The art of medicine

from SD:

doctors often rely on "gut feelings" when treating patients.

This used to be called the "art" of medicine.

some of this is observation (small clues, ala Sherlock Holmes, or of body language), and knowledge of the patient's background/history/culture.



and some of it is sensing emotions in the patient (so the teenager coming in for a cold seems a bit worried, and yes she is pregnant).

Breast is best

We always encouraged our moms to breast feed, and one problem was when milk formula companies peddled their products to poor women.

But as the kids got older, the parents couldn't afford formula, so watered it down and the kids ended up malnourished and often vulnerable to die from infections.

So when I read the headlines claiming Trumpieboy opposed breast feeding, I thought "WTF?"

No, not because I suspected fake news (I am used to nuances being twisted by the MSM against Trumpieboy), but because public health docs have pushed to stop this for years at the local level.

So making it a UN resolution means lots of money for UN bureaucrats to push their weight around, but not much else.

and my other question was: This issue has been around for years (we opposed this in the early 1970s) so why did it come up now, at a time when people in third world countries are a lot richer, and there are a lot more women who need to work outside the home and use formula because they can't breastfeed?

This is what I found back in the 1970s: breastfeeding was universal in rural Zimbabwe, where babies often were not weaned until 2 years old, but in urban Liberia, the patients and nurses pointed out that these women needed to work and so needed formula to feed their babies.

Nowadays, here in the Philippines, they often breast feed for up to a year, but again often supplement the child's feeding with formula.

TV ads here for formula often only are about older kids, and do insist that breast feeding is better.

what has changed in the last 40 years is that people are now richer.

Yes, there are poor people, especially in war torn countries, but as a whole, there is a lot less poverty around.

And insisting on breast feeding until one year of age means women would not be able to hold a job outside the family. Back to the good old days!

Hmmm... this is the real "Handmaiden's tale".

The Federalist has the backstory and indeed it is "fake news".

“The Trump Administration believes it’s a public health priority that women and their families have all the information to decide how to appropriately deliver nutrition to their children, whether it is via breastfeeding or other methods,” an HHS spokesman said. The agency pointed out that the United States has a long history of supporting breastfeeding and breastfeeding programs, and is the largest bilateral donor of foreign assistance programs in this area. Exclusive breastfeeding rates have doubled across 20 of countries where these programs have focused between 1990 and 2014, they say. The U.S. also supports complementary feeding programs and accurate description of the same as a matter of long-standing policy. The original resolution would have made that policy goal difficult, officials said.

infectious disease update

StrategyPage on Central Africa notes that there is a polio epidemic, thanks to BokoHarum, a small Ebola outbreak, and lots of refugees fleeing political infighting. Sigh.

 they also note China's investments there in mining for copper and cobalt, but that China is getting shafted and may have second thoughts on the deal.

but there is some good news: Volkswagon is making cars in Rwanda...
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Measles outbreak in Brazil originated in cases imported from Venzuela.

measles outbreak in Portland Oregon. No report on it's origin.

other recent measles outbreaks include Taiwan, Ukraine, Greece, Serbia, and Minnesota.

this disease is very infectious person to person: and it can kill, especially those with malnutrition or immune problems.

But more disturbing are diseases that are being spread by mosquitoes: such as Yellow Fever (in Brazil and Nigeria).

Brazil is fighting with vaccine, but there is a vaccine shortage. 
But habitat clean up is most needed (as in "drain the swamp" and use insecticides). The article blames people for moving into the jungle. Dang those poor people trying to make a living. But it is spreading to the cities, so maybe it is the lack of sewers to drain the rain and the failure of the gov't to spray high risk areas.

There was an epidemic in Angola back in 2916, that spread to the Congo and even to China, but they did manage to clean up the place and give out enough vaccines to stop it:

that was good news, because the same mosquito that carries dengue fever, which is endemic in East and south Asia, also could spread yellow fever.

And no, this moquito spread disease is not from global warming: Ask Dr Rush about the 1793 epidemic in Philadelphia.

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speaking of dengue: The newfangled anti Dengue vaccine that they gave out to stop the local epidemic here was found to make things worse.

Now they are checking if corruption/bribes led to the introduction of the vaccine prematurely.

Duterte, so far, is keeping his mouth shut, because it's not clear if it was corruption, or merely ignorance (and a coverup by the vaccine manufacturer about possible problems) that encouraged the government to buy and use the vaccine, which was originally tested and found to work in Brazil...

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related item: I put a few drops of medicine on my dogs to keep them free from ticks.

Time notes that this could work in humans, not just for ticks but for mosquitoes. (headup Instapundit.)

in the past, moms would put animal flea collars on their kids, but this is discouraged because they are toxic if the collar gets chewed on or even if it gets wet.

DEET works best, but the "natural" method is citronella of course: or eat Marmite.

it does't work very well, but better than nothing.

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essay crossposted from my main blog.

Hospice history

I Pad neck

from science daily: the latest occupation disease.

"iPad neck," sometimes called "tablet neck," is usually associated with sitting without back support, such as on a bench or on the ground, or slumping over the tablet while it rests in the user's lap.

Other postures significantly associated with pain included using tablets while lying on the side or back.

The condition is more prevalent among young adults than older adults. Women were 2.059 times more likely to experience musculoskeletal symptoms during iPad use than men. Those with a history of neck and shoulder pain reported experiencing more neck and shoulder symptoms during tablet computer use.

The Gosport scandal

My last rant might have sounded paranoid, but the problem is that very sick and dying patients can be "offed" if the doc is overworked (as happened with the deliberate Euthanizing of patients during Katrina) or just because.

The "protocol" for "terminal sedation" has been misued to kill people: but the protocol is actually guidelines to relieve severe pain: the problem is the physicians etc. want the patient to be dead.

( I might add: I was once accused of overdosing a dying patient who was moaning in pain and I had ordered doses of narcotics to be given until he was pain free...there is a small line here, but I should note that several patients who were given huge doses of sedation actually got better once the pain was relieved and the cause of their pain or infection was treated).

this would be kept quiet in the USA, but the UK papers have this about the Gosport scandal:

In 1991, Anita Tubbritt, a staff nurse working nights on an elderly ward at the Gosport War Memorial Hospital in Hampshire, asked to have a quiet word with her local union representative.

Mrs Tubbritt, along with a number of her colleagues, had become concerned over the way medical heroin was being administered to patients, who in their opinion did not require it.

On Wednesday, more than 27 years later, those concerns were finally acknowledged, when an independent inquiry concluded that more than 650 patients’ lives could have been prematurely ended by the “institutionalised regime” of prescribing and administering opioids without medical justification. In arriving at that conclusion, the Right...

that one is behind a pay wall, but here is the UKGuardian article about the scandal.

The independent report found that Dr Jane Barton, a GP working as a clinical assistant at the hospital, routinely overprescribed drugs for her patients in the 1990s.

consultants were aware of her actions but did not intervene. Nurses and pharmacists collaborated in administering high levels of drugs they would have known were not always appropriate.

Some senior nurses in 1991 tried to raise the alarm over using diamorphine – the medical name for heroin – for patients who were not in pain, administered through a syringe-driver pumping out doses that were not adjusted to each patient’s needs.

the whole issue of "assisted suicide" will not only encourage the depressed to think suicide is rational, but it will change the ethics of the medical profession to think that killing is okay, and hey, they will do it to "help" people.

“Handing over a loved one to a hospital, to doctors and nurses, is an act of trust and you take for granted that they will always do that which is best for the one you love,” Jones said in the introduction to the report.

 “It represents a major crisis when you begin to doubt that the treatment they are being given is in their best interests. It further shatters your confidence when you summon up the courage to complain and then sense that you are being treated as some sort of ‘troublemaker’.

Right now, there is a level of mistrust by minorities against doctors, and this is going to make it a lot harder to practice medicine .

Materialism kills

“Social Causes of Rational Suicide in Older Adults,” 

 Neoliberalism changed human relationships within society from a civil sphere that enshrined a commitment to social solidarity and collaboration among fellow citizens to that of a universal market where human beings are pawns in calculations of profits and losses. Rather than emancipation and freedom, the markets created atomization and loneliness... 

The declaration of aging as a disease, pathologizes aging as an entity to be shunned and avoided, in oneself and others.

and who benefits? well, it will cut medical bills. (/s)

 . .Clinicians should also feel empowered to speak up against agism and recognize it in themselves. Acceptance of the idea of rational suicide in older adults is in itself ageist. It implicitly endorses a view that losses associated with aging result in a life that is not worth living.

from the Journal of the American Geriatrics Society.
 via National Review.

it goes beyond this of course: you know, I have always worked with the poor, (mostly AmerIndians but also rural white and Hispanics). This is not a problem with them, because they still hold the idea of family and respect their elders as being a source of wisdom. And despite what outsiders see as "family dysfunction", the family is still there as the first line to help each other.

or as one of our caregivers told a neurologists who pressured the family to remove the feeding tube from an alert but brain damaged relative: That's the difference between you white folks and us Indians: we respect our elder.

But the real danger is something no one wanst to admit: That it is minorities who are most vulnerable to be pressured into "non treatment" decisions, or being the victim of removing "futile care" or even the victim of a doctor who "gives them morphine haha" instead of treating their stroke.

(I refer to a visiting doctor who suggested we do this to one of our admissions with a stroke: the attending merely said "we don't do things like that here", but the visitor was a resident from Baltimore, and I wonder how many black old ladies got "morphine, ha ha" without their families knowing what he was doing).

traditional societies and most religions see the elderly as a source of experience and wisdom, and my Objibwe patients put it: suffering as part of the road that the Great spirit wants them to travel, to be endured bravely (This is not just Amerindian: my geeky brothers said the same thing about his cancer).

Indeed, evolutionary scientists now recognize that grandparents were important to the evolution of humanity: because they help raise grandchildren, and they often teach from the wisdom of experience.

ah yes: The subcontext of pushing suicide is the expense of caring for the senile... but hints that this would also treat the handicapped who are now supposedly more common than they were in the past. But were they? This argument goes back to the days of Plato, and anyone living in "S***hole countries" know that a lot of families have one or two of these people being care for in their homes.

but of course, in the modern world, if you are busy caring for Grandmom (or your autistic son, or even your normal 2 year old) it makes it hard for you to be productive and work full time.

But the real underlying reason for this is that the western culture that stresses autonomy and success defines life in money terms. If you aren't successful, you are a failure. And this is one reason that a lot of folks are taking drugs (legal and illegal), to treat their internal angst of a meaningless life.

in contrast, we prevatican II catholics saw suffering to be endured and offered up as a prayer. Indeed, in traditional societies there is the idea that everything that happens to a person is for a reason: we may not know the reason, and like Job we may be angry at God for letting us suffer, but nevertheless there is a reason for us to live despite weakness and needing help.