Black market organ donations.

I've been busy reading my old stash of Dean Koontz novels... He writes horror stories,  and a lot of them are on line as audiobooks at Youtube, but it's hard to fast forward the unpleasant parts as an audiobook, so I prefer to read them so I can skip the nasty parts.

But they are popular, and easily found in our used book kiosks here in the Philippines.

I was reading one I hadn't read before, Your Heart Belongs to me, is about hypertrophic cardiomyopathy and heart transplants. Interesting, because this is one cause of sudden cardiac death problems, and often isn't diagnosed until autopsy.

Because he is a novelist, he can describe how the symptoms affect a person: not just the pain but psychologically.

The protagonist is a nice guy who is a bill gates/Steve Jobs type... since Steve Jobs actually moved to a different state to get a liver transplant quicker, I suspect part of the story was inspired by is actions (although I'd have to check the dates for this).

Here is a 2009 article asking how he got on top of the list. Actually it makes sense. Not everyone is willing to donate an organ. And living in states where "good old boys" don't wear seatbelts and wreck their pickup trucks while smashing their brains is a good place to find an organ, especially since their good Christian parents will often sign for it, seeing an organ as a gift of life for someone else's child.

But it can look suspicious. When Pennsylvania Governor Casey quickly got a heart and liver tranplant, it did raise eyebrows. (His donor was a man who was mistaken for someone else and beaten up over a drug deal he had no part in).

But this also brings up another dirty little secret about transplants: Size.

Kidneys are place inside the abdomen, so no problem. Livers can be divided and given to several patients (and a parent can donate his left liver lobe to save his child's life... we sent one family to Chicago to do this, but alas the father's liver was damaged, and the child died of a brain hemorrhage relatedcd to the clotting problems of liver failure before they found another donor or decided his dad's bad liver was better than nothing). In transplants, sometimes the patient recovers too and lives longer without it, and in other cases, they have so many other problems they die despite transplant.

But for heart transplants, size is critical. Too small and the person can't survive, too large and it causes pressure on the lungs. And then there is the problem of splicing different size arteries and veins to each other.

A lot of transplant propaganda acts like people die "waiting for tranplant", but a lot of them don't fit the criteria either. I had one druggie who died in a prison hospital awaiting tranplant: he was just too sick and they couldn't find a liver... but I suspect his multiple problems were one reason someone else got the available organs (although since he was in prison, his unreliability was not an issue, but his other medical problems from drug abuse were).

Then we come to the "surprise surprise" part of the novel: The transplant was done in China.

This again is inspired by Harry's Kidney, a romp through China's organ donation system.

Romp is my word: The actual title states:

Larry's Kidney: Being the True Story of How I Found Myself in China with My Black Sheep Cousin and His Mail-Order Bride, Skirting the Law to Get Him a Transplant--and Save His Life

well selling kidneys in China, like selling them here in the Philippines, is no big deal, except that it exploits poor people. UKGuardian article here.

the dirty little secret is that China used organs from condemned prisoners.

Including those whose only crime was to belong to the Falun Gong, a Buddhist sect.

this was supposed to be stopped  awhile back, but this CNN article 2016 says it's still going on... and the number of transplants is grossly exaggerated by the Chinese government.

"The (Communist Party) says the total number of legal transplants is about 10,000 per year. But we can easily surpass the official Chinese figure just by looking at the two or three biggest hospitals," Matas said in a statement.
The report estimates that 60,000 to 100,000 organs are transplanted each year in Chinese hospitals. According to the report, that gap is made up of executed prisoners, many of them prisoners of conscience locked up for their religious or political beliefs.
China does not report its total number of executions, which it regards as a secret.
The report's findings stand in stark contrast to Beijing's claim that, since the beginning of 2015, China has moved from almost completely relying on organs from prisoners to the "largest voluntary organ donation system in Asia." 

Sigh.

So a famous novelist published a book about the problem.

But the book really about egotism, callusness to death, and...about redemption.

And in this one, the dog doesn't appear until the ending...

(Koontz joke: many of his novels have a dog companion to the good guys).

The disease making a comeback with the Heroin epidemic and gangs

A two part series in the NYTimes.  One Two

this is what I posted on my main blog about part one of the story:



Syphilis is back, and the NYTimes blames gangs, drug s and "uneducated doctors".

yes, Syphilis is spread by IV drug use, and this is about the heroin injection epidemic.

And in Asia/Russia, IV drug use, not sex, is the major cause of HIV...

the article notes they are going back to the good old days of tracing contacts (a practice that was discouraged when HIV became a protected disease).

But if you read way down in the article, you find that syphilis is common in another group: men who have sex with men.

When I was in medical school, we learned syphilis was the "Great pretender" because it looked like so many other diseases.

and the underbelly of evil is here:

Usually such efforts lead to sagas of unrelenting grimness: mothers who prostitute daughters, and men who forcibly inject runaways with drugs to hook them, a practice known as guerrilla pimping.

Something to remember the next time you hear a libertarian insist that "sex workers" like to do their jobs.

In the good old days (until it was stopped because there were so few cases, in the 1970's)  everyone admitted to a hospital got a screening test for syphilis because often people didn't know that they had been exposed, especially women.

Sigh. In our prayers.

------------

part two discusses how public health officials investiage contacts of those diagnosed with the disease.


read the whole thing.

But every day, the disease intervention specialists keep reporting the same harsh story, a growing specter of broken young lives....

Th

And where, exactly, are all the clergymen in the Bible Belt state?

yes, they are there, trying to help.

they do it for the money

Documentary film about male sex workers in Japanese bars. LINK

day of the heroes

one of  the local artists/ graphic artists came over to borrow a photo of Lolo's brother for a "day of the heroes" exhibition at the mall.

I sccanned a photo of him from one of the relative's albums, and posted it here to give to him on a thumb drive.

Fentanyll death rates soar

UKMail

The rate of deaths in US cities related to fentanyl overdoses increased 600 percent from 2014 to 2016, data from the Washington Post has shown The synthetic opioid can be ordered from China or bought from Mexico and is 50 times stronger than heroin The new report emphasizes the expanding role fentanyl is playing in America's drug crisis, especially in East Coast cities Read more: http://www.dailymail.co.uk/health/article-4802852/Fentanyl-death-rates-gone-600-percent-cities.html#ixzz4qG3uTz44 Follow us: @MailOnline on Twitter | DailyMail on Facebook

so stop blaming the doctors.

Damming river decreases snail linked disease in China

Schistosomiasis affects over 200 million people worldwide, but you have probably never heard of it.

One reason might be because it makes people weak, but doesn't kill a lot of people quickly in a dramatic fasion.

from SciDaily:

After they built the three Gorges dam in China, the number of snails decreased, as did the rate of snail related schistosomiasis.

Following the opening of the dam, they found, the volume of annual runoff into Dongting Lake declined by 20.85% and the sediment volume discharged into the lake declined by 73.9%. In turn, the mean density of living snails decreased by 94.35% and human rates of schistosomiasis decreased from 3.38% in 2003 to 0.44% in 2015, a reduction of 86.98%. The researchers hypothesize that low water levels in the summer and high levels in the winter led the lake to become an unsuitable environment for snails.

Rice growing in paddies requires a lot of contact with muddy water, so did people catch the disease from planting rice in the mud, or because they washed in the river water? One is curious.

this article suggests that growing rice in paddies in Uganda (and fishing with baskets) has increased the intestinal type of parasite. article is from 1994

In Eastern Uganda, paddy-rice growing, which has only become popular in recent years, seems to be associated with the emergence of schistosomiasis mansoni as a new problem in public health. 

the article suggests the farmers should wear boots, which gave me an LOL moment: the boots would sink into the thick mud. That is why we use handtractors or waterbuffalo instead of regular tractors in our rice fields.

this is a slightly different parasite than what we saw in Afro, but it makes me wonder if a similar drop was seen after other dams were built..

1975 article on the Aswan dam (Egypt).

An increase in the prevalence of schistomiasis in Egypt, as a result of the Aswan High Dam, has for long time been predicted because of reclamation of land and conversion of annual flooding (basin irrigation) into perennial irrigation in Upper Egypt.

Two aspects, neglected in the predictions, have been investigated in the present study, and these are: the ecological changes, relevant to the transmission of the disease, in the Nile itself, and those in irrigation canals and drains in areas which had been under perennial irrigation before the constriction of the dam.

The findings indicate that the Nile, at least in the Delta, has become a favorite habitat for breeding of the snail hosts of both urinary and intestinal schistosomiasis, a center for human activities and evidently for transmission, and that irrigation canals and drains now harbor throughout the year undisturbed and stable populations of these snail hosts.

This has resulted from the elimination in these canals, of the so-called 'winter closure', because it is no more needed. Before the dam the closure was enforced for about 40 days, during which the canals were closed and dried up, and the silt deposited on their beds during the Nile flood dredged out together with the snails and aquatic weeds.

translation: The irrigation canals no longer dry up so there are more snails.

here is a 1979 Lancet reference that compared the population data with data from 1935 and found the urinary parasite decreased but the intestinal form (that can affect the liver) increased quite a bit.

The prevalence of Schistosoma mansoni infection had increased from 3.2% to 73%, whereas S. haematobium infection, which had been very common in 1935 (74%), had almost disappeared (2.2%).

So what about other areas of Africa? we had quite a few small irrigation dams in Zimbabwe (the veldt is dry and with irrigation you can grow two crops a year).

But  ppeople tended to get the urinary type infection from swimming or bathing or washing things in the rivers so changes could also be from digging wells to supply water..

Here is a study in Senagal, Zambia and Mali (sub saharan Africa).

Recent ecological changes caused by the construction of dams at Diama and Mananatali on the Senegal River, such as reduction in salinity, more stable water flow, creation of irrigation canals and development and extension of rice culture, have contributed towards the occurrence of new outbreaks of both intestinal and urinary schistosomiasis in the Senegal River Basin

 In Mali, the four main areas of high prevalence of S. haematobium are Office du Niger (irrigation areas), Bandiagara (small dams), Selingué (dam areas) and Baguineda (irrigation areas). Apart from the Office du Niger, S. mansoni infections are rare.

again, one wonders if the infection is caught during planting/weeding in rice paddies (or in mud) or just from bathing or contact with the water from the canals.

The entire article is not available.

finally, the Uganda article notes that the rice growing was a new project.

In more recent years, China (and Saudi) are buying up land in Africa for agriculture. Will this include rice growing and increase intestinal schisosomiasis?

related article: Chinese returnees are bringing back the intestinal and urinary forms to their native country.

heh. the article blames climate change.

but it does show that globalization can spread diseases that are "below the fold" and pretty well ignored by the world.

nor is this a new problem:
here is an article about the British soldiers getting infected during the Boer war and the Yanks getting infeccted in the Philippines during World War II.

prevention was the key:

3. * * *. The following precautions will be observed: (a) All water used by troops will be obtained from approved water points * * *. This is meant to include water used for drinking, bathing, laundry, and washing of vehicles or floors. (b) Wading, bathing, and washing of clothing by troops in any fresh water river, swamp, pond, or rice field is prohibited * * *.

a report on the problem in the Philippines: and it is worse in the southern regions.

Schistosomiasis japonica has a long history in the Philippines. In 1975, 24 endemic provinces were identified in the northern, central, and southern islands of the Philippines. More than five million people were at risk, with approximately one million infected. In 2003, new foci of infection were found in two provinces in the north and central areas. For the past 30 years, human mass drug administration (MDA), utilizing the drug praziquantel, has been the mainstay of control in the country. Recent studies have shown that the schistosomiasis prevalence ranges from 1% to 50% within different endemic zones. Severe end-organ morbidity is still present in many endemic areas, particularly in remote villages with poor treatment coverage. Moreover, subtle morbidities such as growth retardation, malnutrition, anemia, and poor cognitive function in infected children persist.

There is now strong evidence that large mammals (e.g. water buffaloes, cattle) contribute significantly to disease transmission, complicating control efforts. Given the zoonotic nature of schistosomiasis in the Philippines, it is evident that the incidence, prevalence, and morbidity of the disease will not be controlled by MDA alone. There is a need for innovative cost-effective strategies to control schistosomiasis in the long term.

so in the Asian parasite, water buffalo are part of the problem...discussion here.

hmm... wonder if anyone has done a study comparing areas tat use waterbuffalo vs handplows.

JAMA: Racism in medicine?

Poverty kills... or maybe racism kills. JAMA explains why black babies have a higher death rate but notes it is going down.

A lot of the deaths are related to maternal complications or prematurity.

 No comparisons of black children with immigrants (including immigrants from Africa or the West Indies)  or Hispanics, so we don't know if it is racism per se, or poverty, or the barriers to access medical care.

and if it is an access problem, we don't know if it is urban (where long lines in huge clinics where you see the doc of the day discourage folks) or if it is rural (where no docs at all).

Yes there is racism in medicine: I saw a lot when I worked for the IHS.

There are also programs to recruit docs for inner city and rural "underserved areas"... alas like the IHS often it is short term stuff, and the worst one was where they subsidized you for two years then you were on your own (and left with huge numbers of patients who didn't or couldn't pay their bills, or waiting for months to get paid a pittance for Medicaid, provided they didn't turn you down for not dotting your "i's" or crossing your "t's" correctly... hmm.. wonder if Obamacare improved this).


The dirty little secret behind high childhood mortality in the black community is Sickle cell disease, which if it hit cute blond kids would have TV marathons raising money for a cure.

However, Sickle cell disease usually doesn't kick in for a couple months after birth (when the fetal Hemoglobin is replaced with adult hemoglobin).

But I wonder about things like high blood pressure complicating the mix.