Disease also kills: Civil war edition

StrategyPage has a review of a recent book about non combat deaths in the US Civil war....

Willis opens by pointing out that for both sides taken together, combat deaths amounted to perhaps a third of all deaths. He then sets out to explain how the other two-thirds perished.

Naturally disease was by far the biggest killer, causing most of the non-combat deaths, particularly early in the war as volunteers flocked to improvised training camps.

Mostly men of rural origins – even most Northerners – the recruits usually lacked immunity to many commonplace diseases, and died in droves. Dysentery was apparently the biggest killer, acquired from bad food or water, but malaria and pneumonia were up there as well.

Wills also looks at other causes, which seem to have accounted for about a tenth of all deaths. Accidents ranged from drowning to weapons malfunction or misuse, lightning strikes, sun stroke, falls, even snake bites. And there were also some murders, suicides, deaths in duels, executions, and others.

CSPAN has a discussion here. (R rated)






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related items:

The Swamp Doctor's adventures in the southwest ebook

Reminiscences of a Southern Hospital, by Its Matron

Bye Bye Guinea worm

SPL/Science Source

NPR report: the Guinea worm is almost completely eradicated:

Guinea worm is a horrific infection. First, a painful blister starts to form on the skin. Then a thin, white worm — up to 3 feet long — emerges from the blister over the course of a few weeks. It is an incredibly painful process and temporarily handicaps a person while he or she waits for the worm to come out of the skin...

People catch Guinea worm by drinking contaminated water. Simply filtering drinking water can stop transmission of the parasite. An infected person can also stop the spread of the parasite by keeping the emerging worm away from water. When the worm touches water, it releases tens of thousands of baby worms and contaminates the whole body of water.

the bad news: There is no drug to kill it. You freeze the breathing hole (or bathe the area in cold water) and the worm starts to come out, and you pull it out slowly until it is out, which takes time.

You can freeze the entire worm, and it will shrink inside. We used ethyl Chloride spray for this. But that can cause a bigger infection, so it is only used if the worm is very small... and these worms are very long.

You can also remove it surgically, but again it would be a big incision and a larger area to get infected.

thanks to Jimmy Carter who was behind the initiative to get rid of the worm.

via Instapundit:

monkey pox

CDC reports on outbreaks of monkeypox in several African countries.

several reasons for this: deforestation, "bush meat" trade (i.e. eating monkey meat), and because smallpox vaccination gave people protection, but now that Smallpox has been eliminated and the vaccination stopped, people no longer have this immunity.

the mortality is ten percent, but many cases occur in areas with suboptimal health care, so the real extent is not known.

WHO REPORT on December's outbreak in Nigeria.

From 4 September through 9 December, 172 suspected and 61 confirmed cases have been reported in different parts of the country. Laboratory-confirmed cases were reported from fourteen states (out of 36 states)/territory: Akwa Ibom, Abia, Bayelsa, Benue, Cross River, Delta, Edo, Ekiti, Enugu, Lagos, Imo, Nasarawa, Rivers and Federal Capital Territory (FCT). Suspected cases were reported from 23 states/territories including: Abia, Adamawa, Akwa Ibom, Bayelsa, Benue, Cross River, Delta, Edo, Ekiti, Enugu, Federal Capital Territory (FCT), Imo, Kaduna, Kano, Katsina, Kogi, Kwara, Lagos, Ondo, Oyo, Nasarawa, Niger, and Rivers.

The majority of cases are male (75%) and aged 21–40 years old (median age = 30 years old). One death has been reported in an immune-compromised patient not receiving anti-retroviral therapy. Clustering of cases has occurred within states, however there is no known evidence of epidemiological linkages across states. Further, genetic sequencing results of the virus isolated within and across states suggest multiple sources of introduction of the virus into the human population. Further epidemiological investigation is ongoing....

 Monkeypox, a rare zoonosis that occurs sporadically in forested areas of Central and West Africa, is an orthopoxvirus that can cause fatal illness. The disease manifestations are similar to human smallpox (eradicated since 1980), however human monkeypox is less severe. The disease is self-limiting with symptoms usually resolving within 14–21 days. Treatment is supportive. This is the first outbreak in Nigeria since 1978. The virus is transmitted through direct contact with blood, bodily fluids and cutaneous/mucosal lesions of an infected animals (rats, squirrels, monkeys, dormice, striped mice, chimpanzees amongst others rodents) Secondary human-to-human transmission is limited but can occur via exposure to respiratory droplets, contact with infected persons or contaminated materials.

the question is why the outbreaks didn't spread to more people. This is probably good news, meaning an epidemic is less likely.

yeah. Blame docs for street drug overdoses

I am sick and tired of being told that if we docs had given our patients non narcotics for pain, there would not be an opioid epidemic.

a picture is worth a thousand words:''

the push to relieve pain, even if it mean using narcotics, started in 2000.

Some of those drugs resulted in addiction, but more were used, sometimes in high doses, and allowed people to live pain free.

A lot of the "natural and semi synthetic opioids", i.e. codiene, morphine, etc, are pain killers. Some were of course stolen or diverted/sold and caused overdoses by those not prescribed the medicine. Others caused overdoses to commit suicide, or because the person was mixing drugs or decided to take an extra dose either to relieve pain or (alas too common) to get high..., or (in the elderly) became weak or confused and the drug slowed their respiration enough to cause death. (i.e. accidental overdose).

But the real increase is in heroin or Fentanyl, both drugs bought and sold on the street.

notice the spike since 2010?

That isn't docs: that was street drugs. The drug dealers knew Marijuana was being legalized, so were switching their product. And since they already catered to folks who like to get high, guess what happened?

every thing costs more. duh

Scidaily reports why health care costs have gone up:

the major drivers of high healthcare costs in the U.S. appear to be higher prices for nearly everything -- from physician and hospital services to diagnostic tests to pharmaceuticals -- and administrative complexity.

administrative complexity, as in paper work.

and higher cost for drugs and equipment.

But commonly held beliefs for these differences appear at odds with the evidence, the study found. Key findings included:

Belief: The U.S. uses more healthcare services than peer countries, thus leading to higher costs. Evidence: The U.S. has lower rates of physician visits and days spent in the hospital than other nations.

Belief: The U.S. has too many specialists and not enough primary care physicians. Evidence: The primary care versus specialist mix in the U.S. is roughly the same as that of the average of other countries.

Belief: The U.S. provides too much inpatient hospital care. Evidence: Only 19% of total healthcare spending in the U.S. is spent on inpatient services -- among the lowest proportion of similar countries.

Belief: The U.S. spends too little on social services and this may contribute to higher healthcare costs among certain populations. Evidence: The U.S. does spend a bit less on social services than other countries but is not an outlier.

Belief: The quality of healthcare is much lower in the U.S. than in other countries. Evidence: Overall, quality of care in the U.S. isn't markedly different from that of other countries, and in fact excels in many areas. For example, the U.S. appears to have the best outcomes for those who have heart attacks or strokes, but is below average for avoidable hospitalizations for patients with diabetes and asthma.

so what costs so much?

Administrative costs of care -- activities related to planning, regulating, and managing health systems and services -- accounted for 8% of total healthcare costs, compared with a range of 1%-3% for other countries. 

Per capita spending for pharmaceuticals was $1,443 in the U.S., compared with a range of $466 to $939 in other nations. For several commonly used brand-name pharmaceuticals, the U.S. had substantially higher prices than other countries, often double the next highest price. 

The average salary for a general practice physician in the U.S. was $218,173, while in other countries the salary range was $86,607-$154,126.

Stephen Hawkings: showing disability doesn't mean inability

BBC notes the Hawkings helped public see disability differently.

Prof Hawking's only advice on disability was to focus on what could be achieved.
"My advice to other disabled people would be, concentrate on things your disability doesn't prevent you doing well, and don't regret the things it interferes with. Don't be disabled in spirit, as well as physically," he said in an interview with the New York Times.

Perfumes, bah humbug

I sneeze when exposed to pollen, perfume, or some cats,and during allergy season, my chronic nasal stuffiness morphs into asthma. Often it is a combination: during hayfever season, things I could normally tolerate cause problems.

I found cortisone based nasal spray worked fine, and during allergy season, a cortisone lung inhaler as prevention.

An alternative (which I use here in the Philippines) is anti histamines, but they make me sleepy, so I keep the dose to a minimum, mainly at night, and run my airconditioner for sleeping: even when it is cool, I use the air con fan and a hepa filter in the aircon. 

and I develop nervousness and dermatographia when I eat too much at salad bars, foods with nitrates, bagoong, or eat too many big macs. So I avoid such things, which is easy here in the Philippines.

But at women's conferences, they make a big deal of this: no perfumes especially. Well, since perfumes were first made to cover up body odor, or to attract men, I can't figure out why women would overdo perfumes at feminist converences anyway.

Well, this Science daily article claims:

One in four Americans suffer when exposed to common chemicals...University of Melbourne research reveals that one in four Americans report chemical sensitivity, with nearly half this group medically diagnosed with Multiple Chemical Sensitivities (MCS), suffering health problems from exposure to common chemical products and pollutants such as insect spray, paint, cleaning supplies, fragrances and petrochemical fumes.

well, this found all the "green" enemies of course, leaving out the "organic" stuff like bagoong and pollen.

But you know, most of us never went to a doc to get diagnosed for such things, and I had less than a half dozen patients with "multiple chemical sensitivities" as a diagnosis (and most of them were neurotic women).

The study also found that 71 per cent of people with MCS are asthmatic, and 86.2 per cent with MCS report health problems from fragranced consumer products, such as air fresheners, scented laundry products, cleaning supplies, fragranced candles, perfume and personal care products. In addition, an estimated 22 million Americans with MCS have lost work days or a job in the past year due to illness from exposure to fragranced consumer products in the workplace.

again, asthma? Really? or is this from pollen, cigarette smoke, etc.

so 22 million Americans lot days from work because of perfume?

really?

Sheesh. just take a Clariten and work on, ladies.

and I say "ladies" because I suspect they are neurotic ladies.

Every couple of years, there is a new fad explaining why they are neurotic and you get studies like this.

and I have all of these problems: Neurosis, allergies, sensitive to "chemicals" (e.g. sneeze with perfume), hypoglycemia (and have the GTT to prove it).

Like my aches and pains from arthritis, you cope.

But why do I think this is a study to prove the evils of modern chemicals? In this case, perfume:

To reduce health risks and costs, Professor Steinemann recommends choosing products without any fragrance, and implementing fragrance-free policies in workplaces, health care facilities, schools and other indoor environments.

I should note that in Idaho, where dry skin was a problem, I did have a lot of people who itched from perfumed soap and/or fabric softener in their clothing. But again, I didn't see this as much in areas where the humidity was higher.

so why does the article annoy me? Because it "medicalizes" ordinary aches and pains.

We went into medicine to treat the sick, not to treat ordinary aches and pains and minor stuff that most people in the past managed to live with, without making a "federal case over it", as the saying goes.

But then, the expresssion "don't make a federal case about it" no longer applies given the huge expansion of federal law to punish trivia.

It's the placenta stupid

many many years ago, when a lot of us GP's got out of Obstetrics because of the sudden huge increase in our malpractice insurance due to lawsuits over brain damaged babies, we were told that we should have all placentas examined for inflammatory and other changes, to prove the brain damage occured before birth (i.e. toxins, viruses, etc).

Science Daily reports on one prenatal cause that has been dicovered that are causes of dead babies or late miscarriages.

The role of the placenta in fetal development is being seriously under-appreciated according to scientists. A team studied 103 mutations linked to prenatal death in mice and showed that almost 70 percent affect the placenta. The team also found that some placenta defects could be directly linked to the cause of death. As such, a significant number of prenatal deaths may be due to the placenta, not just the embryo.

transgender problems

VirtueOnLine has a summary of various of longitudinal studies of transgender people.

In her sworn declaration to the federal court, Adkins called the standard account of sex--an organism's sexual organization--"an extremely outdated view of biological sex."

Dr. Lawrence Mayer responded in his rebuttal declaration: "This statement is stunning. I have searched dozens of references in biology, medicine and genetics--even Wiki!--and can find no alternative scientific definition. In fact, the only references to a more fluid definition of biological sex are in the social policy literature."

Just so. Mayer is a scholar in residence in the Department of Psychiatry at the Johns Hopkins University School of Medicine and a professor of statistics and biostatistics at Arizona State University. Modern science shows that our sexual organization begins with our DNA and development in the womb, and that sex differences manifest themselves in many bodily systems and organs, all the way down to the molecular level.

In other words, our physical organization for one of two functions in reproduction shapes us organically, from the beginning of life, at every level of our being. Cosmetic surgery and cross-sex hormones can't change us into the opposite sex. They can affect appearances. They can stunt or damage some outward expressions of our reproductive organization. But they can't transform it. They can't turn us from one sex into the other. "Scientifically speaking, transgender men are not biological men and transgender women are not biological women. The claims to the contrary are not supported by a scintilla of scientific evidence," explains Mayer.

as one writer quipped: They don't want to be women: They want to be teenaged prom queens.

Various studies show most men continue to be promiscuous as men.
Some are gay, of course, and there is a lot of confusion between transgender and cross dressing queens.

Women, however, are also complicated: Often they are lesbians or others who just want to have the freedom of a male role model.

the local transvestites and gays are part of society here in the Philippines, no big deal. Family ties are more important to acceptance than morality or a political agenda.


but the problem with the "gender" and "transgender" arguments that I have read it that they are not about people with gender identification disorders, but actually about an agenda that wants men and women to be interchangable, marriage to be anything they want it to be, and with a hatred of normal sexuality.

In other words, the radicals have taken over, with a broad gender agenda.

One suspects the ordinary folks who just want to be accepted for who they are are the real victims and be blamed for the radicals who insult and even persecute those who are old fashioned enough to say "but it moves he has a Y chromosome"

pushing non narcotics with fake news

when I was in medical school, we learned that the only pain killer that worked better statistically than various pain killers was morphine. The reason? There is a large placebo effect.

So the placebo effect screws up the data.

I remember an anecdote about a doctor who gave out "green pills": ordinary sugar pills, with a long lecture. Or docs who would give prescriptions of them, to increase the placebo effect. And of course, expensive pills work better than cheap ones.

the whole point is that NSAIDs and tylenol are often cheap and over the counter: make them expensive and they will work better because of the placebo effect.

Similarly, I once heard a lecture by a nephrologist about the problems of NSAIDS in causing kidney disease/failure. But after the lecture, he was asked what he took, and he admitted that he took NSAIDS because the pain relief from Tylenol was lousy.

In my own life, I prefer NSAIDS: even after surgery, I found better pain relief from this than the pecocet that I was prescribed, but you know, in the post op period, the problem was they were giving me two percocet every six hours, meaning I slept for three hours, was good for one, and hurt for two hours. So I took the pills and hid one and gave myself the medicine as needed, not as prescribed.

This is also why long acting medicines (MSContin, Fentanyl patches) work so well: They relieve pain without sedation, without the swing from high to low.



So now the NYTimes is insisting tylenol works as well as narcotics for osteoarthritis pain.

“Should we use opioids if nonopioids don’t work?” asked the lead author, Dr. Erin E. Krebs of the Minneapolis Veterans Affairs Health Care System. She answered her own question: “No. We tried four different nonopioids — don’t give up on them too soon — and we should also be using exercise and rehab for most osteoarthritic pain.”

the study was in the VA system. So not a broad population group.

and remember: Most people just buy over the counter medicine in the first place for this type of pain, so those needing pain pills come for one of three reasons:

one: They hurt despite over the counter medicine. (the reason assumed in the study). Of course, being motivated to be in a study makes the pills magic, and maybe you will take the pills correctly for pain relief, (you have to take pills on schedule so severe pain never develops: Wait until you can't stand the pain and it takes a much higher dose. using over the counter medicine is taken as needed, rarely according to schedule)...so some will get better pain relief for this reason.

two: They are druggies (how many of the drop outs are these).

Three: The pills are free and they think they are getting magic pills that work because they are in a clinical study. In other words, a better placebo effect.

25 people out of the 240 who finished the study means that ten percent dropped out.

long discussion of the problem of drop outs in clinical studies.


Did they drop out because they hurt?

And how many self medicated with alcohol or borrowing a pain pill.

the P pare not that good either.

In other words, for chronic arthritis, of course you use NSAIDs when possible or tylenol. But how many couldn't sleep at night? (I often gave my patients just a few percocet for night pain).

and how many developed bleeding ulcers or renal problems from the non opioids?

update:

The Power of Nothing: a 2011 article from the New Yorker.

Female cricumcision and problems in chid birth

the TNStar has an article on doctors/ midwives who have to cope with obstructed labor from the scar tissue from "female circumcision"..

a lot of women having their first baby get a small downward cut called an "episiotomy" to make labor shorter. But after the severe type of female circumcision, the scar tissue is so bad you have to cut upward too.

that hasn't stopped the PC feminist types from defending the mutilation:

While WHO is working to eradicated FGM, two U.S. OBGYNs in 2016, published a paper in the Journal of Medical Ethics by seeking to destigmatize FGM by calling it “female genital alteration.” They offer a “compromise solution” that would medicalize FGM if states would “legally permit de minimis FGA in recognition of its fulfillment of cultural and religious obligations…”

Why, yes. We ran into this among our Muslim ladies in Liberia.

the custom predates Islam, and Mohammed, knowing he couldn't eliminate the custom, advised to "just cut a little".

In Arab and North African countries. the removal of all external

genitalia (clitoris, labia minora and labia majora) is still done.

but a small clip of the sheath of the clitoris could be substituted without causing problem.

Rabies: Still a threat: 60 000 cases a year

This article from the CDC is about a few women in VietNam who didn't get anti rabies vaccine after being bitten because they were pregnant or breastfeeding and worried it would harm their fetus.

But the article includes this terrible fact:

Most of the world’s estimated 60,000 annual rabies deaths occur in countries where canine rabies is endemic and where PEP is often inaccessible to bite victims (4).

but cases have decreased in Vietnam thanks to the availability of the antirabies vaccine:

Vietnam has made progress in reducing human rabies deaths. The number of human rabies cases declined 82%, from 505 cases in 1994 to 91 in 2016 (3). The expansion of PEP centers in the country has played a critical role in this reduction by increasing access to PEP. 

this chart is from the Philippine health dept: we have about 200 cases a year here, and there is a push to eliminate cases by providing the shots, and also dog control.

our new mayor has started providing free post exposure rabies vaccine at the local health clinics.

Alas, they keep running out of the free vaccines, so I have provided money for two people in the last three months so their kids can finish the series of shots. (650 pesos a shot, four shots: that is 13 US dollars. But the minimum wage here is 300 pesos or six dollars a day, so you can see the problem).

Stray dogs are a problem: The authorities will pick them up (and kill them, infuriating PETA and their ilk). But stray dogs are miserable: Thin, mangy, and usually shy.

But most of the bites are from neighbor's dogs, who weren't vaccinated.

The government does have rabies shot clinics in our farm areas, for farm dogs to get shots, and you can get free shots here for the dogs if you know when they hold the clinic, but not everyone is doing it.

We usually pay to have the vet come here and give Rabies shots to all our dogs in May each year. It is cheaper than paying for vaccine when a visitor gets bitten. Not just by George, our killer lab (who used to bite anyone who got close to him even though he is chained at all times) but even Joy's masseuse was bitten by one of our small pet dogs who didn't recognize she was a friend.

and this audiobook tells the story of rabies:

Opioid overdoses in the ER

CDC report

Among approximately 45 million ED visits reported by the 16 ESOOS states from July 2016 through September 2017, a total of 119,198 (26.7 per 10,000 visits) were suspected opioid overdoses. Opioid overdose ED visits increased 34.5% from third quarter 2016 to third quarter 2017 (Table 2). Ten states experienced significant increases in prevalence during this period, although substantial variation was observed among states in the same region. For example, in the Northeast, significant increases occurred in Delaware (105.0%), Pennsylvania (80.6%), and Maine (34.0%), but other states, including Massachusetts, New Hampshire, and Rhode Island experienced nonsignificant (<10%) decreases. In the Southeast, a significant increase (31.1%) occurred in North Carolina, a significant decrease (15.0%) occurred in Kentucky, and a small, nonsignificant decrease (5.3%) was observed in West Virginia. In the West, a significant increase (17.9%) occurred in Nevada. All states in the Midwest reported significant increases, including Wisconsin (108.6%), Illinois (65.5%), Indiana (35.1%), Ohio (27.7%), and Missouri (21.4%).

All urbanization levels experienced large and significant increases in ED opioid overdose visits from third quarter 2016 to third quarter 2017, including large central metropolitan (54.1%), medium metropolitan (42.6%), small metropolitan (36.9%), micropolitan (23.6%), large fringe metropolitan (21.1%), and noncore (20.6%) areas. Large central metropolitan areas experienced significant linear increases (Figure 2).

most are in urban areas in the midwest.

 one interesting item is that xanax laced with fentanyl is now being sold in the street.

Drugabuse.com:

Most buyers simply don’t realize they’re getting something totally different than what they intended to purchase, especially when this new counterfeit Xanax is made to look exactly like a 2mg Xanax pill. It even bears the fake “XANAX” label, along with boasting a similar size, shape and color. Some of these fake pills are so good, in fact, even forensic scientists can’t tell the difference just by looking at them. That’s just how good these counterfeiters have become at manufacturing Xanax dupes.

what is not being said: Most of the fentanyl comes from China, as does these "counterfeit" xanax pills.

FoxNews: it is a popular "party" drug and popularized by the hip hop music industry types:

Xans have been glorified by hip hop artists in the music industry, they’ve appeared in numerous of their music videos, and they’re being sold all over social media, especially Instagram, including by a popular DJ in the San Fernando Valley.
“I think the reason Xanax is popular with the kids is it’s being popularized in music, social media platforms, it’s in almost every song, my son even asked me what’s molly Percocet, and he’s nine years old,” Whitfield said. “Fentanyl has been pouring in from China, where there are looser regulations and an abundant amount of pharmaceutical companies...

 The DEA told FOX 11 that fentanyl has been pouring into the United States from China, where there are looser regulations and numerous pharmaceutical companies, and that between 2014 and 2016 the amount that was seized coming into the US went up eighteen fold.
2017 is expected to be even worse.

CNN report here.

Pill presses -- which can easily be bought online -- allow someone to take powder and press it into a pill that looks legitimate. "People have died from ingesting what they think is a legitimate painkiller, (but really) it's a counterfeit pill that contains fentanyl," Martin said.
Across the country, authorities have seen this play out.

The Fentanyl comes from China, often is bought via the dark net, and the pill making machines are also from China.

 Most come from China. That's where much of the illegal fentanyl is manufactured, as well. Clandestine Chinese labs manufacture a synthetic version of fentanyl that is easily bought on the dark Web. Mexican drug cartels later began to buy it and resell it across the border.

the problem? This was not an unforseen problem.

This April 2016 article on STAT warned of the problem. and the article notes that the CDC first noted the problem as far back as 2015...

in other words, while the Obama administration was making it hard for docs to give pain pills to their old folks who were hurting, they knew most of the problem was illicit opioids.

lots of details in the article:

T

he dozen packages were shipped from China to mail centers and residences in Southern California. One box was labeled as a “Hole Puncher.”

In fact, it was a quarter-ton pill press, which federal investigators allege was destined for a suburban Los Angeles drug lab. The other packages, shipped throughout January and February, contained materials for manufacturing fentanyl, an opioid so potent that in some forms it can be deadly if touched.
When it comes to the illegal sale of fentanyl, most of the attention has focused on Mexican cartels that are adding the drug to heroin smuggled into the United States. But Chinese suppliers are providing both raw fentanyl and the machinery necessary for the assembly-line production of the drug powering a terrifying and rapid rise of fatal overdoses across the United States and Canada, according to drug investigators and court documents.

and the article notes that it is also a problem in Canada:

In British Columbia, police took down a lab at a custom car business that was allegedly shipping 100,000 fentanyl pills a month to nearby Calgary, Alberta where 90 people overdosed on the drug last year. The investigation began when border authorities intercepted a package in December containing pharmaceutical equipment. Police would not describe the equipment but told STAT it came from China.

the "opioid" crisis was blamed on doctors, of course. Ignoring that it wasn't patients in pain who were overdosing but druggies, young people who were into the party culture, etc.

Yes, we often hear of all those tragic deaths about a teen/young person who just borrowed a pill to go to sleep and died. But you know, I am cynical: how did that young person know who was selling pills?

It's not like our old ladies who would sell their pain pills when they needed cash, or lend them to a friend who was hurting, but also buy one when their arthritis kicked up. That is friends to friends.

In these cases, it is bought from street dealers who are known.

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

one note: it's nice to say give non opioids to people for pain.

I take a lot of NSAIDS for various problem in the past, and now for osteoarthritis.

But the dirty little secret is that these pills have side effects on the kidney (and heart) and cause bleeding ulcers if you take a lot, or even at normal doses in the elderly. Long review article from AgingDis:

PMC full text:

Aging Dis. 2018 Feb; 9(1): 143–150. Published online 2018 Feb 1. doi:  10.14336/AD.2017.0306 Copyright/License ►Request permission to reuse

Table 1

NSAIDs’ common adverse effect profile.

Gastrointestinal toxicity	•Dyspepsia •Gastroduodenal ulcers •GI bleeding and perforation
Cardiovascular adverse effects	•Edema •Hypertension •Congestive heart failure •Myocardial infarction •Stroke and other Thrombotic events
Nephrotoxicity	•Electrolyte imbalance •Sodium retention •Edema •Reduce glomerular filtration rate •Nephrotic syndrome •Acute interstitial nephritis •Renal papillary necrosis •Chronic kidney disease

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

update: Article from the PhilInquirer (9-2017) about Chinese illicit drug business in the Philippines.

here the main problem is "Shabu" aka meth.

Whether the Senate inquiry amounts to substantive amendments to Republic Act No. 9165 (or the Comprehensive Dangerous Drugs Act of 2002) remains to be seen. But the probe highlights the fact that China, President Duterte’s newfound ally, is the biggest exporter of shabu and its precursors not only to the Philippines but also to other countries.

Known in the trade as “cooks” and “chemists,” meth production experts are flown into the Philippines from China by drug syndicates to work in laboratories like the one recently dismantled on Mount Arayat in Pampanga.
Synthetic drug manufacturers in China have been able to ply their trade due to the country’s large and loosely monitored chemical industry.

One report said the lack of regulatory practices in China has made it easy for crime syndicates to divert chemicals with legitimate uses, such as fertilizer, pesticides and medicine, toward the production of addictive drugs.

Read more: http://opinion.inquirer.net/107267/drugs-china-bigger-threat-ph#ixzz590s2SJ37 Follow us: @inquirerdotnet on Twitter | inquirerdotnet on Facebook