I will be sarcastic: Right now, the CDC wants to screen women and babies for it, but there is no treatment.

Ah, but expect an upsurge in late term abortions and arguments for "infanticide" in the press in the near future.

Tuesday, January 26, 2016

why are younger folks getting colon cancer?

Article HERE.

when I started medical school, most colon cancer was in the rectum, so we had to do rectal examinations on all our patients, since over half the cancers were withing finger lengthe of the anus. We family docs also learned how to do simple sigmoidoscopies, using the hard tube type (later, the flexible one was used, but by that time, we had enough specialists so I stopped doing them).

To cure them, they removed the rectum and diverted the colon to drain into a colostomy bag...and we had lots of discussions if they could later join or divert the feces to the anus, which had a sphincter, for social reasons.

But as time went on, these cancers became more rare (I hadn't seen one in the last 10 yrs of medicine). But colon cancer upstream increase so the emphasis was to do colonoscopies.

This is a more invasive procedure, often requiring some anesthesia, and an expensive scope and lots of training to do it well.

So how should we screen? Well, if you do "occult blood" screenings, often folks never bring them back, and there is a high false positive and false negative rate.

We did see colon cancer in young people: we had a family where one aunt died at age 34, and although funds for the IHS were limited, we tried to get the family screened...we even had a 7 year old sent out for a pediatric colonoscopy at a specialized center (she had pre cancerous polyps removed)...

So why are there more colon cancer? Or is it just that older folks are picked up and their pre cancerous polyps removed before they turn into cancer?

And is the changing history due to diet? Burkett noted that colon cancer was rare in east Africa, where high fiber corn sadza was the main food. So yes, fiber probably helps, by increasing transit time i.e. getting rid of toxins (yes, this sounds like those colon cleansing fads, but there is a small bit of truth in them: They merely exaggerate to make money).

Meat may increase the rate, or maybe it just means if you eat meat, you get less fiber in your diet.

Ironically, aspirin and Ibuprofen cut the rate of colon cancer.

In the meanwhile, stomach cancer, which was almost an epidemic at the turn of the 20th century, pretty well disappeared as smoked food was replaced with chemicals to keep them from rotting.
Nowadays, if you get a stomach cancer, it is probably lymphoma (something almost unheard of when I was in medical school...and again, I have had two patients with stomach lymphoma in my last ten years of practice but no cancer of the stomach for the last 20 years of practice)

something I will have to search google about.

Tuesday, January 19, 2016

GM Mosquitoes vs disease

BBC report that releasing GM mosquitoes leads to a drop in the local mosquito population.

they are using it against the mosquito that carries dengue.

The Village of "idiots"?

Interesting BBC article discussing a small isolated hill village in India where one quarter of people are mentally or physically disabled.

Poverty and bad diet, probably...but why did it start in the 1950's?
the article suspects iodine deficiency caused by the Cassava diet.
Most rely on a diet of rice and cassava, known locally as nasi tiwul. But certain substances in cassava can inhibit the uptake of iodine, which in turn can lead to birth defects.

Iodine deficiency
  • The WHO estimates that more than 30% of the world's population have insufficient iodine intake
  • Since the 1990s there have been efforts to introduce iodised salt in iodine-deficient countries
  • UNICEF estimates that 50 million people worldwide live with intellectual, motor and hearing disabilities due to iodine deficiency

And the good news is that the rate of birth defects is down with some help with food and a local midwife who monitors diet.\

cases like Campret's have sharpened Mulyadi's resolve to prevent more children being born with disabilities. That's why he's taken it on himself to monitor every pregnancy in the village, especially those of women who are disabled, encouraging them to eat a healthy diet with plenty of green vegetables.
And for those who can't get to the local hospital, which is 45 minutes away, or who can't afford a scan, he will offer to take them in his car and pay.
Within the village, there is also now a health centre with a midwife and a doctor. The result is encouraging, says Mulyadi. "In the last few years there haven't been any babies born with birth defects."
you know, when I worked in rural Africa, the students got supplements in school and most of the women got prenatal care and vitamins, so most were ok in the IQ area.

But when I worked in Liberia, I was almost in despair with the local's low IQ's, including many of the staff.

They ate cassava and rice in Liberia, so maybe that was an iodine problem too. Or else because few women breast fed (leading to a very high infant mortality).

Which of course shows the problem with Eugenics (including it's newer versions of "no immigrants"): IQ in the world is going up with good nutrition.

demography: White southern women death rate increasing not men

For later reading: I assumed the increase in middle aged southern whites was due to male drug use (narcotic overdoses etc)

But via AnnAlthouse: this statistical blog notes: The increase is actually in women

First they note that the cohort differs: different demographics....
the higher death rate is probably from poverty, but why the increase in women?

yes, there is narcotic/drug/meth abuse in women, but is it high enough to show on the graphs?

Maybe obesity/heart disease/ Diabetic complications?

check comment from Sarang, who links to this article on AmericanProspect:

poverty and lack of a high school diploma are clues to the increased death rate...obesity, lack of social support/marriage, lack of a job. Teen motherhood...Increase in smoking behavior is another link.

and of course, no local doc who knows you and makes sure you are taken care lady went to the ER and was sent home because they didn't screen for heart disease. Without continuity of care, you miss stuff...

In other words, things we docs see all the time.

My question: why only southern white women, when we see this in black, Native Americans, and northerners too...

I suspect the problem is found in all of the above, but is attributed to drugs or diabetes.

bad statistics or real?

The latest is that if you eat too many potatoes, you get fat.

Well, duh. Oh yes: and potatoes are linked to anencephaly (although our area in Africa had a rate similar to that cited in the literature...most were premies or stillborn so not counted in statistics).

Or could it be that Ireland and Russia have a genetic tendency toward anencephaly?

Or maybe it is socioeconomic: Lower middle class eats french fries/chips, upper class yuppies eat salad.

Not clear from the article, and I didn't peruse the original article.

Similar problem: heartburn drugs and kidney problems.

Well, if you are fat, you are more likely to have GERD/reflux, so take more of them.

And if you are fat, you are more likely to get diabetic kidney disease.

Again I wonder what the original article says, but I am too lethargic to google to find out.


on my main blog, I wrote about plastics may be behind obesity.

UK Mail article HERE.

Hospice notes

UKMail says fewer terminally ill cancer patients die in hospitals in the US than in Europe.

Yes, probably because we have hospice care.

So why the kerfuffle about all those end of life expenses that need to be cut by living wills?

Dirty little secret: The patients died but they had a chance to live. and the article laments all these dying patients who spent time in ICU in the last six months of their life.

Well, duh, they weren't terminal...

So if you have cancer, but they treat your pneumonia because you haven't hit the terminal stage yet, the bioethicists moan and groan you are wasting taxpayer money.

Sunday, January 10, 2016

Roman parasites

Some articles noted that despite all their irrigation and sewage technology, that Romans were found to have lots and lots of worms.

Archeology paper here

Piers Mitchell of Cambridge a press release. He thinks that the warm communal waters of the bathhouses, which may have been changed infrequently, could have contributed to the spread of parasitic worms. The Romans also used human excrement from the public latrines as a crop fertilizer. And the widespread use of garum, a condiment made from uncooked, fermented fish parts, may have contributed to the increase of fish tapeworm eggs during the Roman period. “It seems likely that while Roman sanitation may not have made people any healthier, they would probably have smelt better,” Mitchell said. 

The obvious is not noted: That without the clean water and sewage system, a lot more people might have died of diarrhea at an early the presence of parasites might imply they lived to be adults. Until we have an estimate of the death rate, we don't know.

The dirty little secret is that people can live with the parasites quite nicely, and do. But they die of more deadly diseases that are spread by dirty water (e.g. typhoid, dystentary).

in the medieval world of Europe, urbanization was quite deadly because of lack of water and sanitation.

the study was done at Portus, an artificial port of Rome, not actually in Rome itself.

(De Agostini Picture Library/Bridgeman Images)
Portus, now some two miles from the Mediterranean shoreline, was built by the Romans in the 1st century A.D. to be their main maritime port. A 16th-century fresco in the Vatican Palace shows an idealized reconstruction of Portus’ grand architectural and engineering features
Hmm... I was not aware that Rome built an artificial port.

I was aware that Rome was built on the Tiber and had swamps nearby (and that malaria was imported from Egypt causing a high mortality from the local mosquitos)..

But I always assumed they had a natural port, Ostia. Well they did: Portus was sort of an extension of it to make it easier for ships.

From Wikipedia:

Claudian phase[edit]Rome's original harbour was Ostia. Claudius constructed the first harbour on the Portus site, 4 km (2.5 mi) north of Ostia, enclosing an area of 69 hectares (170 acres), with two long curvingmoles projecting into the sea, and an artificial island, bearing a lighthouse, in the centre of the space between them. The foundation of this lighthouse was provided by filling one of the massive Obelisk ships, used to transport anobelisk from Egypt to adorn the spina of Vatican Circus, built during the reign of Caligula.

The harbour thus opened directly to the sea on the northwest and communicated with the Tiber by a channel on the southeast.

The object was to obtain protection from the prevalent southwest wind, to which the river mouth was exposed. Though Claudius, in the inscription which he caused to be erected in AD 46, boasted that he had freed the city of Rome from the danger of inundation, his work was only partially successful: in AD 62 Tacitus speaks of a number of grain ships sinking within the harbour during a violent storm. Nero gave the harbour the name of "Portus Augusti".[1]

n AD 103 Trajanconstructed another harbour farther inland—a hexagonal basin enclosing an area of 39 hectares (97 acres), and communicating by canals with the harbour of Claudius, 

but it silted up during the dark ages

Ostia also silted up.

Friday, January 8, 2016

It's done with mirrors

 Another article (on Gizmodo this time) about how "experts" are saying that cancer screening doesn't save lives.

For example, a 30 year follow-up to a colon cancer study showed that for every 10,000 patients who were screened for colon cancer, 128 died of the disease, while the rate of death due to colon cancer was 192 out of every 10,000.
 Those numbers indicate that screening is critical. It causes mortality due to colon cancer to plummet.
But another set of numbers is less encouraging. Of the group of unscreened patients, 7111 out of 10,000 had died by the time of the follow-up. Of the screened group 7109 had died—making for a difference of two people.

the article then goes on to blame the "stress" of treatment, the "stress" of false positive results.

Ah, but the dirty little secret is: These people are often older and have comorbidities (lots of things wrong with them)

So they die of something else.

When the anti cholesterol medicines came out, a similar finding was found: If you take it, your heart attack rate is slightly lower, but the death rate was the same.

In one study, the reason for the difference was death by violence/accident/suicide/homicide.

Another study was done, and the death rate was the same due to cancer of the colon deaths.

The Docs joked that since they'd rather die of a heart attack than cancer, why take the medicine?

Similar problem here.

Another dirty little secret is that the numbers sound impressive, but they are low risks for the actual patient.

then there is the "GIGO" problem: garbage in, garbage out.

What’s more, the researchers did a review of 10 meta-analyses of cancer screening studies. These meta-analyses combined the results from several studies to give an overall picture of the research done on screening for different cancers. Only three showed a reduction in mortality due to specific cancers. Not one showed a reduction in overall mortality.
a lot of these studies include those where there are a lot of drop outs, or the population was not representative of normal folks. In others, the numbers weren't significant.

Finally, not mentioned: that many cancers metastasize early, when it is too small to detect from screening. So early diagnosis of a young women with aggressive hormone dependent breast cancer might not make a difference, since it has already spread.

This might not be true of an elderly  person with slow growing cancer, who will die of something else.

And finally a dirty little secret: Malpractice suits are one reason that doctors were forced to order a lot of tests that didn't make a difference.

I was once sued for not ordering a test that wasn't being done because it was being done experimentally 500 miles away, the lawyer argueing that I should have known that the test was available.

Ironically, what saved me in that malpractice suit was sex: The lawyer was caught sleeping with the 16 year old daughter of one of his "expert" witnesses, and the sister of the deceased who knew her sister didn't keep follow up appointments, knew that the husband suing for "wrongful death" had a bimbo on the side, which made his wife ignore the growing cancer as a way of passive suicide...

Thursday, January 7, 2016

Ancient ulcers

Scientist have found HPylori in the stomach of Otzi the iceman...

The scientists found a potentially virulent strain of bacteria, to which Ötzi's immune system had already reacted. "We showed the presence of marker proteins which we see today in patients infected with Helicobacter," said the microbiologist. A tenth of infected people develop further clinical complications, such as gastritis or stomach ulcers, mostly in old age. "Whether Ötzi suffered from stomach problems cannot be said with any degree of certainty," says Zink, "because his stomach tissue has not survived and it is in this tissue that such diseases can be discerned first. Nonetheless, the preconditions for such a disease did in fact exist in Ötzi."

Tuesday, January 5, 2016

Yes, and it was important

Improbable research usually links to papers about absurd reseach, but today's link is about the morbidity caused by diarrhea in soldiers serving in Iraq: probably because two of the four authors had absurd names. (Riddle and Tribble).

ah but it is a major problem... and they also link to another paper about the problem of constipation.

Well, some people attribute Napoleon's loss at Waterloo to his hemorrhoids (a complication of constipation).
or maybe not:
As detailed in Phil Mason’s book “Napoleon’s Hemorrhoids: And Other Small Events That Changed History,” some scholars believe the French military leader suffered a painful bout of hemorrhoids on the morning of the Battle of Waterloo that prevented him from riding his horse to survey the battlefield as was his custom and could have contributed to his defeat. However, Waterloo expert Alasdair White told the New York Times that the story is “an absolute myth” concocted by Napoleon boosters because they “cannot believe that the great man lost, so there must have been something wrong with him.”

social networks are important to health

Related to the previous post on suicide is a study that having a "social network" is important.

The more social ties people have at an early age, the better their health is at the beginnings and ends of their lives, according to a new study. The study is the first to definitively link social relationships with concrete measures of physical well-being such as abdominal obesity, inflammation, and high blood pressure, all of which can lead to long-term health problems, including heart disease, stroke and cancer

The suicide cult

For many years, those in preventive medicine knew that when the press reported a suicide, that other suicides would follow> That is why they alway recommended to newspapers to minimize the story and NOT to be sympathetic to the person or to his/her action.

Well, in recent years, the pro suicide movement has been glamourizing suicide for those unhappy with life. My cynical take is that this is a forerunner to the idea that the old/handicapped/brain injured should be offed by their docs, with or without the consent of their families or themselves. And the reason behind it is not compassion but to save money.

So ScienceDaily reports on why the suicide rate of white men is so high.

Particularly pernicious for this group may be the belief that suicide is a masculine response to "the indignities of aging." This is a script that implicitly justifies, and even glorifies, suicide among men.
 As illustrations, in her article Canetto examines two famous cases. Eastman Kodak founder George Eastman died of suicide in 1932, at age 77. His biographer said Eastman was "unprepared and unwilling to face the indignities of old age." Writer Hunter S. Thompson, who killed himself in 2005 at age 67, was described by friends as having triumphed over "the indignities of aging."
Both suicides were explained in the press through scripts of conventional "white" masculinity, Canetto asserts.
"The dominant story was that their suicide was a rational, courageous, powerful choice."
 Canetto's research challenges the notion that high suicide rates are inevitable among white older men. As additional evidence that suicide in this population is culturally determined, and thus preventable, Canetto points out that older men are not the most suicide-prone group everywhere in the world. For example, in China, women of reproductive age are the demographic group with the highest suicide mortality.
 Among the implications of Canetto's research is that attention to cultural scripts of suicide offers new ways of understanding and preventing suicide. As cultural stories, the "indignities of aging" suicide script as well as the belief that suicide is a white man's powerful response to aging can and should be challenged, and changed, she says.