Dying alone in Japan

There is a bestselling manga in Japan called "stargazing dog" about a middle aged man who was fired from his job due to downsizing, had his wife and children leave him, and ended up dead of neglect in the middle of a field.

the author insists it was not a sad book.

A manga titled “Stargazing Dog” starts with the discovery of the skeletal remains of the protagonist who lost his job and family and died in an isolated field with his dog at his feet. However, Takashi Murakami, 54, author of the manga, said this is not a tragic story. “He was not unhappy at all,” Murakami said of the protagonist. Murakami objects to characterizations of people who die alone as sad “losers in life” who have not prepared for death. Of course, the author says, people who do not want to die alone should receive help and support. What he objects to is the classification that all isolated deaths indicate the person has lived an unhappy life.

most of those who die, die alone in their own homes, neglected by their families.

The author feels society has unfairly attached labels to those who die alone and those who die surrounded by loved ones.

WINNERS, LOSERS OF LIFE “The ‘winners’ might be the group of people who can disperse the risks and avoid living in isolation,” said Midori Kotani, 50, president of a research center for senior citizens who specializes in clinical thanatology.

Eight years ago, Kotani, who also teaches at Rikkyo Second Stage College in Tokyo, lost her husband. His death spurred Kotani to form a group to help people maintain their lifestyles after their partners die. “If you want to avoid isolation or a lonely death, it is important to connect to people other than family members who can be relied upon when you are still vigorous,” Kotani said.

Akihisa Kono, 50, who runs a surgical hospital in Sakai, Osaka Prefecture, saw many lonely death cases when he was a medical examiner in the prefecture. Kono said that Japan’s wealthy and convenient society helps to free us from the troubles of meeting people face-to-face.

But, he added, “The communication skills of people are worsening regardless of age, which widens the disconnect within a community and between generations and leads to isolation.” Since the first half of the 1990s, the number of “muen botoke,” people who die alone and go unnoticed, even by their children or relatives, has been rising in Yokosuka, Kanagawa Prefecture.

The number started surging after fiscal 2005. Alarmed by the trend, the city four years ago started supporting “Shukatsu” (preparing for death) for people who live alone and are financially strapped. Kazuyuki Kitami, a social worker at the welfare division of Yokosuka city, said changes in society are fueling the trend in lonely deaths. “It is not about losing bonds but rather the environment has made it easier to sever bonds,” Kitami said.

He said sharp social changes can be traced back to two time periods: in 1990, when the average family size shrank to three members or fewer, and the 2000s, when the use of cellphones spread. People now have fewer immediate relatives to connect with, and human relationships are maintained chiefly through smartphones.

Those who find themselves with few real-life connections may die alone, and their families or relatives might not care, he said. “What generates such an atmosphere that even relatives don’t receive the remains? I think we need to think about that question,” Kitami said.

and it's not just the eldely who disappear

Military suicide

strategyPage has a long essay on PTSS, suicide, and the military, and how the military is trying to control the epidemic.

LINK

Military epidemiologists (experts on medical statistics) have long sought to convince people outside the military that the rise in suicide rates within the military has little to do with the stress of combat and mostly to do with the stresses of military life during wartime or peacetime. In other words, the increased suicides were not concentrated among the combat veterans, who make up less than 15 percent of those in the military but are more evenly distributed among all service personnel.

For example, during the last decade over 75 percent of suicides were among troops who had never gone overseas. The military, especially the army, has long documented all deaths and the Department of Defense in 2013 released a study of all suicides since 2001, when more troops saw combat, to 2008, when the heavy fighting in Iraq ended.

A similar study for 2009-2012 suicides found little change. The researchers also point out that the reasons for suicides in the military are quite similar to those for civilian suicides, especially when victims are of the same age, education, and other factors as their military counterparts. In other words, periods of intense combat for the military have little impact on the overall suicide rate because so few troops are exposed to combat.

These revelations were not well received by the mass media which makes much of the rising suicide rate in the military but pays less attention to rising suicide rates among civilians of the same age and education. That was 9 per 100,000 in 2001 but had risen to 17.5 in 2013 and by 2016 was 26 per 100,000 men aged 25-44, which is the age of most men in the military.

This was declared to be a health emergency, and to a certain degree, it was. What was missed in all the discussion was that the higher suicide rate in the military is usually below the rate for civilians of military age.

CDC in the news

CDC: most violent deaths are... suicides.

by white males, young or old, or AmerIndian/Innuits.

homicides are more likely among Black non Hispanic teenage males.

Less than 1 percent are death by law enforcement.

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CDC reports one third of those with Lupus (SLE) take opioids for pain, and the experts are not happy about it.

Quick: What's wrong with this statement.

The widespread and long-term use of prescription opioids among this cohort of patients with SLE was striking given lack of evidence regarding safety and efficacy of opioids for treating chronic pain associated with rheumatic disease (1,7).

translation: we don't have scientific studies that opioids work for this type of pain (just ignore the experience of thousands of physicians who find it's the only thing that keeps their patients comfortable enough to function)

Particularly concerning is that some of the less appreciated medical risks associated with long-term opioid use, such as myocardial infarction, immunosuppression, and osteoporosis (8), are potentially compounded in persons with SLE, whose baseline risks for these comorbidities are elevated because of the underlying disease and adverse effects of immunosuppressive and glucocorticoid therapies.

translation: opioid use is associated with these things, but hey, the disease of the patient cause them too.

Further, recent preliminary data suggest that opioids are associated with increased mortality in lupus.¶

so is it from the opioids, or because we give opioids to the patients whose lupus is worse?

The study about increased mortality is, of course, a "metanalysis" meaning it took a bunch of studies and averaged the results.

so what does this mean?

A qualitative review was performed because the number of articles pertaining to specific adverse effects of opioids was typically small, and the diversity of adverse effects across systems precluded a quantitative analysis.

hmm.. in other words, not a lot of data out there so the analysis might not be accurate.

Through a variety of mechanisms, opioids cause adverse events in several organ systems. Evidence shows that chronic opioid therapy is associated with constipation, sleep-disordered breathing, fractures, hypothalamic-pituitary-adrenal dysregulation, and overdose.

True. Constipation in cancer patients on opioids is a big problem no one wants to talk about. You get respiratory depression, and I've seen this in the elderly, who are doing well on their opioid dosage until they pneumonia... a Overdoses might be accidental or deliberate (not just suicide but from taking extra dosese because you hurt and take a second or third dose before the first dose starts to work).

However, significant gaps remain regarding the spectrum of potentially opioid-related adverse effects. Opioid-related adverse effects can cause significant declines in health-related quality of life and increased health care costs.

or maybe they increase the quality of life when taken. That part is not addressed.

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remember all the hysteria about the Zika virus causing mental retardation among infants whose moms were exposed to it?

well the dirty little secret is that Rubella does this too:

but thanks to vaccine, (MMR means Measles Mumps Rubella) it has gone down world wide.

CDC report:

Progress toward rubella elimination has resulted in 168 (87%) of 194 countries protecting infants with RCV and 81 (42%) eliminating rubella transmission. Equity between countries using rubella-containing vaccine has increased as lower-income countries have introduced rubella-containing vaccine.

this paper notes the decrease in cases from 2000 to 2016 

In 2016, 22,361 rubella cases were reported to WHO, a 97% decrease from 670,894 cases reported in 2000, and a 76% decrease from 94,277 cases reported in 2012 

there is a big worry that the increase in refusing "measles" shots (actually MMR shots) will increase the rate of fetal rubella syndrome: 

but one might not see this until these unvaccinated kids grow up and get pregnant.

and in some poorer countries, only measles vaccine was given, not the MMR combination which is usually used in the USA.

CSI

Atlas Obascura relates the story of an outbreak of botulism in a Scottish hotel,in 1922.

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there is a link between the San Francisco political elites, Harvey Milk, Mayor Moscone and Jim Jones murderous people's temple.

the link is how sociopaths manipulate each other.

actually people back then knew about this, but it has been airbrushed out of history.

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the Ebola outbreak in the Congo has spread to a large city of Butembo which has 1,2 million people.

Unlike previous outbreaks, which have been restricted to fairly remote, rural areas, the present epidemic has swept through populated parts of northeastern Congo, a lawless area that is infested with rebel groups, freelance militias and armed criminal gangs. Already struggling in conditions more challenging than previous outbreaks anywhere in Africa, health workers are now trying to deal with an outbreak that has multiple epicentres. But nowhere is as worrying as Butembo, where a blend of insecurity, suspicion of aid workers and a large, mobile population have created an ideal landscape for the rapid spread of the disease.

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why is esophogeal cancer so common in the Rift Valley?

is it due to chewing Khat (Miraa)?

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AlJ: Diabetes affects 25 percent of Pakistanis.

the local paper says 10 to 20 percent.
Is it a genetic problem due to intermarriage?

Hmm... almost as high as in some AmerIndian tribes like the Objibwe or Pima tribes. We attributed it to the high fat diet from the free commodities the gov't gave the tribe to combat malnutrition that was behind the high TB rate.

When you read about the epidemic of fat people in the world, just remember the alternative is not think healthy people, but malnourished folks who die of TB or after minor infections.


In both the Objibwe and Pima tribes, obesity is the norm. Yet the Apache, who lived a more active traditional lifestyle, had much lower rates, and the Pima who live across the border in Mexico tend to eat poorly, work hard in the fields, and be thin, do not have much diabetes.

And we are seeing it more and more hree in the Philippines: along with high blood pressure (from the high salt diet) we now see diabetes.

Is the gene for metabolic syndrome behind this? Is having enough to eat causing the diabetic syndreome, or could it be plastics etc in the environment?

and then we see this:


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Is all the publicity ccausing copy cat shootings, asks MomJones.

Why, yes. Duh.

Similar to the suicide increases when sympathetic films about teenage suicide like 13 reasons why can inspire suicide in vulnerable people.

and the propaganda about euthanasia is encouraging the disabled and elderly to kill themselves so they are not a burden.... and probably also encouraging medical personnel to kill their patients who they see as useless eaters.

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brain damage discussion

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actually, this is not new. 30 Years ago, I took a couple months of psychiatry residency (and dropped out when I needed surgery).

They knew back then that a large percentage of people in jail had positive findings of brain damage, often from poor prenatal care, abuse/ head injuries in the past, and low grade lead poisoning, either from eating paint chips or from pollution before they took lead out of gasoline.

and they were just starting to use PET scans to see the damage in real time.

They also knews that LSD and other drugs caused permanent brain changes, and that Temporal lobe epilepsy caused both visions (St Paul, anyone?) and violent outbursts.

When I recovered from surgery I took a job at an institution for the profoundly retarded, at that time when the intellectually disabled were being discharged to the community. (and don't correct me and tell me that I shouldn't use the word "retarded": I am so old that I remember when we used the word "moron" and "imbicile" instead of moderate and severely mentally retarded).

Many of the mildly retarded had already been discharged by the time I took the job, and the nurses remarked that, alas, many of them ended up in jail, either for petty theft or for temper tantrums/violent outbursts. The problem was so bad that the state made special sections for these prisoners, to protect them from the real criminal predators.

The only treatment in the past was to fill these folks up with anti psychotic medications, which sedated them.

But the powers that be decided we needed to stop these "unneeded" medicines, so we were busy weaning them off of medicines and restraints and even protective equipment such as helmets that protected their heads from falls or head banging behavior.

But one doctor who worked in these institutions put out a newsletter suggesting anti seizure medicines for violent outbursts, and voila, it worked on many (but not all) of our violent patients.

Before I started to work there, most of the "mild" cases had been sent to the community, often with little supervision, and alas many of them ended up in jail.

Being naive many of them were horribly abused by other prisoners.

So will Kanye tell Trumpie maybe we should start treating people with these problems in jail, so they can be released?

Or will the civil rights folks, who were behind the "deinsitutionalization" lawsuits, but who never followed up to make sure community services could keep them safe, complain? They  already have pretty well made it impossible to save lives of the depressed via shock treatment, often oppose "forced medicine" for hallucinating schizophrenics, made it almost impossible to hospitalize the mentally ill whose families are in despair over their problems,  or have the police remove those who wander the streets talking to themselves in a delusional state, yet if we try to help the mentally ill, point out clockwork orange that we are harming the prisoners?

The abuse of people in psychiatry in the past was real, but one who never worked with the really dangerous mentally ill can appreciate how bad their behavior can be.

One thing that one needs to remember: there is a difference between use and abuse.

A medicine that allows you to cope and work and interact with your family is a medicine.

A medicine that leads you to addictive behavior, neglect of family in order to get high, or to hurt others is abuse.

Cross posting: Suicide chic, Yellow jack

From my other blog: Two articles on suicide chic in a hit TV chick flick series aimed at female teenyboopers..
lLINK
LINK2

and link to a CDC technical article on why they have a yellow fever vaccine shortage.

essentially only one company makes it, and they had to throw out a lot of vaccine because of technical difficulties. Now they want to manufacture a new version but they have to do extensive testing.

And I have written in the past about the YF outbreaks on Africa and now in Brazil, that has used up a lot of the world's stock of vaccine even though they give partial doses to some folks.

High morbidity with a syndrome? Maybe we should find a cure

shal we accept transgendered people, or seek to cure them?

via Mom Jones: Here is a genetic and/or behavioral psychiatric condition with a high morbidity:

Of the 25 million transgender people in the world, the depression rate is 60 percent in some regions, compared with an estimated 5 percent of non-transgender people.

The rate of attempted suicide is 41 percent for trans people, compared to 1.6 percent for the general population.

Transgender people are nearly 50 times more vulnerable to HIV than their cisgender—people whose gender is in line with their sex assigned at birth—counterparts.

Between 2008 and 2016, there were 2115 documented killings of transgender people. (That's most likely an undercount.)

In the United States, a 2011 study found of those who expressed gender non-conformity at any point between kindergarten and 12th grade, 35 percent were victims of violence.

question: Should we encourage them to act on their desires, or find a way for them to control their behavior?

IT seems to me to be a variation of Obsessive compulsive disorder: Like the multi plastic surgery etc. types we see on reality TV shows.

So should we as doctors try to cure them? True, previous "medical" ways to treat gays didn't work well, but does that mean we might not find that, say, stem cells into the hypothalmus might work, or maybe an SSRI to lower the OCD part of the disorder? I have no idea if there are studies on this.