Wednesday, November 22, 2017

Hepatitis: now in LaLaLand

Yes, the lovely city of Los Angeles now has a problem with hepatitis.

 Back In 2012, the Los Angeles Community Action Network predicted that Skid Row was ripe for disease in a report similar to the one earlier this year. Then, just as now, restrooms often lacked soap, water, toilet paper and trash cans.
“The City of Los Angeles has failed miserably when it comes to providing accessible and clean public restrooms, thereby creating and maintaining the human rights violations cited in this report and others,” the report said. “It is an obvious fact that human beings simply must relieve themselves regularly. All residents face the need for public restrooms, it’s just that homeless residents are entirely reliant on public options.”
Maybe they should hire Claire Frazer to tell them how to fight the epidemic

basic hygiene:


and hand washing

Tuesday, November 21, 2017

SARS and Plague and Birdflu

NYtimes reports over a thousand cases of birdflu  in China, with some cases suspected of being spread person to person.

and there is some evidence it is evolving, plus evidence it has spread to ferrets.

and I''m old enough to remember how China covered up the SARS epidemic, so this might be worse than reported.

Ironically, the SARS epidemic was stopped the old fashioned way: Quarantine and isolation of patients. 

Everyone in airports were checked for fever before boarding, and stopped from flying, and local cases were isolated in hospitals.

but why worry about bird flu when the black death is becoming epidemic in Africa? This is especially dangerous because it is the pulmonary  variation, which is airborne and doesn't require fleas.

Monday, November 20, 2017

GEtting high on Tramadol

There is a bit of a kerfuffle on the BBC because a british lady was arrested for smuggling Tramadol to her young husband who claimed he needed them for his back pain.

She was carrying 300 tablets, so the number is borderline if personal use or for sale.

Tramadol in the US is a mild narcotic pain killer we give instead of the more addicting Percocet or Tylenol 3 to old folks in pain.

But in the Middle East, it is a major problem for abuse, including having the terrorists take it to get high before they go out to fight.

UKMirror article.

an interpol article says the source of the drug in the Middle East comes from "Asia". Well, duh.

this article in the Indian press suggests one of their companies was behind the huge amount seized in Italy.
DNAIndia also notes that they are the source of illegal Tramadol used by terrorists and others in the Mediterranean. has a long article on the uses of this mild narcotic, but then goes on to discuss it's abuse in Africa and the Middle East.

 tramadol is popular in Egypt and is misused widely. Indeed, besides it being a recreational drug, many people – especially from the poor working class – take tramadol to give them more energy, to work for longer or to hold down two jobs.
It has been a particularly serious problem in places such as Gaza, where addiction has led to an illegal trade in tramadol, often smuggled in through underground tunnels. This has led the government to take a particularly hard line on it.

but use and abuse are two different things: The dosage differs.

The usual dosage of Tramadol for pain is one 50 mg tablet every six hours. The TamolX is a longer acting version of the drug, used for chronic pain, with 225 mg. Since the drug can be ground up and give an instant high, it is the drug of choice.

in contrast, abuse takes larger amounts. Again from the DNAINDIA article:

The Gulf and Middle East countries, where the armed conflicts fueled growth of an illegal drug economy, demand in trafficking of powerful amphetamines and opioid painkillers from source countries like India has increased. Pills like Captagon and Tramadol are favored by militants for their sedative effects as it makes them 'invincible' during fighting.
captagon is a variation of methamphetamine with theophylline, a variation of caffine... in other words, a stimulant.

Fenethylline, also known by its brand name Captagon, is a combination of amphetamine, a stimulant, and theophylline, a drug traditionally used to treat respiratory diseases such as asthma. The latter greatly enhances the former's psychoactive properties, making the codrug a powerful amphetamine, according to scientists from the Scripps Research Institute in La Jolla, California, who published their findings in the journal Nature on Wednesday.
“It boosts the overall stimulant activity,” Cody Wenthur, the study's co-author and a postdoctoral research associate at the Scripps Research Institute, said in a statement. “You get a faster onset than other amphetamine drugs and a stronger effect than just amphetamine alone.”
more here.

alcohol and marijuana and other drugs have a long history of being used by soldiers, and may be behind a lot of the worst atrocities in war.

I remember when my father's small company was bought by a larger one that had many medically related businesses. One day, back in the 1970's, he told me he had run across evidence that his company was shipping millions of amphetamine type pills to clinics in Tiajuana... all legal, of course.

Back then, it was being used for dieting, for students trying to study hard, and by truck drivers to stay awake in long hauls. What got it banned was after a couple of bad accidents by these truck drivers, but any student could tell you of the paranoia and violence by students who did too much drugs for all nighters, i.e. 24 hour study before tests.

so the illegal drug trade not only funds terrorism, but is used by terrorists to fight.

the use of stimulents in the US military is another dirty secret: because the alternative is being sleepy and making mistakes when you fly a plane, or being too tired to fight.

the use of amphetamines goes back to World War II...

but were mainly used by Japan and Germany... a recent book discusses the widepread use in Nazi Germany not just in the military but in civilians.

But now the use of "go/nogo" pills is an open secret.

oday, American and other nations’ armed forces use more modern stimulants and sleep aids to improve performance in combat.  The policy to use these medications, however, has not always won unanimous support from military leadership.  In 1992 Air Force Chief of Staff Gen. Merrill A. McPeak banned the distribution of amphetamines to aircrew, though he admitted that his decision was not based on science but only his own personal experiences as a pilot.  The practice was reinstated by the USAF in 1996 when Gen McPeak left his position as USAF Chief of Staff.2  In the aviation community, these meds are often better known as ‘Go’ and ‘No-Go’ pills.

NYTimes article on the problem (2012) wonders if the increased use of stimulents has increased the rate of PTSS.

Because norepinephrine enhances emotional memory, a soldier taking a stimulant medication, which releases norepinephrine in the brain, could be at higher risk of becoming fear-conditioned and getting PTSD in the setting of trauma. This possibility is supported by both animal and human studies.
Finally, the fact that China is looking the other way when their drugs kill people (both opioids in the US and stimulents throughout asia) is an open secret.

One commetator quipped that the opioid crisis in the US was China's payback for the Opium wars when Britain forced them to buy opium.

But here in the Philippines, it is the meth/stimulents/ "shabu" that is the problem.

The drug war gets all the press, but the murders by druggies do not.

For example, over the last few years, several older people were killed in home robberies, which in the past would have been non violent. Were drugs involved?

A young lady across the street died of a "heart attack". she had once bee in jail for drug pushing, and it was suspected the heart attack was a drug related overdose.

Or one of our cousins shot his brother and killed him. The Brother was angry at this first brother for something, and one night, he was "drunk" and attacked him while he was sleeping. The sleeping brother always kept a shotgun by his bed so grabbed it and shot.  Shotguns are not usually fatal, but in close range, it hit an artery in his leeg and he bled to death.

Alcohol might have been enough to fuel the anger of the dead man, of course, but with all the shabu locally, I wonder if he wasn't doing that also.


In other words, the "human rights" folks are up in arms about the drug war, but not about drug crime.

Ditto for the local Catholic church which worries about the "poor", the Pope's "green" agenda, and about dead drug dealers, but not about the poor becoming addicted.

 the bile quote is:

English Standard Versionnor did they repent of their murders or their sorceries or their sexual immorality or their thefts.
Sorcery in the good old days was often taking drugs to see visions: using "religion" as an excuse to get high.

Drugs were around back then.
of course they also used drugs as... medicines.

One of the passages in the Odyssey was when Helen mixed some Egyptian drugs into the wine so her husband and the other soldiers could forget their sad memories.

So the drug treatment of PTSS has a long history too.

Sunday, November 19, 2017

Californaa crazy

----  ban leaf blowers and lawn mowers -----

--- don't build toilets because it is their right to defecate on the streets and spread disease.

Doctors and nurses here are grappling with a population that’s extremely challenging to work with, or even find. Because homeless people are transient and receive little regular health care, even severe illnesses can go unnoticed and untreated for long periods. In the case of hepatitis A, this allows a carrier to keep spreading it. Issues such as mental illness and a deep culture of mistrust of the government also make many homeless patients difficult to reach or reason with. Many routinely turn away offers of free vaccines or medical attention.
“This is new territory,” said Dr. Wilma Wooten, San Diego County’s public health officer. “It’s challenging on so many levels.”

this angers me in so many ways.

This is not "new territory. This is basic public health prevention, and should have been addressed last year.

I suspect it is either political correctness or incompetency on her part.

Reminds me of the early chapters in Ringo's book the Last Centurian, where the Public health docs in California follow all the rules instead of common sense getting people the flu vaccine as quickly as possible.
and this was a priority for the IHS: and yes, they have emergency reponse teams.

Their job was supplying clean water and sanitation to the remote areas on Indian reservations in the USA.
It must be successful: When I worked with them in the early 1980's we still saw salmonella and typhoid, but I didn't see this when I worked in these same areas 15 years later.

sanitation, cleaning up garbage, providing sewers and clean water are more important than penicillin or even vaccinations.

the first thing that the military learns to do is keep the camp sanitary (yes, this is in the Bible and also a basic idea in Roman military camps, so it is not new).

military Field sanitation team site there are courses available.

one of the ironies of the Haitian earthquake in 2010 was that some of the UN peacekeepers from Nepal were cholera carriers. Alas, they built their latrines where the ground water would drain into a nearby river used by locals for drinking water: The result was a cholera epidemic that killed almost 10 thousand people and is still going on there.

wikipedia article.

AlJ report here.

also here;

NYTimes article from this year is mainly about the lawsuit of course.

 Studies showed the cholera bacteria came from poor sanitation by the peacekeepers. The United Nations never acknowledged it was at fault, and even when Mr. Ban apologized last December for its failure, he worded the apology to avoid any mention of who had brought the cholera to Haiti, the Western Hemisphere’s poorest country.

Tuesday, November 14, 2017


according to Physorg, the brown rat originated in SE Asia and spread theoughout the world via ships.

there are six lineages of black rat, however and they also probably came from Asia, and are most famous for being the rodent behind the spread of the black death:

“Black Rats are carriers of many different human diseases, including plague, typhus and leptospirosis,” says CSIRO mammal expert Dr Ken Aplin, lead author of the study.
Read more at:

some attribute the decrease in plague in Europe to the fact that they discplaced the plague carrying black rat... but Wikipedia isn't sure.

The original carrier for the plague-infected fleas thought to be responsible for the Black Death was the black rat, and it has been hypothesized that the displacement of black rats by brown rats led to the decline of bubonic plague.[85] This theory has, however, been deprecated, as the dates of these displacements do not match the increases and decreases in plague outbreaks.[86]

but you can catch other diseases from them: again, Wikipedia.

brown rats may carry a number of pathogens,[76] which can result in disease, including Weil's diseaserat bite fevercryptosporidiosisviral hemorrhagic feverQ fever and hantavirus pulmonary syndrome 

Weil's disease is also called leptospirosis, and is a major problem here in the Philippines after flooding. People wade through shallow water, but the spirochete can enter through wounds in the skin.

it is treatable with antibiotics, but often in times of major flooding, folks don't get around to getting treatment in time: so the gov't puts out reminders about seeing a clinic or doc if you get a fever.

Sunday, November 5, 2017

Plagues and other disease in the news.


marburg virus (spread by ?) and Black death/plague (spread by fleas and also air borne in this epidemic) in Africa.

CDC course on biosafety

ukIndependent article on different hazmat suits.

you know, the "modern" folks always ridicule those superstitious docs of the middle ages for using the medieval equivalent of a biosuit, but I wonder if it did work: Covered the body so no flea bites, and the herbs in the beak which were supposed to filter the germ might indeed have filtered the bacteria in pneumonic flu.



but epidemics aren't just for Africa anymore:

SanDiego, a year after a Hepatitis A epidemic hit, is finally goin officially after the source of the epidemic: Homeless camps. (private NGO's have already tried to help them, but now it's official).

City officials said, so far, clean-ups have taken place on two dates in locations around Qualcomm Stadium, with more are to come.
Homeless outreach teams with the San Diego Police Department have also conducted outreach efforts in recent months along the river that included offering hepatitis vaccinations and access to shelter services.
“Our crews will continue to make progress cleaning the city’s portion of the San Diego Riverbed,” said Mario Sierra, director of the environmental services department. “Many areas are challenging because of topography, vegetation and access, but we must do what we can to ensure the river is as free from debris and trash as possible.”
Late last month, behind a Kaiser Permanente medical office building, a well-entrenched homeless camp of about five tents sat tucked out of sight along the San Diego River. “With them cracking down downtown so bad, we’re getting over populated down here,” said a 27-year-old living on the river who identified himself as Rabbit. Rabbit points out bags of trash piled up around his tent and the colorful mess that is a typical river camp — evidence, he said, that folks have tried to keep the area somewhat tidy.

"tidy"? Hell. The city has the right to arrest or forcibly remove both the people and the trash: and arrest the if necessary.

you know, it used to be you could do this for the sake of public safety, (one is reminded when Honolulu stopped a plague epidemic by buning down China town, the source of the disease).

and in th past, doctors could inspect hookers, and close bars which were the source of STDs, including bathhouses where gays would have multiple sexual contacts.

but after the gays got upset and arranged a "recall vote" against Mayor Feinstein because she tried to shut down the bathhouses because of an epidemic of syphillis, Hepatitis B, and other diseases, now that is against "civil rights".

The result of that action, of course, was hundreds of deaths from HIV...

Something to remember when the gay lobbies place "ain't it awful" stories about homophobia when foreign countries raid and shut down bars that are a source of disease.

ironically, few "gays" have protested how Cuba prevented an HIV epidemic by quarantining their soldiers who returned from Africa with the infection. Guess communists get a pass on such things.

An aside note: a US teen magazine aimed at teenaged girls had a how to do it guide to sodomy... never mind that this spreads disease and is humiliating for most women. The good news is that the magazine has now shut down, maybe because of a boycott.

It used to be you were a prude to say it's okay to say no, but now with the Weinstein/Hollywood/Spacey stories in the news, the victims who were shamed in the past to agree to sex, or who lost jobs because they refused, are now hitting back.

Why, yes. That is why the rules were devised in the first place: not to stop your fun but to protect you from predators and sociopaths.

there is a quip that the sexual revolution was won by the bad boys, but now the ones they hurt are getting their revenge.

Tuesday, October 31, 2017

Stem cells

after all the hype on why we have to kill embryos, it turns out that fat can supply stem cells.

Historically, stem cells can come from a variety of tissues. These include umbilical cord, fetal tissue, bone marrow, or the best source as adipose or fat cells.
Adipose derived stem cells have the highest numbers of cells when collected and tested compared to all others . This is by far the preferred method of stem cell therapy because of sheer numbers and the fact that they are coming from your own body. This is called autologous therapy.

Friday, October 27, 2017

CDC on drug deaths

Fentanyl and its analogues are indicated in half of the "opioid" deaths, not to mention heroin, cocaine, meth and "other" drugs.


In other words, druggies, not people getting medicine for pain.

I wonder if the OD's are now higher because the "pill pusher" docs, who gave out percocet are now out of business so the addicts no longer buy the pills from someone who got them for "pain", or from the drug pipelines who got them from pharmacies (often just across the Mexican border)

The opioids are from China and sent up via the Mexican drug gangs. Building the wall might help.

And yes, making Naloxone over the counter will help.

The problem? often the Naloxone wears off before the drug used in the overdose wears off (and it won't work when the drugs are mixed with non opioids). So an hour later, they die anyway.


and I also wonder how many cases are patients in chronic pain who accidentally overdose, or people who use these type of drugs to kill themselves.

Thursday, October 26, 2017

Poio (take three) could be eliminated?

Bill Gates is using his money to push vaccinations, and now says the goal of eliminating the Polio virus is at hand.

  • Billionaire and co-founder of Microsoft said the polio cases worldwide have decreased from 350,000 in 1988 to only 12 
  •  The infectious disease is spread from human-to-human contact where its most severe cases causes paralysis 
  •  Critics remain skeptical saying the symptomless virus can live in a person's intestines for years and then spread to someone else.

good news.

Tuesday, October 24, 2017

Polio take two

StrategyPage has this about the polio edification effort in Pakistan and Afghanistan:

There is another major effort this year to vaccinate vulnerable Afghan and Pakistani children against polio. In 2016 there were 20 cases of polio in Pakistan and 13 in Afghanistan. There were four in Nigeria, a country that is expected to be free of polio this year or next. In Pakistan and Afghanistan there are still religious problems with vaccination. The Afghan Taliban have openly supported the vaccination program but there still some rural areas where local Moslem clerics or teachers continue to denounce the vaccinations. There is a similar situation in Pakistan, where some fringe Islamic groups will still try and kill members of the vaccination teams. Despite this continued resistance polio cases in both nations continues to decline....

 In the last decade the main obstacle has been Islamic terror groups who ban polio vaccinations and attack anyone trying to deliver the vaccine to vulnerable children. Islamic terrorists in general tend to believe the vaccination teams are spying for the government and that the vaccinations are a plot to sterilize Moslems. 

New age placebo, polio, and other medical stories in the news.

UCIrving is pushing medical nonsense, and the press finally noticed it.

medical professionals who believe that healthcare should be based on treatments validated by science view the very term “integrative medicine” as a path to introduce unproven or disproven therapies into medicine. UC Irvine has hewed very close to that line in relation to an earlier gift from the Samuelis, which was used to fund a center at the university that actually offered homeopathy to patients. (The mention of homeopathy disappeared from one of the college’s web page after I asked about it; but a naturopath on the staff is still promoting homeopathy under the UC Irvine imprimatur even now.)

yeah. Read the whole thing. It's quackery.

When I got an "Audiodigest" tape pushing this nonsense I actually complained (and apparently other docs did too, because they emailed me back thanking me for my 'opinion').

Hopefully this will get a "headsup" from the NYTimes Health editor who tend to push this trendy pseudoscience.

and not noted in the article: These practitioners tend to attract a cerain type of person who is open to these magical ideas.

placebo, suggestion, and hypnosis do work on 30 percent of people: 

about the same percentage of people who test high or moderately high on the neurological test for ability to be hypnotized.

The "art" of medicine is in the sympathy that we docs bring to our care, and in the "laying on" of hands: because the comfort and sympathy helps even when we can't "help".

But notice that this type of "medicine" tends to stress New Age ideas like "meditation" or similar scams like Reiki, yoga or acupuncture? (the last two are included because they often stress the religious aspects on patients.. yes you can do yoga exercises for back pain, but if the teacher starts talking about awakening your kudalini point you know it's religion).

This is religion: and what disturbs me is that we docs are not supposed to push our religious beliefs on people.

When I did stress control or advise folks on coping, I took my patient's belief system into consideration.

Quiet Bible study, saying the rosary, spending an hour in "Eucharistic adoration", doing art or music, having a "Sing" or traditional ceremony or having the local prayer group pray over you all are ways that people integrate their souls, minds and bodies in times of stress and illness.

But these aren't part of the curriculum. I wonder why (/sarcasm).


awhile back I referred to the "Black Legend" of Spanish atrocities.

TeaAtTrianon links to a post at CountingStars with the facts that the legend ignores.

Remember that in 1512, when the first news of mistreatment of the Indians, King Fernando II signed the Laws of Burgos that considered Indians “free men” and the obligation to pay them a fair wage for their work. In 1542 the Emperor Carlos V dictated the New Laws, which expressly prohibited the submission of Indians to slavery and forced labor. To this we must add that between the Spanish population and the Indians there was a great miscegenation, even among the nobles. On the contrary, in British North America, the miscegenation between colonists and Indians was almost non-existent, and the Indians were robbed of their lands and confined to reservations, which did not occur in Spanish America. (Read more.)
and of course, the epidemics, not atrocities,, that killed people were not deliberately spread by the Spanish soldiers who, like everyone in those days, had little knowledge of how disease is spread. (athough the British, not the Spanish, gave gifts of smallpox infested blankets).


letter in LATIMES:

This country has no use for John Kelly's nostalgia

because respecting those who die to defend civilians from terrorists is soooo yesterday.

As I pointed out a few days ago: Often patients and their families are angry and upset, so they mis hear what you are trying to say, and turn their anger on you, the healer, not on the disease or cause of the death (in this case, some very bad terrorists who attack local civilians in the area).

AnneAlthouse points out that

If we make it too hard to talk to a person in dire circumstances, a lot of people will play it safe and not speak at all.

From "Half Empty" by David Rakoff (who was facing the cancer treatment of amputation of his left arm and shoulder): 
But here’s the point I want to make about the stuff people say. Unless someone looks you in the eye and hisses, “You fucking asshole, I can’t wait until you die of this,” people are really trying their best. Just like being happy and sad, you will find yourself on both sides of the equation many times over your lifetime, either saying or hearing the wrong thing. Let’s all give each other a pass, shall we?


eu plans to ban another weedkiller because it might cause cancer.

Chemicals often have subtle adverse effects. But banning them might cause more problems.

Is there an alternative that is cost effective, or will it result in higher food cost and less food available, both of which will cause poor people to starve?

so how many will die of malnutrition related disease vs how many will die (at a much older age) of cancer? CNN report here says they found 800 cases that might be associated with the chemical... the number of people dying of poverty related malnutrition because there is enough food around, but they can't afford to buy it?

it is sort of like the massive arsenic poisoning of Bangladesh: They dug deep wells to eliminate cholera and other causes of diarrhea that killed thousands every year, but the ground water has arsenic and that is the major problem.

but by eliminating diarrhea, a major cause of death in small children, it means moms are now willing to use birth control and have more kids, and since they have fewer kids, they can afford to send them to school... and Bangladesh is slowly eliminating poverty. 

great books podcast of the week: The Gulag Archipelago


Instapundit links to
NYTimes the Long War on Polio.

it is still going on, ,and remember: the Taliban and other Islamicist types kill those trying to wipe it out. Not because they want the kids to die but because they read "anti vaccine" articles in the UK Guardian etc and believe the non scientific Hollywood types that push these ideas.

Thursday, October 19, 2017

Gluten: Celiac disease discussion

Freakonomics discusses Gluten and celiac disease.

podcast link

old NYTimes article HERE.

both overdiagnosed (thanks to a sensitive lab test, mild cases are now being diagnosed) and under diagnosed (a lot of mild cases of irritable bowel disease probably never got diagnosed in the past).

the gene varies in different populations

CD has a worldwide distribution, being described in different ethnic groups from North and South America, Europe, south and west Asia, Australia and New Zealand[,]. The disease is rare among Africans and not expected among populations with no HLA DQ2, like Chinese and Japanese, except in individuals presenting HLA DQ8[].

west Asia and south Asians do have the problem.

but the low incidence in China might be from under diagnosis, or dietary, but the disease can be found in those with irritable bowel syndrome.

This article suggests it is "rampant"  and blames the westernization of the diet, (i.e. less breast feeding, earlier weaning, and the increased use of bread instead of rice in the diet) and notes that it is more common in areas with Caucasian genes (western China... they are presumably discussing the Uighur, who are Turkish in origin).

what you have to realize is that in places with primitive water supplies, diarrhea in children is common, and is indeed one of the major causes of death in young children. So a child with failure to thrive and diarrhea would just die, and everyone, including doctors, would assume it was from the many diarrhea causing diseases in the environment.

But now, with clean water, such cases are rare, so a child with constant diarrhea and failure to thrived would be seen by doctors and checked for food intolerance, including lactose deficiency and celiac disease.

a full review of the history of the disease can be read here.

this map from Dr Shar Institute shows incidence, but note all the blank areas.

 a new epidemiology of celiac disease, characterized by growth in the traditional fields and spread into new regions of the world

just like previous studies showed the disease was rare in Asia, but is now being diagnosed, one wonders about the low rate in Africans. Again, unsafe water supplies lead to lots of diarrhea deaths, and diarrhea from protein deficiency due to earlier weaning and/or using a baby bottle but not being able to afford powdered milk.

So who has money for an expensive lab test when children are more likely to die from norovirus, measles or malaria?

but as Africa follows Asia out of rural poverty to urban living, one suspects it will be found to be much more common, and it will be diagnosed more often.

and replacing traditional diets of sorghum, maize and rice in some areas with wheat based food might make cases more common.

Tice is, of course, gluten free, and might be one reason that so few cases of celiac disease were seen in rice eating areas, but what about maize, which is a staple in many areas, i.e. East Africa, Latin America?

Ironically, that is unclear: most lay sites say avoid it, but it seems to be less problematic.

This article says maybe

Hypothetically, maize prolamins could be harmful for a very limited subgroup of CD patients, especially those that are non-responsive, and if it is confirmed, they should follow, in addition to a gluten-free, a maize-free diet.

Monday, October 16, 2017

The Plague is still with us

an outbreak of plague in Madagascar : LATimes.

from occassional cases in the countryside, it has spread to the city.

ecause a man with the pulmonary form rode in a bus.

and you may not be safe:

The biggest problem for authorities trying to control the outbreak is that it took two weeks after the first case to detect it, and that most cases — 277 so far — have been a particularly virulent form of the disease.
Madagascar, an island off Africa’s east coast, is the country most seriously affected by plague, but others, including the United States, Russia, China, Peru, Bolivia and several African nations, regularly report cases.
By Monday, 387 cases had been reported, including 167 in the densely populated capital.
related item:

 Podcast on the Plague in ancient history

Sunday, October 1, 2017

Hepatitis out break (podcast)

PTSS and concussion

Because of better diagnostic tools and techniques, many other combat zone injuries could now be measured as well. These included over a quarter million cases of traumatic brain injury (more commonly called concussion) and over a hundred thousand cases of PTSD (Post Traumatic Stress Disorder) that were discovered among combat veterans since 2001. 
In the past these conditions were not considered “wounds” in the same sense as something that made the victim bleed. This was despite the fact that many soldiers were put out of action temporarily because of concussion and PTSD.
Physical injuries to the brain can now be detected using more precise instruments like MRI and can often be treated. In the last decade it has become clear that there are several sources of PTSD (post-traumatic stress disorder) and concussions from explosions were more of a factor than previously thought. Many troops, because of exposure to roadside bombs and battlefield explosions in general, developed minor concussions that, like sports injuries, could turn into long term medical problems.
Often these concussions were accompanied by some PTSD. Examining medical histories of World War II, Korea, and Vietnam War vets showed a pattern of later medical problems among many concussion victims. The same pattern has been found among athletes and accident victims who suffered concussions.

Plasma substitute and red tape

StrategyPage has an article on plasma that does not need refrigeration but the military can't order any because the FDA regulations stand in the way

U.S. SOCOM (Special Operations Command) is gradually getting access to freeze dried plasma (FDP) for use by their combat medics. Plasma is used to replace clotting and other essential blood components in emergencies. It is not whole blood but is taken from whole blood and must be kept refrigerated. FDP is not yet legally available in the United States so SOCOM has been using French FDP, which the French military has been producing and using since 1994...
The problem was that in the United States the FDA (Food and Drugs Administration) needed an American firm to produce FDP that they could put through their testing and approval process. There were problems with finding an American firm that would and could do it and then going through the FDA approval process. It was estimated that this would take until 2020 to complete. 
and that isn't the only battle field innovation saving lives:

Dealing with massive blood loss has always been a seemingly unsolvable problem. While tourniquets have been around for thousands of years, these devices only work on limbs. Preventing death from most other rapid blood loss situations was achieved after 2001 with the development and widespread use of powders and granules that could quickly stop the bleeding. First (in 2003) 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. 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 when 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, September 28, 2017

Making doctos scapegoats for drug cartel opiods.. And patients suffer

Inside Sources: Misdiagnosing the Opioid crisis.

Policymakers in Washington and in state capitals are misdiagnosing the opioid crisis as a doctor-patient problem. Their policies are coming between doctors and patients. They are preventing doctors from using their judgment and expertise to ease pain and suffering. They are making many patients suffer needlessly, with some turning in desperation to the black market.
yeah. Old ladies often sell or give each other their pain pills, not so their friends can get high, but so they can get pain relief. Ditto for tranquilizers. This doesn't bother me too much.

Then you have the stealing of grandma's medicines by druggies or by teenagers trying to get high. This can be a problem, especially if the one stealing the drug is the caregiver or friend who "helps" the old person (often they are not working and living off of grandma's pension, or stealing money from her).

This is low level crime, and hurts our patients.

But this is nothing new.

The real problem behind the "crisis" is the drug cartels. Again from the article.

On August 1, and September 5, two separate raids by combined federal and local narcotics police in New York City seized the largest haul of the powerful opioid fentanyl in New York history. This included 140 pounds of fentanyl (32 million lethal doses), 75 pounds of fentanyl mixed with heroin, and additional stores of heroin and cocaine.
New York City special narcotics prosecutor Bridget Brennan told reporters, “The sheer volume of fentanyl pouring into the city is shocking. It’s not only killing a record number of people in New York City but the city is used as a hub of regional distribution for a lethal substance that is taking thousands of lives throughout the Northeast.”

unfortunately, he then says: stop drug prohibition and the overdose problem will go away.

Nope. Because they will still go to illegal sources to get high. And Fentanyl is a much better "high" than marijuana. The dirty little secret is that marijuana is almost legal anywhere: it is rarely prosecuted (all those folks jailed for "marijuana possession" are often plea bargains for bigger crimes that might be hard to prove, maybe because the victim is afraid of being killed if they testify, and more often because the court system if overworked).

And of course, the societal problems from being high is huge, as we see in broken families, in car accidents, and in unemployment because who will hire such a person.

I have been saying this for quite some time: The "opioid crisis" is not from doctors prescribing opioids for pain, but from drug cartels smuggling in opioids, often fentanyl and analogs that are powerful and easy to overdose. And, like in the Philippines "Shabu" drug wars, a lot of it is from China.

That is why Duterte remains popular here, despite the  SJW complaining all the time and spreading their complaints all over the world. That is why the "huge" anti drug war anti Duterte demonstration that the MSM in the US lauded as showing people are starting to oppose his war last week only had 5000 demonstrators, even though you can hire people to demonstrate for ten dollars a day: because even the unemployed street people won't take your money. (and three times that many supporting Duterte, something that the MSM missed).

So where are the anti drug types in the USA?

A friend used to tell me about the huge amounts of cocaine etc. used by the elites in Washington back in the 1990's (a friend's daughter worked for the Justice Dept and was scandalized).

And of course, I worked on the Indian reservations, where alcohol was the drug of choice: Keep them drunk, and they won't be a problem. (which is why as the tribes get more sovereignty they often prohibit alcohol). Nowadays, of course, it is stronger drugs, but never mind.

Who was the black politician who blamed the CIA for the crack epidemic in the 1990's? Yup. Maxine Waters. She is still at her "Conspiracy theories" of course, but you know, most conspiracy theories arise from information that is not being reported, and then they exaggerate and/or twist the information, so easily get things wrong, but there is a core of truth underneath.

But who benefits from the drugging of America?

Place conspiracy theory here.

I know who "benefits" from Shabu trade here.

Politicians, and businessmen, and crooked cops, and crooked officials looking the other way when it is smuggled in (e.g. like the recent discovery of how a load was let thru customs at the airport).

Also, since Filipinos work all over the place, it is easy to find a drug mule to carry the stuff all over: So we have been a hub for distribution.

Who suffers? The poor who take it to get high, or to be able to work harder. And their families. And now, of course, a lot of the casualties are ordinary folks who were in the local distribution racket: When a tricycle driver makes 600 pesos ($12) a day, it is hard to support a family, so why not take that package and deliver it because you need the money for your family?

This is why many of the casualties of the drug war are "innocent": No, they are often in the wrong place at the wrong time when a raid is going on.

But the rich are the ones behind the problem, the rich who don't care about the casualties of taking drugs, they are still at large, and using the SJW types to try to take Duterte down before he finds enough evidence to put them away.

The Catholic bishops are busy condemning Duterte's drug war, but they don't seem to see the casualties of drug use here.

Like the lady across the street who died of "a heart attack" at age 37 (shabu/meth induced of course).

Or the teenage girl killed by her druggie boyfriend whose body was dumped in the cemetery near Lolo's grave (she was breaking up with him).

or the elderly people killed in ordinary robberies/home invasions (three in our area in recent years).

Or the many bodies that are found tied up and with evidence of torture (by drug gangs, usually for being a snitch: these bodies were commonly reported found before the drug war started, so don't blame Duterte).

so where are the churches in all of this?

The Catholic bishops here of course condemn the poor pushers killed in Duterte's drug war, but how many bishops have condemned the politicians who take bribes and kickbacks from the drug lords?

Maybe in private, or maybe in vague terms without naming names.

Or are they too busy pushing the Green agenda and the Francis church's idea of "mercy" to bother to see the casualties of corruption?

The old Testament prophets wrote a lot of stuff condemning such corruption in business and government.

Ah but mercy!

Those who insist Jesus meek and mild would never condemn someone, well, could I remind you he broke up the sellers in the Temple. The naive left wing types that run the church hint this was anti capitalism, but anyone who lives with corruption figures they were over-pricing and gouging customers, and giving kickbacks to the priests.

Wednesday, September 27, 2017

Disease in the headlines

From the UK Mail:

Fight against anal cancer. Yes, gay and Bi men problem.

probably related to warts/ human papilloma virus. And a depressed immune system from HIV.

And hopefully the vaccine will cut down the epidemic.

So exactly why did a feminist magazine aimed toward teenaged girls have an article about how to do anal sex?

Cancer cluster at a police station in Cincinnati

The District 5 police station sits just on the other side of Interstate-75 from Mill Creek, which was declared 'the most endangered urban river in North America' by American Rivers in 1997.

also from the UKMail.


public pooping and the 4F problem

A mentally ill person is defacating in public on a person's lawn, and lawyers are claiming it's his/her right. (as a trans, a protected minority I guess). (via Instapundit)

Attention: One common way that disease spreads is the "Finger Feces Food Fly" route of transmission.

from Wikipedia:

Wikipedia lists diseases that spread this way:

Bacteria[edit] Viruses[edit] Protozoans[edit] Helminths[edit]

second headline: Death toll from San Diego Hepatitis epidemic reaches 17.with no signs of slowing.

guess where it came from?

In this case, genetic analysis has shown that the strains in this outbreak are unrelated to another ongoing outbreak in Southeastern Michigan and to previous multistate outbreaks connected to frozen strawberries and pomegranate seeds. But the same analysis has also proven that there is a connection to a much smaller recent outbreak in Santa Cruz County, which has 69 confirmed cases mostly among homeless residents and illicit drug users, much like in San Diego.

the second story has a photo showing them cleaning off the sidewalks with bleach water.

they are also giving out hepatitis A vaccine and handing out hand cleaner and towels and plastic bags to discard the excrement safely.

well, duh.

And both articles note that they are going to teach the public the ways to prevent the virus, such as handwashing, and getting Hepatitis A vaccine.

yup. that will protect yuppies, but not the hallucinating or high homeless person who has no access to running water or toilets.

The epidemic seems to be spreading from public defecation by street people. One article on the right wing site Breitbart said part of the spread was because plastic bags were banned, so street people could no longer bag their excrement. (/sarcasm).

but I am linking to them because they pulled their story from the local paper.

According to the San Diego Union-Tribune, something as simple as a ready supply of littered plastic bags may have slowed the spread of the outbreak.
“The reason the outbreak has spread so rapidly is because homeless are living in more concentrated areas,” said Dr. Jeffrey Norris, the St. Vincent De Paul medical director who has been managing the charity’s response to the public health threat. “They often have to defecate in their tent, or next to their tent, and that exposes their neighbors on the street. Hygiene becomes incredibly difficulty.”
By “taking away a manageable alternative to defecating outside a bathroom,” the article suggests county health workers have been forced to play catch up and spend more money “handing out thousands of ‘hygiene kits’ that include plastic bags.”

Here is another article from Kaiser news, that discusses the response, or lack thereof:

Health officials in California are struggling to contain fierce outbreaks of hepatitis A among homeless people and drug abusers in three counties, including San Diego, where at least 17 people have died.
Hundreds more have become ill and been hospitalized, mostly in the San Diego area, often not far from tourist destinations. The disease also has cropped up farther north in Los Angeles and Santa Cruz counties. Poor access to restrooms and sinks in homeless encampments is largely to blame.
Public health officials say the crisis has caught them off guard because it’s rare for the disease to spread so rampantly when it isn’t tied to a common source, such as a tainted food product. Meanwhile, as cases mount with no end in sight, critics fault authorities’ response as lethargic.
why the sluggish response? They are poor, and homeless. Many homeless are mentally ill and/or drug abusers, and some are aggressive if you bother them.

“We go into the canyons, we go everywhere,” said Amy Gonyeau, chief operating officer for the Alpha Project, a nonprofit that provides homeless services. “We go out every day. We have our own vehicles and vans … we educate people on what’s going on.”
On a recent morning, an Alpha Project team delivered hygiene kits — soap, hand sanitizer and other toiletries packaged in clear plastic bags — to a crowded encampment in downtown San Diego’s East Village neighborhood. Tents and shopping carts line the sidewalks in this section of downtown that’s largely hidden from the city’s tourists.
“It looks like a war zone,” said Larissa Wimberly, an outreach supervisor for Alpha Project. “There’s people out here with HIV, people out here with cancer, there’s people out here with heart issues. There are people who are just old and feeble and they’re not eating right. It’s really sad.”
As Wimberly rides shotgun in a large, white Alpha Project van driven by her colleague Cain Mariscal, she points to the myriad tents and shopping carts. Behind and between them, she says, many residents relieve themselves.
“It’s everywhere,” she says of excrement. “It’s just really bad right now.”

But the real reason: They are invisible.

 critics say health officials have been too slow to act, especially to install toilets and sinks.
“This whole crisis is man-made,” Michael McConnell, a La Jolla, Calif., coin dealer and advocate for homeless residents, told the San Diego Union Tribune in a story published Monday. “The response is certainly much too late, based on when they knew they had a serious problem. Even today, all they’ve done is the most easy stuff. They have taken zero bold action.”
Some told the newspaper that the reaction is symptomatic of a lackluster response to the problems of  poor and homeless people in their midst.
 all of this is basic public health. Their public health spokes person laments

“This is an unprecedented outbreak,” said Dr. Wilma Wooten, the county’s public health officer and director of Public Health Services for the  San Diego County Health & Human Services Agency. “This is new territory.”

sheesh: Unprecedented? Lady, where have you been.

Any doc who has worked in Zimbabwe or in the Philippines or even on the Native American reservations is aware of how these diseases spread.

give a call to the local National Guard or Reserve units and ask for a specialist on field hygiene and water supply.

I know there are a lot of military vets in the San Diego area, so it's not like no one knows this stuff.

Public toilets, or even open pit latrines with disinfection in wooded areas could be dug quickly, and regular toilets with running water could be supplied in a few weeks.

the military knows that disease causes more casualties than being shot at. So they hold regular courses on this for soldiers. LINK more HERE.

you mean, the head of public health hasn't bothered to do basic stuff that any army unit is taught to do (and could probably set up in homeless areas within a few weeks)?

It's basic public health: Or basic sanitation.

the local SDFreePress article (sept 2017) (a progressive paper) is quite blunt about it, and outlines the tepid response to the homeless in that city over the last year.

This explains the background to the epidemic: press conferences and plans being drawn up slowly but little action.


I should note: In rural Africa, one problem was that people relieved themselves in wooded areas: "go to the woods" was a euphemism for "go to the toilet".

But they would not use latrines because they smelled and were full of flies.

We started working with the schools on building latrines with fly traps and with instructions how to put in disinfection so that the smell would be minimal.

Here, men do their thing against walls, and the park downtown has public toilets with running water, but I don't know if anyone uses them.

We have our own septic tank (actually two: one for the house and one for the business compound). But most of the drainage just goes into the open air ditches that serve us for sewers.

Now that the open ditches are being made larger and are covered, it makes me wonder what will happen. I know our local jail drains into a crack in the ditch cover, but overflows badly....But we are rural Philippines, not a first world major city.

mark your calenders: International Toilet day is November 19.