Sunday, June 26, 2016

Arsenic in ground water

I was checking the Pirate bay for downloads (Outlander S02E12 actually... I haven't seen it available on local TV yet but it will probably arrive in Asia next year since we tend to be a year or two behind... except for stuff like the walking dead, which is advertised as "same day as the USA"...) . Illegal? Sort of: they passed a law but it is on hold if I remember correctly.

well, anyway, while on that site I found someone had posted quite a few books on Arsenic and water today.

These textbooks are illegal, of course, but on the other hand they are probably useful for those working in rural areas who don't have oodles of money to spend on such stuff.

No, I didn't download them: Too technical. But one of the books was about South America's arsenic problem.

South America? I was aware of the mass poisoning of Bengladesh from deep wells dug so people could have safe water (and not die of dysentary etc) but I wasn't aware of the problem in South America.

Well, anyway, the WHO has a report here on Peru with an introduction that summarizes the problem

An estimated 200 million people worldwide are exposed to arsenic concentrations in drinking water that exceed the recommended limit of 10 µg/l1 as set out in the guidelines of the World Health Organization (WHO).2 The majority of this exposed population lives in southern Asian countries such as Bangladesh, Cambodia, India, Nepal and Viet Nam. In addition, elevated levels of arsenic have been found in several countries in Latin America, such as Argentina, Bolivia, Chile and Mexico. Recent estimates suggest that at least 4.5 million people in Latin America are exposed to arsenic levels higher than 50 µg/l – the Bangladeshi threshold.

some of this is from mining run off, but a lot is from natural groundwater contamination.

We grow brown rice, and there is a problem with that because the bran concentrates arsenic if the irrigation water is contaminated. more HERE

But so far, this is not a problem here in the Philippines

Superbug? Blame the seagulls

Mom Jones has an article about a superbug E Coli that is resistant to antibiotics.

The cause: Antibiotic use in pigs. In this case, pigs in Chinese farms, and sea gulls who migrate spread it from garbage to you.

Something to remember when you eat food: that modern methods of food production (and big Agri businesses) spread germs, but on the other hand, the alternative might be malnutrition and famine.

We grow organic rice, which is healthier, but if you are a tricycle driver or factory worker in Manila, you can't afford it, so you eat agri intensive (usually imported) rice full of chemicals etc.

There needs to be a middle way, but never mind.

Cut Medicare, and guess what? Obama regulations you haven't heard about

I have complained before about the huge amount of paper work that makes it hard to actually talk to patients, and about how the Indian Health Service has medical rationing for "non emergency" stuff, where you wait forever or maybe don't get it at all.

My area of expertise in bioethics is the pushing of euthanasia and avoiding traditional arguments in favor of "personal" choice.

But one of the dirty little secrets in medicine is that it has become a business: First, by HMO type care and now by Medicare/Medicaid and Obamacare experts telling you how to practice.

(Yes, based on "scientific" investigations, where they take a bunch of papers and average them, nevere mind that a lot of the papers are not very well done. So you are pressured to do what they tell you, never mind what is best for the patients.

Let's face it: An Objibwe patient in an isolated rural village in northern Minnesota or a rancher in rural Oklahoma might not need the same treatment as a rich obedient OCD yuppie in the suburbs. (which is why a lot of us overuse antibiotics instead of telling people to wait a few days to see if the second strep test turns positive, or if the rash of RMSF pops up for their "viral syndrome".

The NYPost has this good summary on how Obama's minions are changing regulations so your grandmom can't get her knee or hip replacement.

This is partly due to comorbidity (we have a relative who needs hip/knees/one shoulder and bladder surgery. All are "elective" but she probably won't get any, because she is also diabetic and 300 pounds making her a high risk for complications.

But as the article points out:

Another Obama rule penalizes hospitals for doing hip and knee replacements on patients likely to need rehab after surgery, causing hospitals to shun older patients with complex conditions. Grandma will have to settle for the painkiller as candidate Obama notoriously suggested. 
whoops: The feds are also making it impossible for people to get narcotics...blaming docs instead of heroin dealers and druggies who lie.

It's mainly about the money, of course.

the beancounters who have decided medicine is now a business also will decide what you get, and people like Daniel Callahan, as early as 1990, already made lists suggesting not to treat those who are old or lack "quality of life.

LINK from SantaClara Univ:

Currently, about 12% of the population is 65 years or older. By the year 2030, that figure is expected to reach 21%. The fastest growing age group is the population aged 80 and over -- the very segment of the population that tends to require expensive and intensive medical care. 
Two problems with this:

One, a 65 year old today is not as "old" as one was in 1980, and probably this trend will continue into the future.

Two:  most people over age 80 do have living wills, or relatives who will not demand all the expensive care. Part of this is logical because of comorbidity, where treatment of one thing means you probably will die of something else (which is why both I and my husband refused chemo for his leukemia: he had heart and renal problems from his hypertension, and it probably would not have prolonged his life).

However, the trend is if you refuse extraordinary treatment (as in a living will) you might end up with no ordinary treatment (e.g. antibiotics or fluids or being fed properly in your nursing home because hey, who has time for such things when the person is a dead man walking?)

the article goes on:

The projected demands from a growing elderly population on a health care system that is already taxed to the breaking point, together with continual advances and availability of expensive life-extending technology, have led to troubling questions about society's ability to meet future health care demands, and to the increased tolerance of proposals for rationing. Perhaps the most prominent advocate of aged-based rationing is Daniel Callahan, author of Setting Limits. In this book, Callahan proposed that the government refuse to pay for life-extending medical care for individuals beyond the age of 70 or 80, and only pay for routine care aimed at relieving their pain.
so now the NYP article cited above observes:

 Obama claims his rules reward quality instead of quantity. Don’t believe it. Adirondack Medical Center in Saranac Lake has one of the worst scores in New York on patient outcomes, indicating its patients get more infections and die sooner from heart problems and pneumonia than at other hospitals. Yet Adirondack got a Medicare bonus because it’s a low spender.

more about Callahan and rationing HERE. 
one of the least discussed stories you never read about: How unelected "experts" will decide if you can get medical care.

Twenty-two years ago, the co-founder and president emeritus of the Hastings Center, a nonpartisan bioethics research institute in New York, wrote the highly controversial book, “Setting Limits — Medical Goals in an Aging Society.” It made the case for limitations on care based on age – a topic that recently provoked intense, if sometimes hyperbolic arguments during the health care debate — and against the provision of extraordinary, expensive medical procedures for people who have already lived a full life...
that was 22 years ago but even then, the NEJM was already quietly pushing the idea of euthanasia...

follow the money.

Saturday, June 25, 2016

High morbidity with a syndrome? Maybe we should find a cure

shal we accept transgendered people, or seek to cure them?

via Mom Jones: Here is a genetic and/or behavioral psychiatric condition with a high morbidity:

  • Of the 25 million transgender people in the world, the depression rate is 60 percent in some regions, compared with an estimated 5 percent of non-transgender people.
  • The rate of attempted suicide is 41 percent for trans people, compared to 1.6 percent for the general population.
  • Transgender people are nearly 50 times more vulnerable to HIV than their cisgender—people whose gender is in line with their sex assigned at birth—counterparts.
  • Between 2008 and 2016, there were 2115 documented killings of transgender people. (That's most likely an undercount.)
  • In the United States, a 2011 study found of those who expressed gender non-conformity at any point between kindergarten and 12th grade, 35 percent were victims of violence.

  • question: Should we encourage them to act on their desires, or find a way for them to control their behavior?

    IT seems to me to be a variation of Obsessive compulsive disorder: Like the multi plastic surgery etc. types we see on reality TV shows.

    So should we as doctors try to cure them? True, previous "medical" ways to treat gays didn't work well, but does that mean we might not find that, say, stem cells into the hypothalmus might work, or maybe an SSRI to lower the OCD part of the disorder? I have no idea if there are studies on this.

    Tuesday, June 7, 2016

    War surgery: Tiny sponges save lives

    StrategyPage report on new techniques to save lives.

     Preventing death from most other rapid blood loss situations was achieved in the last decade with the development and widespread use of powders and granules that could quickly stop the bleeding. First (in 2004) came special bandages like the Chitosan Hemostatic Dressing (more commonly called HemCon). This was basically a freeze dried substance that caused rapid clotting of blood and was incorporated into what otherwise looked like a typical battlefield bandage. But this bandage greatly reduced bleeding, which had become the most common cause of death among wounded American troops. This device was a major breakthrough in bandage technology. Over 95 percent of the time, the HemCon bandages stopped bleeding, especially in areas where a tourniquet could not be applied. This did not work for extreme cases, especially if the abdominal aorta was involved. HemCon was followed by WoundStat powder to deal with some of the bleeding that HemCon could not handle. While medics, and troops, prefer the bandage type device, there are situations where WoundStat (a fine granular substance) is a better solution (especially in the hands of a medic). Only the medics got packets (usually two) of Woundstat powder. That's because this is only needed for deep wounds and has a theoretical risk of causing fatal clots if it gets into the bloodstream.

    Thursday, June 2, 2016

    Stem cell treatment for stroke?

    UK Mail article here.

    this was used in patients several months (or years) after their stroke, and some had recovery, although it did not work as well with older patients.

    And no ethical problem:

    Previous trials have also been controversial because they use embryonic stem cells from aborted babies – but this trial avoids those ethical issues because it uses adult stem cells available ‘off the shelf’ from a commercial provider. Read more: Follow us: @MailOnline on Twitter | DailyMail on Facebook