Wednesday, June 28, 2017

Opiods not helped by reversal medicines?

UKMail article says

  • Police have found two Narcan-resistant strains of the opioid fentanyl in Georgia
  • Acrylfentanyl, linked to deaths in Illinois, can kill with just 0.00015 grams
  • Tetrahydrofureon, so new it is not on a banned drugs list, is lethal to touch

  • Read more: Follow us: @MailOnline on Twitter | DailyMail on Facebook

    Wednesday, June 21, 2017

    the new health care act

    one reason I went into the Indian Health Service was that I objected to the price controls in the HMO's and the fact they only treated their own people, i.e. the uninsured weren't seen.

     Of course, we did have rationing in the IHS too, but actually it wasn't much worse (and in many ways a lot better than working with the uninsured and under insured in my private rural practice.

    So two items for later reading

    Will th new version deny medical care to the most vulnerable and allow insurance companies to push suicide as a side effect of their cuts?

    NotDeadYet, a disability rights group, discusses the problem:

    The American Health Care Act (AHCA) is dangerous for people with disabilities. If passed, among other things, it will most likely eliminate affordable insurance coverage for people with pre-existing conditions, cut $834 billion from Medicaid over ten years (most people with disabilities, including seniors, rely on Medicaid for personal care, long-term care services and supports and durable medical equipment), and make drastic cuts in primary healthcare programs and services that low income people rely on. For people who live in states where assisted suicide is legal, this will be a deadly combination. Insurance companies will be more emboldened to deny people with life-threatening conditions the medications they need to save or prolong their lives, offering them, instead, the “option” of the suicide prescription. The lives of people with disabilities are already devalued, and doctors are likely to either intentionally or unintentionally influence, recommend or coerce their patients into assisted suicide, citing the financial burden they will be on their families. With services such as mental health on the chopping block in AHCA, newly disabled individuals, seniors or terminally ill people will have less access to these services, putting them at greater risk to succumb to coercion by unscrupulous family members, heirs, or caregivers ....

    read the whole thing.

    And then read Dilbert's take on the matter: No one understands the old bill except that it guarantees them health care, so replacing it will cause it to be unpopular.

    Family docs don't always follow elite "studies"

    I think that is that this article claims.LINK

    What they ignore: a lot of these "Evidence" studies ignore real life, and many are biase.

    often they are "Garbage in Garbage out".

    Often they are small numbers. Or a scholarly article that takes a lot of GIGO articles and summarizes them.

    Often the studies are of small numbers of people.

    Often they ignore cost, or hman beehavior For exaple, studies taht show newer medicines that cost a lot more work better, but the patients know their older meds. Or the experts decide taking many pills several times a day give a better result (eg when they stopped all those lovely combinations of medicines for blood pressure, so our patients had to take three pills a day instead of one: They don't like to take pills or forget to take the twice a day pill in the evening).

    And of course, they are assuming we are treating what we say we are. If a person comes in to complain about her husband for a half hour, we list her problem as blood pressure. But of course she isn't having a problem with her pills, so we don't chage them to the newest one. Or don't give any
    pills at all.

    And of cours no one wants to suspect a lot of drug companies bias the "evidence".

    Friday, June 9, 2017

    Legionaire's disease take two

    Longer cdc article on Legionaire's disease in health care facilities.

    Results: A total of 2,809 confirmed Legionnaires’ disease cases were reported from the 21 jurisdictions, including 85 (3%) definite and 468 (17%) possible health care–associated cases. Among the 21 jurisdictions, 16 (76%) reported 1–21 definite health care–associated cases per jurisdiction. Among definite health care–associated cases, the majority (75, 88%) occurred in persons aged ≥60 years, and exposures occurred at 72 facilities (15 hospitals and 57 long-term care facilities). The case fatality rate was 25% for definite and 10% for possible health care–associated Legionnaires’ disease.
    Conclusions and Implications for Public Health Practice: Exposure to Legionella from health care facility water systems can result in Legionnaires’ disease. The high case fatality rate of health care–associated Legionnaires’ disease highlights the importance of case prevention and response activities, including implementation of effective water management programs and timely case identification.

    Legionaire's disease from water birth (city water used)

    Two cases of legionaire's disease in infants who were born after mom had labor in water, aka water birth.

    is it the water supply from the city, or because the water got stagnant in the pipes?

    , it can be reduced by running hot water through the hose for 3 minutes before filling the tub to clear the hose and pipes of stagnant water and sediment. 

    Zika update from CDC

    Long article on Zika in pregnancy at the CDC site

    the good news: Microcephaly is rare.
    The bad news: it is ten percent:

     This report from the territories, with more robust late pregnancy data, suggests a risk for birth defects throughout pregnancy; further study is needed to confirm this finding. The percentage of infants with possible Zika-associated birth defects after infection identified in the first trimester was 8% (95% CI = 5%–12%) in the U.S. territories compared with 15% (95% CI = 8%–26%) in the U.S. states (5); the confidence intervals for these estimates overlap and both are based on relatively small numbers. In addition, for the analysis of the U.S. territories data, a more restrictive definition of confirmed infection, limited to NAT-confirmed infection, was used.