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  • Archive for the 'Health Care' Category

    More evidence that Obamacare is just expanded Medicaid.

    Posted by Michael Kennedy on 2nd November 2015 (All posts by )

    I have been saying that Obama care is just Medicaid for all. As time goes by, here is more and more evidence that this is the case.

    The latest evidence is in The Wall Street Journal and behind a pay wall but I will quote some of it.

    But a new paper from the Heritage Foundation, however, suggests that nearly all of the increase came from adding nearly nine million people to the Medicaid rolls.

    In other words, ObamaCare expanded coverage in 2014 to the extent that it gave people free or nearly free insurance. That goal could have been accomplished without the Affordable Care Act. To justify its existence, ObamaCare must make affordable private insurance available to a broad cross-section of uninsured Americans who are ineligible for Medicaid.

    But with fewer people buying insurance through the exchanges, the economics aren’t holding up. Ten of the 23 innovative health-insurance plans known as co-ops—established with $2.4 billion in ObamaCare loans—will be out of business by the end of 2015 because of weak balance sheets.

    And while rates vary widely by state, the cost for private insurance through the exchanges is also increasing dramatically. An analysis by consulting firm Avalere Health released on Friday shows that some of the most popular insurance plans in the ObamaCare exchanges will experience double-digit premium hikes in 2016.

    My earlier objections to Obamacare were that it promises too much and pays too little.

    As it turns out, Medicaid patients can’t get appointments with physicians.

    “America has severe primary care physician shortages, and many physicians will not accept Medicaid patients because Medicaid pays so inadequately,” said Michael Gerardi, MD, FAAP, FACEP, president of the ACEP.

    Read the rest of this entry »

    Posted in Big Government, Health Care, Medicine | 6 Comments »

    Medicine: The Public-Health Model is Wrong

    Posted by Jonathan on 30th October 2015 (All posts by )

    This Theodore Dalrymple post is a variation on a conventional argument whose unstated main premise is that medical cost decisions should be evaluated from a public-health perspective.

    The annual medical is a kind of ceremonial or ritual which, according to its critics, is without rational foundation despite the fact that so many patients, and perhaps a majority of doctors, believe in it. This proves that superstition is not dead: but perhaps that is no fatal criticism of the annual medical after all, because superstition will never be dead. If it does not attach to one thing, it will attach to another.
    [. . .]
    In fact, most medicals are bureaucratic procedures rather than exercises in getting-to-know-you (as The King and I put it). The doctor asks a few questions, ticks some boxes on a computer screen, performs a perfunctory physical examination equivalent to examining a cubic inch of haystack to find a pin, and does a few selected blood tests, the interpretation of whose abnormal results (if any) will be far from straightforward. In fact, what has been done and measured in annual medicals over the years has changed, without any change in their ineffectiveness.

    Ineffective for whom?

    The answer depends on who is paying the bill. If it’s third parties such as govts or insurance companies then the conventional argument has merit: maximizing system utility is an important goal. However, if patients control their own medical spending then the main goals should be whatever the individual customers want them to be.

    Dalrymple’s analyses are usually much better than this one. Perhaps his frame blindness in this case is a function of his background with the NHS.

    Posted in Health Care, Medicine, Systems Analysis | 14 Comments »

    The Doctor Shortage Update.

    Posted by Michael Kennedy on 5th October 2015 (All posts by )

    There is an interesting piece today in the Daily Mail about young NHS GPs quitting and going to Australia.

    In the past five years, the number of GP appointments made by Britons has risen from 300 million to 370 million a year, an increase of more than 20 per cent.
    The number of GPs employed to meet that demand has risen by around 1,600, or just over five per cent.
    All of which has led to the second major factor behind their exodus — in the UK, they often feel terribly overworked; after moving they find themselves having to spend far less time at the coalface.
    ‘More and more British GPs talk about the pressure they’re under,’ says Guy Hazel. ‘I’m not sure the general public understand how mentally draining it is to see 35 to 40 patients a day. All the British GPs I know are exhausted.’
    An Australian GP, by contrast, will see 20-25 patients per day.

    This concerns the young, newly trained doctors. I posted some concerns about the issue of primary care in the US.

    Primary care here is referred to as “General Practice” in Britain and they seem to be having a loss at both ends of the doctor career.

    Britain is already suffering from a serious, and unprecedented, shortage of GPs, on a scale that doctors’ leaders say is fast becoming a crisis.

    According to figures released last week, a staggering 10.2 per cent of full-time GP positions across the UK are currently vacant, a figure that has quadrupled in the past three years.

    Read the rest of this entry »

    Posted in Big Government, Britain, Health Care, Medicine | 9 Comments »

    Melanoma and Pregnancy.

    Posted by Michael Kennedy on 26th September 2015 (All posts by )

    This is just a brief post to mention that that today’s Daily Mail has an article about a pregnant women with a spreading melanoma. In my book, linked on this site, I have a chapter on melanoma and several stories of patients whose melanoma went wild during a pregnancy. There is no report in the medical literature that supports this connection. Most reports deny any connection, although a few mention some negative prognosis.

    The literature continues to be split on the role of pregnancy in melanoma; however, most recent series show no difference in survival. Multiple studies have failed to show significant effects of female hormones on melanoma cells or on the incidence or progression of melanoma.

    In my book, I describe several cases where pregnancy would “awaken” melanomas that had been removed years earlier or would stimulate worrisome growth in moles. Two of my patients had extensive metastatic melanoma during pregnancy that disappeared after the baby was delivered, in one case with my help. Both women were disease free many years later and neither had another pregnancy.

    How interesting that this young woman has developed metastatic melanoma during pregnancy. I wonder how it will turn out.

    Posted in Health Care, Medicine | 4 Comments »

    C. Steven Tucker on “Against the Current” with Dan Proft

    Posted by Lexington Green on 23rd September 2015 (All posts by )

    Steve Tucker

    My friend Steve Tucker may be the foremost expert on the Obamacare legislation. He was interviewed on Dan Proft‘s video show Upstream Ideas.

    Steve has an infuriating tale about being targeted by the IRS because of his public criticism of the Obama administration. The blatant abuse of government power by this administration is an outrage and a disgrace. The migration of the “Chicago Way” to Washington DC is a story which is suppressed, and the victims are ridiculed and dismissed by the mainstream media, if they are mentioned at all.

    One of the best things I ever did was go to some early Chicago Tea Party events. I met many wonderful, patriotic people. Steve Tucker is one of the best.

    Posted in Health Care, Obama, Tea Party | 3 Comments »

    A Day at Ypres

    Posted by Michael Kennedy on 13th September 2015 (All posts by )

    We spent today at Ypres an the huge military cemeteries from the battles of the Ypres Salient.

    This was an early battle of WWI and the “first battle of Ypres” occurred at the end of “The Race to the Channel.” I have read a bit about the First World War but it really comes home when you are standing the place that consumed the British youth in 1914 to 1918. The First Battle ended the Race to the Sea and began the trench warfare of the next four years.

    We visited the “Sanctuary Wood Museum today, and I took some photos of the trenches which were preserved all these years by then owner of the small cafe where we had a beer.



    These trenches are the originals preserved by the property owner who probably has cleaned out debris over the years. The owners of the cafe are the children of the original owners of the property who preserved these relics. Their museum has many objects no doubt excavated from the fields around.

    Recent highway construction, which has now been suspended, has bodies buried in a trench during the war, which are preserved.

    The bodies of 21 German soldiers entombed in a perfectly preserved World War One shelter have been discovered 94 years after they were killed.
    The men were part of a larger group of 34 who were buried alive when a huge Allied shell exploded above the tunnel in 1918, causing it to cave in.
    Thirteen bodies were recovered from the underground shelter, but the remaining men had to be left under a mountain of mud as it was too dangerous to retrieve them.
    Nearly a century later, French archaeologists stumbled upon the mass grave on the former Western Front in eastern France during excavation work for a road building project.

    The road building has been suspended for now but every construction project in this area uncovered evidence of war dead. Today we visited an enormous memorial for the war dead whose bodies were never recovered. It is called the Menin Gate Memorial and the names of 54,000 dead are posted on the walls representing most of the dead from the Ypres Salient who could not be identified.

    Menin Arch Memorial

    The sheer number of dead whose bodies were destroyed, or lost, is staggering.

    The city of Ypres (pronounced by our hosts as “eep” has been rebuilt as it was destroyed in the war.


    The cathedral was rebuilt from a stump of the tower. The bottom 20 feet to so was protected by rubble and is in better shape. The entire city was rebuilt completely.

    British WW1 Cemetery, Ypres

    The city is surrounded by British war cemeteries of which there are about 150, each with about 500 to 1,000 graves.

    Osler Grave

    One grave that particularly interested me was that of Sir William Osler’s only son who was killed by shrapnel while serving as an artillery officer in 1917. His fathers friends had tried to save him and his last words, reflecting many young men who were wounded, “Surely this (wound) will get me home. ” His last words.

    Today, we arrived at Brussels and will do some touring tomorrow of the Waterloo Battlefield. We passed on the road one of Wellington’s battle fields from the 18th century.

    The TV tonight is all about the “refugees” which we saw a few of today in Brussels.

    Posted in Europe, France, Health Care, Military Affairs, Personal Narrative, Photos | 6 Comments »

    The Coming Shortage of Doctors.

    Posted by Michael Kennedy on 3rd August 2015 (All posts by )

    33 - Lister

    I’m sure everyone is tired of my pessimism about politics so I thought I would try something new. Here is a piece on pessimism about health care.

    This Brietbart article discusses the looming doctor shortage.

    Lieb notes, that the U.S. is only seeing 350 new general surgeons a year. That is not even a replacement rate, she observed.

    A few years ago, I was talking to a woman general surgeon in San Francisco who told me that she did not know a general surgeon under 50 years old. The “reformers” who designed Obamacare and the other new developments in medicine are, if they are MDs, not in practice and they are almost all in primary care specialties in academic settings. They know nothing about surgical specialties.

    They assume that primary care will be delivered by nurse practitioners and physician assistants. They are probably correct as we see with the new Wal Mart primary care clinics.

    The company has opened five primary care locations in South Carolina and Texas, and plans to open a sixth clinic in Palestine, Tex., on Friday and another six by the end of the year. The clinics, it says, can offer a broader range of services, like chronic disease management, than the 100 or so acute care clinics leased by hospital operators at Walmarts across the country. Unlike CVS or Walgreens, which also offer some similar services, or Costco, which offers eye care, Walmart is marketing itself as a primary medical provider.

    This is all well and good. What happens when a patient comes in with a serious condition ?

    Read the rest of this entry »

    Posted in Health Care, Medicine, Politics | 22 Comments »

    Still Too Early – But Perry Makes Some Points

    Posted by Ginny on 6th July 2015 (All posts by )

    Most here haven’t commented on the darting and illusory fortunes of the huge Republican field; I’d mentioned earlier that Perry would have trouble – double or triple BDS syndrome, a bit too much of an Aggie for Texas, God knows for the rest of the country. But that great t-sipper, Kevin Williamson, discusses the case for Perry after a strong speech. That’s worth reading and both Williamson & Perry are worth while.

    Perry’s fighting, turning arguments around to free market principles, to the human: he did this earlier on the relatively friendly Fox’s Chris Wallace. Wallace pressed him on the number of uninsured Texans. Perry didn’t fight him on those grounds but on the far more important, far more serious, and far more consequential grounds of “access.” Access in Texas to health care has risen sharply with Perry’s policies. And, let’s face it, if there is enough access, all the assurances of insurance are pretty useless. Or, as Venzueleans found out, Chavez had promised to meet their every need – government promises of toilet paper and oil were there, access was not.
    Read the rest of this entry »

    Posted in Entrepreneurship, Health Care, Medicine, Politics | 17 Comments »

    Obamacare Lives !

    Posted by Michael Kennedy on 25th June 2015 (All posts by )


    UPDATE: The decision is analyzed at Powerline today with quotes from the decision.

    The Affordable Care Act contains more than a few examples of inartful drafting. (To cite just one, the Act creates three separate Section 1563s. See 124 Stat. 270, 911, 912.) Several features of the Act’s passage contributed to that unfortunate reality. Congress wrote key parts of the Act behind closed doors, rather than through “the traditional legislative process.” Cannan, A Legislative History of the Affordable Care Act: How Legislative Procedure Shapes Legislative History, 105 L. Lib. J. 131, 163 (2013). And Congress passed much of the Act using a complicated budgetary procedure known as “reconciliation,” which limited opportunities for debate and amendment, and bypassed the Senate’s normal 60-vote filibuster requirement. Id., at 159–167.

    Therefore, Roberts rewrote it. Nice !

    Today, the Supreme Court upheld the Obamacare state exchange subsidies.

    The Supreme Court has justified the contempt held for the American people by Jonathan Gruber. He was widely quoted as saying that the “stupidity of the American people “ was a feature of the Obamacare debate. This does not bother the left one whit.

    Like my counterparts, I have relied heavily on Gruber’s expertise over the years and have come to know him very well. He’s served as an explainer of basic economic concepts, he’s delivered data at my request, and he’s even published articles here at the New Republic. My feelings about Gruber, in other words, are not that of a distant observer. They are, for better or worse, the views of somebody who holds him and his work in high esteem.

    The New Republic is fine with him and his concepts.

    It’s possible that Gruber offered informal advice along the way, particularly when it came to positions he held strongly—like his well-known and sometimes controversial preference for a strong individual mandate. Paul Starr, the Princeton sociologist and highly regarded policy expert, once called the mandate Gruber’s “baby.” He didn’t mean it charitably.

    Read the rest of this entry »

    Posted in Big Government, Civil Society, Conservatism, Current Events, Economics & Finance, Health Care, Leftism, Medicine, Obama, Politics | 30 Comments »

    A Bleg.

    Posted by Michael Kennedy on 16th June 2015 (All posts by )


    I have a new book out on Kindle that is now published. It is called “War Stories: 50 Years in Medicine.”

    I’ve been working on this for 20 years and kept having to revise it as I would put it down and then go back to it after ten years. I finally decided to rework it and publish it two years ago. My students were reading the draft on my laptop while I was editing so maybe it will be interesting.

    It is a memoir of patients. They are all patients’ stories that I have tried to describe accurately and to describe what we did then. Sometimes I screwed up and I tell those, too. Sometimes we did the best we could and we now know better. Some of these cases are still hard to explain.

    Two of them, in the chapter on Melanoma, are about young women who developed major melanoma metastases years after the primary was excised but when they had become pregnant. The melanoma went wild in pregnancy, in one case ten years later. In the other, three years after I had removed the primary, she developed extensive metastases while pregnant. She refused abortion and I thought it would cost her her life. In both cases the melanoma vanished after pregnancy ended. In one case, the woman, last I heard, was free of melanoma 25 years later. The other was free ten years later. The medical literature says pregnancy has no effect on melanoma. Neither ever became pregnant again.

    Another case is an example of the only supernatural near-death experience I have ever heard.

    The book starts when I began medical school in 1961 and describes experiences with patients, including my summer working with schizophrenic men in 1962. I have a series of stories about patients I saw as a student and sometimes intersperse stories from later that are about similar cases and events. One that is amusing, I guess, is about my very first pelvic exam, on a 40 year old prostitute who had just gotten out of prison and enjoyed it thoroughly. I had a dozen student nurses as witnesses. I do have some biography in it but try to keep it to minimum.

    After the first eight chapters, I go on to residency and then finally to private practice. I continued to teach and there are a few of those stories. There is a chapter on ethics including my thoughts on euthanasia and “benign neglect.” Toward the end of my career, I started and ran a trauma center in our community hospital. I also did a fair amount of testifying in court in both trauma cases and some civil cases where I testified for plaintiffs and for defense. I consider it a compliment that Kaiser Permanente had me testify for their defense even though I had also testified against them.

    Anyway, the book is on Kindle and I hope somebody is interested. It has some similarity to my medical history book, which I plan to do a Kindle version of once this one is launched. In this one, I spend some time explaining the diseases in a way that I used to explain to patients and I still do to students. Without some basic understanding, most of these stories would not make sense and I hope the explanations are not too dull. If so, all comments are welcome. If anyone likes it, feel free to post a review on Amazon. Two reviewers from the first book in 2004 told me to let them know if I did another one and I have contacted them.

    If anyone wants to discuss the book here, feel free to add comments.

    Posted in Biography, Blegs, Book Notes, Health Care, Medicine, Personal Narrative | 16 Comments »

    Why Doctors Quit.

    Posted by Michael Kennedy on 29th May 2015 (All posts by )

    Today, Charles Krauthammer has an excellent column on the electronic medical record. He has not been in practice for many years but he is obviously talking to other physicians. It is a subject much discussed in medical circles these days.

    It’s one thing to say we need to improve quality. But what does that really mean? Defining healthcare quality can be a challenging task, but there are frameworks out there that help us better understand the concept of healthcare quality. One of these was put forth by the Institute of Medicine in their landmark report, Crossing the Quality Chasm. The report describes six domains that encompass quality. According to them, high-quality care is:

    1) Safe: Avoids injuries to patients from care intended to help them
    2) Equitable: Doesn’t vary because of personal characteristics
    3) Patient-centered: Is respectful of and responsive to individual patient preferences, needs and values
    4) Timely: Reduces waits and potentially harmful delays
    5) Efficient: Avoids waste of equipment, supplies, ideas and energy
    6) Effective: Services are based on scientific knowledge to all who could benefit, and it accomplishes what it sets out to accomplish

    In 1994, I moved to New Hampshire and obtained a Master’s Degree in “Evaluative Clinical Sciences” to learn how to measure, and hopefully improve, medical quality. I had been working around this for years, serving on the Medicare Peer Review Organization for California and serving in several positions in organized medicine.

    I spent a few years trying to work with the system, with a medical school for example, and finally gave up. A friend of mine had set up a medical group for managed care called CAPPCare, which was to be a Preferred Provider Organization when California set up “managed care.” It is now a meaningless hospital adjunct. In 1995, he told me, “Mike you are two years too early. Nobody cares about quality.” Two years later, we had lunch again and he laughed and said “You are still too years too early.”

    Read the rest of this entry »

    Posted in Big Government, Health Care, Medicine, Politics, Science | 17 Comments »

    Obamacare = Medicaid

    Posted by Michael Kennedy on 8th May 2015 (All posts by )


    I have been interested in health care reform for some time and have proposed a plan for reform. It is now too late for such a reform as Obamacare has engaged the political apparatus and sides have been taken. The Obamacare rollout was worse than anticipated and it was hoped that the Supreme Court would have mercy on the country, but that didn’t happen and it has been the law for two years.

    What has it accomplished ? Well, the forecast drop in ER visits hasn’t happened. It also didn’t happen in Massachusetts when that plan took effect.

    Wasn’t Obamacare supposed to solve the problem of people going to the ER for routine medical problems? We were told that if everyone had “healthcare” — either through the ACA exchanges or through Medicaid expansion — people would be able to go to their family doctors for routine care and emergency rooms would no longer be overrun by individuals who aren’t actually experiencing emergencies.

    As it turns out, Medicaid patients can’t get appointments with physicians.

    “America has severe primary care physician shortages, and many physicians will not accept Medicaid patients because Medicaid pays so inadequately,” said Michael Gerardi, MD, FAAP, FACEP, president of the ACEP.

    Read the rest of this entry »

    Posted in Business, Health Care, Law Enforcement, Leftism, Medicine, Obama, Politics | 7 Comments »

    Myopia and why it is increasing.

    Posted by Michael Kennedy on 25th April 2015 (All posts by )


    A couple of interesting articles about the increasing incidence of myopia in children.

    Myopia isn’t an infectious disease, but it has reached nearly epidemic proportions in parts of Asia. In Taiwan, for example, the percentage of 7-year-old children suffering from nearsightedness increased from 5.8 percent in 1983 to 21 percent in 2000. An incredible 81 percent of Taiwanese 15-year-olds are myopic.

    The first thought is that this is an Asian genetic thing. It isn’t.

    In 2008 orthoptics professor Kathryn Rose found that only 3.3 percent of 6- and 7-year-olds of Chinese descent living in Sydney, Australia, suffered myopia, compared with 29.1 percent of those living in Singapore. The usual suspects, reading and time in front of an electronic screen, couldn’t account for the discrepancy. The Australian cohort read a few more books and spent slightly more time in front of the computer, but the Singaporean children watched a little more television. On the whole, the differences were small and probably canceled each other out. The most glaring difference between the groups was that the Australian kids spent 13.75 hours per week outdoors compared with a rather sad 3.05 hours for the children in Singapore.

    This week the Wall Street Journal had more. There are some attempts to deal with the natural light effect.

    Children in this small southern Chinese city sit and recite their vocabulary words in an experimental cube of a classroom built with translucent walls and ceilings. Sunlight lights up the room from all directions.

    The goal of this unusual learning space: to test whether natural, bright light can help prevent nearsightedness, a problem for growing numbers of children, especially in Asia.

    The schools have tried to get Chinese parents to send the kids outdoors more but it doesn’t seem to work.

    And it isn’t limited to Asians.

    In the U.S., the rate of nearsightedness in people 12 to 54 years old increased by nearly two-thirds between studies nearly three decades apart ending in 2004, to an estimated 41.6%, according to a National Eye Institute study.

    But Asians with their focus on education are the most effected.

    A full 80% of 4,798 Beijing teenagers tested as nearsighted in a study published in the journal PLOS One in March. Similar numbers plague teens in Singapore and Taiwan. In one 2012 survey in Seoul, nearly all of the 24,000 teenage males surveyed were nearsighted.

    So, what to do ?

    Though glasses can correct vision in most myopic children, many aren’t getting them. Sometimes this is because parents don’t know their children need glasses or don’t understand how important they are for education. Other times, cultural beliefs lead parents to discourage their children from wearing them, according to Nathan Congdon, professor at Queen’s University Belfast and senior adviser to Orbis International, a nonprofit focused on preventing blindness. Many parents believe glasses weaken the eyes—they don’t.

    Getting kids to spend even small amounts of time outdoors makes a difference.

    Why myopia rates have soared isn’t entirely clear, but one factor that keeps cropping up in research is how much time children spend outdoors. The longer they’re outside, the less likely they are to become nearsighted, according to more than a dozen studies in various countries world-wide.

    One preliminary study of 2,000 children under review for publication showed a 23% reduction in myopia in the group of Chinese children who spent an additional 40 minutes more outside each day, according to Ian Morgan, one of the researchers involved in the study and a retired professor at Australian National University in Canberra. (He still conducts research with Sun Yat-sen University in the Chinese city of Guangzhou.)

    That is a very significant effect of small changes in behavior. Now the researchers are trying something new.

    Dr. Morgan, Dr. Congdon and a team from Sun Yat-sen are now testing, as reported recently in the science magazine Nature, a so-called bright-light classroom made of translucent plastic walls in Yangjiang to see if the children can focus and sit comfortably in the classroom. So far it appears the answer is yes.

    In 2007, Donald Mutti and his colleagues at the Ohio State University College of Optometry in Columbus reported the results of a study that tracked more than 500 eight- and nine-year-olds in California who started out with healthy vision6. The team examined how the children spent their days, and “sort of as an afterthought at the time, we asked about sports and outdoorsy stuff”, says Mutti.

    It was a good thing they did. After five years, one in five of the children had developed myopia, and the only environmental factor that was strongly associated with risk was time spent outdoors6. “We thought it was an odd finding,” recalls Mutti, “but it just kept coming up as we did the analyses.” A year later, Rose and her colleagues arrived at much the same conclusion in Australia7. After studying more than 4,000 children at Sydney primary and secondary schools for three years, they found that children who spent less time outside were at greater risk of developing myopia.

    What is the mechanism ? Maybe it is this.

    The leading hypothesis is that light stimulates the release of dopamine in the retina, and this neurotransmitter in turn blocks the elongation of the eye during development. The best evidence for the ‘light–dopamine’ hypothesis comes — again — from chicks. In 2010, Ashby and Schaeffel showed that injecting a dopamine-inhibiting drug called spiperone into chicks’ eyes could abolish the protective effect of bright light11.

    Retinal dopamine is normally produced on a diurnal cycle — ramping up during the day — and it tells the eye to switch from rod-based, nighttime vision to cone-based, daytime vision. Researchers now suspect that under dim (typically indoor) lighting, the cycle is disrupted, with consequences for eye growth. “If our system does not get a strong enough diurnal rhythm, things go out of control,” says Ashby, who is now at the University of Canberra. “The system starts to get a bit noisy and noisy means that it just grows in its own irregular fashion.”

    Another possible treatment is the use of atropine drops in the eye.

    Atropine, a drug used for decades to dilate the pupils, appears to slow the progression of myopia once it has started, according to several randomized, controlled trials. But used daily at the typical concentration of 1%, there are side effects, most notably sensitivity to light, as well as difficulty focusing on up-close images.

    In recent years, studies in Singapore and Taiwan found that a lower dose of atropine reduces myopia progression by 50% to 60% in children without those side effects, says Donald Tan, professor of ophthalmology at the Singapore National Eye Centre. He has spearheaded many of the studies. Large-scale trials on low-dose atropine are expected to start soon in Japan and in Europe, he says.

    More than a century ago, Henry Edward Juler, a renowned British eye surgeon, offered similar advice. In 1904, he wrote in A Handbook of Ophthalmic Science and Practice that when “the myopia had become stationary, change of air — a sea voyage if possible — should be prescribed”.

    Posted in China, Education, Health Care, Medicine, Science | 5 Comments »

    Why Gruber has to lie

    Posted by Michael Kennedy on 10th December 2014 (All posts by )

    The left does not do economics. They do politics and elections and lying to get past the “stupid voters” but, when pressed, nothing they do qualifies as numerically or mathematically sound. Social Security worked until everyone found the queue and until Congress raided the trust fund in the 90s.

    Obama and the Democrat leaders knew that Hillary made enemies of the insurance companies in 1992. The insurance companies funded devastating TV ads with “Harry and Louise” that cost the Democrats Congress in 1994. Therefore, they had to do what was necessary to get the insurance companies “inside the tent pissing out and not outside the tent pissing in” in Lyndon Johnson’s immortal words.

    Insurance companies have considered health insurance a loser for 25 years now. What they prefer is becoming “Administrative Service Organizations” which administer self funded health plans by employers.

    Corporate benefits include- organizing/ negotiating health insurance, group dental, STD, LTD, life, etc.

    The plan the Democrats came up with, with Gruber’s help, was to make the government the funding entity and pay the insurance companies to run the program. That way everybody is happy, except, of course, the taxpayer. The taxpayer does not like tax increases which would be needed to pay the bills. Therefore the taxpayer has to be fooled.

    The excise tax on high-cost health plans was among the many fees and taxes proposed as offsets to help slow the rate of growth of health costs, particularly premium growth, and finance the nationwide expansion of health coverage. When the Affordable Care Act was signed into law in March 2010, its coverage provisions were estimated to cost more than $900 billion over the next decade, from 2010 to 2019, and were to be paid for by fees and taxes on both individuals and businesses. At the time the health reform bill passed, the excise tax on high-cost plans was estimated to raise roughly $32 billion in revenue over the next decade, or by 2019.

    Without the taxes to pay the bills, the whole plan collapses. At its base, Obamacare is Medicaid for everyone. The employer mandate has been, contrary to the text of the law, postponed as the flaws in implementation appear. If it were to be enforced, there would be a revolution. Basically, Obamacare will destroy the health care plans of the 85% of the population who are satisfied with what they have to enroll everyone in a new program that approximates what Medicaid does. The reason for this is that our betters in Washington have decided that we spend too much on health care. That may even be true. One way to deal with this would be to use a market-based approach that resembles how health care was paid for 60 years ago. I have previously discussed how this worked and how it might be restored.

    Today, the vast majority of Americans get health insurance as a benefit from their employer. How this developed has been discussed at length and began during World War Two. In 2008, John McCain proposed a possible way to disconnect employment, alleged to create “Job Lock” but he lost the election. A hostile analysis of his proposal is here. The McCain campaign’s description is here.

    What became Obamacare is the work of the Democrat staff of Congress when the Democrats had filibuster proof majorities in both houses. The election of Scott Brown in a reaction to the impending passage of the health plan forced them to rush the bill through without amendments before Brown was sworn in January 2010.

    The taxes to fund Obamacare were hidden as “fines and penalties” until exposed by the Supreme Court in its 2012 decision on the constitutionality of Obamacare. All penalties are now taxes. The largest are on employer-funded plans.

    The funding from employee plans is called “The Cadillac Tax which is an excise tax on employer plans that exceed the benefits of Medicaid. The “exchange plans” are increasingly looking like Medicaid, especially in the narrow networks of providers, as doctors are now called.

    As health coverage expands to tens of millions of Americans–through Medicaid expansion in states and the new state health insurance exchanges that will soon begin selling individual health coverage–some Americans with employer-sponsored health coverage are seeing their benefits decrease.

    One of the most significant, and controversial, provisions of the Affordable Care Act is the new excise tax on high-cost health plans proposed to both slow the rate of growth of health costs and finance the expansion of health coverage. The provision is often called the “Cadillac” tax because it targets so-called Cadillac health plans that provide workers the most generous level of health benefits. These high-end health plans’ premiums are paid for mostly by employers. They also have low, if any, deductibles and little cost sharing for employees.

    If this is ever implemented, the Medicaid-for-all nature of Obamacare will become obvious. That’s why it will not happen. The fundamental premise behind Obamacare is not viable. That is why it will fail and the numbers do not add up.

    Gruber can’t say this. All he can do is obfuscate.

    Posted in Elections, Health Care, Law Enforcement, Leftism, Medicine, Taxes | 22 Comments »

    Don’t Panic: A Continuing Series – Ebola Realities and the True Test

    Posted by Jay Manifold on 22nd November 2014 (All posts by )

    as airline stocks tracked – and predicted – Ebola did not become established in the US

    as airline stocks tracked – and predicted – Ebola did not become established in the US

    Although the false alarms might continue for a few more weeks, we have obviously transitioned into the lessons-learned phase of the Ebola non-outbreak in the US. I will list those lessons below, but first, a useful summary of a talk I attended on the evening of Tuesday the 4th.

    [Readers needing background may refer to the earlier members of this series, Don’t Panic: Against the Spirit of the Age; Don’t Panic: A Continuing Series; and Don’t Panic: A Continuing Series – Ebola or Black Heva?]

    The venue was the Johnson County Science Café, a monthly forum sponsored by Kansas Citizens for Science. Johnson County is, by some measures, the wealthiest county in the country outside of the DC and NYC metro areas; greatly simplifying, this is a product of a somewhat unique combination of blue-state salaries and red-state cost of living. Kansas Citizens for Science was founded in the wake of upheavals on the Kansas Board of Education, which resulted in the initial imposition of, and subsequent drastic changes to, science-curriculum standards for public primary and secondary schools for ~300 school districts half a dozen times between the early 1990s and mid-2000s. The most famous was a 1999 board vote to remove key questions about the historical sciences (including astronomy, geology, and paleontology) from assessment testing, but there were several others which either re- or de-emphasized those sciences as the makeup of the board fluctuated with each election. After a decade and a half of chaos, as of now the board is relatively quiescent – its makeup was ironically substantially unaffected by this month’s wave election – and teaching and testing of the historical sciences is in place. I know several of the key personalities involved, and could certainly tell some interesting stories, but that controversy is not the subject of this post. Read the rest of this entry »

    Posted in Bioethics, Civil Society, Current Events, Ebola, Health Care, Human Behavior, International Affairs, Markets and Trading, Medicine, Organizational Analysis, Personal Narrative, Predictions, USA | 5 Comments »

    Don’t Panic: A Continuing Series – Ebola or Black Heva?

    Posted by Jay Manifold on 2nd November 2014 (All posts by )

    [Readers needing background may refer to the earlier members of this series, Don’t Panic: Against the Spirit of the Age, and Don’t Panic: A Continuing Series.]

    Time is running out, the man explains, speaking calmly and confidently, in the manner of a university professor. A deadly disease, spread by primitive tribespeople through dead bodies, will kill vast numbers of Americans unless the Federal government uses its powers to stop it.

    The man is Russell Eugene Weston Jr., a paranoid schizophrenic who murdered two policemen inside the Capitol building in the summer of 1998. He has been institutionalized ever since.

    As I write this, the most widely-read individual blog in the English-speaking world, written by a genuine university professor, is infested with (invariably pseudonymous) commenters not readily distinguishable from Weston; we can only hope that none of them will act on their impulses as he did. Read the rest of this entry »

    Posted in Big Government, Bioethics, Civil Liberties, Civil Society, Current Events, Ebola, Elections, Health Care, Human Behavior, International Affairs, Libertarianism, Medicine, Politics, Science, Systems Analysis, Terrorism, Tradeoffs, USA | 8 Comments »

    Ebola is now acknowledged to be airborne.

    Posted by Michael Kennedy on 29th October 2014 (All posts by )

    I was just going to add another comment to my previous post on whether Ebola can be airborne but comments are now closed. The CDC has now changed its guidelines on transmission. I linked to Patterico because he has a good post on this. The guidelines are out now as public knowledge.

    “If you are sniffling and sneezing, you produce microorganisms that can get on stuff in a room. If people touch them, they could be” infected, said Dr. Meryl Nass, of the Institute for Public Accuracy in Washington, DC.
    Nass pointed to a poster the Centers for Disease Control and Prevention quietly released on its Web site saying the deadly virus can be spread through “droplets.”

    Why is this stuff coming out in drips (sorry for the pun) like it was Benghazi ?

    “The CDC said it doesn’t spread at all by air, then Friday they came out with this poster,” she said. “They admit that these particles or droplets may land on objects such as doorknobs and that Ebola can be transmitted that way.”

    I won’t duplicate any more of Patterico’s post as he has been on the case nearly as long as I have.

    As for the idiot nurse from Africa who defied authority about quarantine and is suing, she has more trouble today.

    Maine state police were stationed outside the home of Ebola nurse Kaci Hickox Wednesday as Gov. Paul LePage said he was seeking legal authority to force the “unwilling” health care workers to remain quarantined for 21 days.

    The 33-year-old nurse, who has shown no symptoms of the deadly virus, arrived in Maine on Monday after being forcibly held in an isolation tent in New Jersey for three days under that state’s strict new law for health care workers who have recently treated Ebola patients in West Africa.

    There is actually little risk as she is a CDC Epidemiology Fellow with little contact with patient care.

    She is also a lefty Obama supporter.

    It turns out that Kaci Hickox is a registered democrat and Obama supporter who works for the CDC. “The nurse currently quarantined in New Jersey is an employee for the Centers for Disease Control and a registered Democrat with a history of left-wing advocacy,” reports

    The CDC Epidemiology Fellowships are not patient care positions.

    EIS officers are on the public health frontlines, conducting epidemiologic investigations, research, and public health surveillance both nationally and internationally.

    She has an number of published papers on epidemiology that are statistical studies, not clinical care.

    Posted in Ebola, Health Care, Medicine, Politics | 17 Comments »

    China Syndrome comes home to roost.

    Posted by Mrs. Davis on 19th October 2014 (All posts by )

    Two viruses are making the news these days. One, Ebola hemorrhagic fever has infected two in the United States with no deaths yet. It has created wide spread concern bordering on panic. The other, Non-Polio Enterovirus D 68, appears to have infected 825 this year and been directly responsible for at least one death and indirectly responsible for many others, primarily among children. It has generated comparatively little media attention and very little panic. Why the difference?

    First the victims of D 68 are primarily children, Ebola also strikes adults. As a culture we no longer value children as much as we once did. Children are an option, almost a luxury. They have become more expensive than most luxuries we consume. Perhaps it is because the high cost to rear a child is reflective of the damage we humans are doing to the planet Or because so few of them die at an early age as compared to the past. And I suspect that childlessness is far more prevalent among our media elite opinion makers. In any case, few children vote and so they don’t really matter to policy makers.

    Second, D 68 generally kills indirectly by weakening the child so that pneumonia or some other respiratory illness can be the cause of death. Ebola eats you alive! I’ve seen it on TV! And it is a terrible new way to die unlike ways we’ve died before.

    Finally, WE’RE ALL GOING TO DIE. D 68 is poorly understood and we have no idea how prevalent it is in the population or how many childhood deaths it has contributed to. And it’s non-Polio. But we know Ebola has a 50-70% fatality rate among those who contract it in African third world countries. After all it’s hemorrhagic fever. We’re going to bleed to death. So, if it gets loose here we could have millions of deaths like that! But we actually have all the tools we need in our public health system to prevent it from spreading widely, once we get the Bozos out of power. So it’s highly unlikely that this outbreak will spread among the general population.

    It’s a very small probability of a terribly frightening event. And some folks have used the propensity of people to exaggerate the possibility of catastrophic outcomes to further their political goals. I’m thinking of nuclear power, an energy source that has killed no one in the US. Compared to the coal industry, which routinely contributes to the death of both its producers and consumers, nuclear power is harmless. However, some used Three Mile Island to shut down the development of power plants that could have cushioned us from the effects of the OPEC cartel. Or how about the Anthropogenic Global Warming (AGW) fraud? Or the reaction to a terrible but unrepeated terror bombing? The public has been taught to fear by leaders who want to harness public opinion to support their political goals.

    Now comes Ebola. True, a threat. But a highly improbable one. Except when the incompetence of our elite leaders is made abundantly clear for all to see. And then those leaders have the audacity to be surprised when a formerly courageous people are reduced to trembling? The chickens are coming home to roost.

    Posted in Current Events, Deep Thoughts, Ebola, Health Care, Human Behavior, Science, Statistics, Terrorism, Tradeoffs | 23 Comments »

    A Cool Startup Story, Revisited

    Posted by David Foster on 18th October 2014 (All posts by )

    In 2005, I posted about a company called Theranos, as part of the “cool startup story” series at Photon Courier.  The company was founded by Elizabeth Holmes, who left Stanford at age 19 in order to pursue her idea for a quantum improvement in blood testing.  The original focus was on the detection of adverse drug reactions and the analysis of drug effectiveness on a more-individualized basis.

    My, how this little company has grown up.  Theranos now has 500 employees and a valuation of about $9 billion.  They can currently perform 200 of the most commonly-ordered blood diagnostic tests, and can do it without a syringe–only a few drops of blood are necessary, and these are obtained from a finger prick using “a patented method that minimizes even the minor discomfort involved with that procedure.” (The Fortune writer tried it, and said “to me, it felt more like a tap than a puncture.”)  Theranos now has a deal with Walgreens, initially making its service available in stores in California and Arizona and with plans to roll the service out to all 8200 Walgreens stores nationwide.


    There are a billion tests done every year in the United States, but too many of them are done in the emergency room. If you were able to do some of those tests before a person gets checked into the ER, you’d start to see problems earlier; you’d have time to intervene before a patient needed to go to the hospital. If you remove the biggest barriers to these tests, you’ll see them used in smarter ways.


    Phlebotomy is such a huge inhibitor to people getting tested. Some studies say that a substantive percentage of patients who get a lab requisition don’t follow through, because they’re scared of needles or they’re afraid of worrying, waiting to hear that something is wrong. We wanted to make this service convenient, to bring it to places close to people’s homes, and to offer rapid results.

    From a 2005 Daily Duck post about Theranos:

    …in how many nations of the world could A TEENAGE GIRL get a serious audience, and then MILLIONS OF DOLLARS in VC funding, to develop her idea ?!?

    There are many unpleasant consequences to American society being perpetually adolescent, a bit shallow and thrill-seeking, with an attention deficit and a naive optimism born of ignorance about the odds, but this type of thing is one of the UPSIDES of being that way.

    In America, if you can do, the odds are pretty good that you’ll be allowed to do, regardless of your shortcomings and quirks. We’re flexible and goal-driven, not so much wedded to process.

    Posted in Business, Entrepreneurship, Health Care, Tech, USA | 15 Comments »

    How many ebola cases before a travel ban is justified?

    Posted by TM Lutas on 17th October 2014 (All posts by )

    The usual formulation for discussing air travel bans is how many ebola cases making it to the US before President Obama is forced to stop air travel to and from west Africa. But there’s another variant of the question, how many ebola cases in the US before others will stop air or sea travel to and from the this country?

    I do not think it likely that we will reach such numbers in this outbreak but it’s an interesting change from the usual breathless journalistic speculation of the US imposing a ban. If we don’t keep our house in order, others will isolate us to keep themselves safe.

    Update: Since this post was written the arrival of travelers from the ebola hot zone have been restricted five airports where screening has been put in place and just now the CDC has announced that all arrivals will be under 21 day observation from entry in a sort of loose post entry disease defense regime. If they travel, they need to notify the CDC and they need to call in daily temperature readings and report any ebola-like symptoms. This might work, and considerably reduces the possibility that we will be under travel ban because we let ebola come in and get out of control.

    Posted in Health Care, Politics, Transportation | 6 Comments »

    Don’t Panic: A Continuing Series

    Posted by Jay Manifold on 16th October 2014 (All posts by )

    [Readers needing background may refer to the first member of this series, Don’t Panic: Against the Spirit of the Age, posted last month. This post, unlike that one, was hastily written due to time constraints involving, perhaps ironically, international travel to a Third World country.]

    Constructive foreword: suggested case studies in disruption are the Chicago blizzard of 1/13-14/1979 (~3 million commuters immobilized) and the Milwaukee Cryptosporidiosis outbreak of 3/23-4/8/1993 (~400k residents sickened simultaneously).

    Thesis: I argue that, at least with Ebola, inept and overwrought responses pose far greater risks to American society than the disease itself. With regard to managing the risks associated with Ebola in the US, it is vital that we identify easily disrupted institutions and design our processes intelligently to avoid creating bottlenecks, mostly by resisting the urge to overreact; likely candidates include …
    Read the rest of this entry »

    Posted in Big Government, Bioethics, Civil Society, Current Events, Ebola, Health Care, Human Behavior, Organizational Analysis, Predictions, Systems Analysis, Tradeoffs, Transportation, USA | 9 Comments »

    Ebola and the “Open Borders Derangement Syndrome”

    Posted by Trent Telenko on 16th October 2014 (All posts by )

    Sometimes looking at politics, the only explanation that makes sense is a personal identity based mental illness affecting the politicians involved.

    So, we see this reported —

    Texas Health Presbyterian nurse Briana Aguirre criticizes hospital over Ebola response
    Nurse speaks out on TODAY Show

    Ashley Fantz, Holly Yan and Catherine E. Shoichet CNN
    9:54 AM, Oct 16, 2014

    “The federal government is weighing putting those who treated Duncan on a list that would prohibit them from being able to fly, an official familiar with the situation told CNN.

    In June 2007, federal agencies developed a public health Do Not Board list, which allowed domestic and international public health officials to request that people with communicable diseases who meet specific criteria and pose a serious threat to the public be restricted from taking commercial flights departing from or arriving in the United States. The CDC and the U.S. Department of Homeland Security manage the Do Not Board list. “

    So follow me here.

    American citizens who have been in the vicinity of an Ebola patient, particularly healthcare workers, would be considered “a serious threat to the public” even though;

    1. They have simply been around people with Ebola but,
    2. They are not exhibiting signs of the disease.

    These individuals (who demonstrate no symptoms of Ebola) may soon be placed on a “Do Not Board List” by the Center for Disease Control and Department of Homeland Security.

    Meanwhile, non-citizens, people from West Africa who are now:

    1. Surrounded by an “out of control” Ebola virus outbreak,
    2. Who are living in countries saturated with Ebola due to its rampant community spread,
    3. Who are not now showing symptoms of the disease yet,
    4. Are free to travel to America, plus wherever they like to in America without restrictions after they get here.

    A sane Federal government would have put all passengers from Ebola Pandemic affected West African nations on a “Do Not Board List” long past. Yet they are not sane, and it gets worse.

    Not only is this “American Citizens With Ebola Only “Do Not Board List” a dumb policy that destroys the credibility of the Federal Government in time of crisis when it is needed most. It is law suit bait on equal protection grounds in Federal court. Yet both Obama and Congressional Democrats, plus a few Republicans, support limiting AMERICAN CITIZENS rights to travel, but not that of WEST AFRICANS.

    What we are seeing here is the outstanding symptom of a mental illness called OPEN BORDERS DERANGMENT SYNDROME. A mental illness shared by 99.5% of Democrats and the Republican leadership in the US Senate.

    A political identity based mental illness now set to kill lots of Americans by Ebola for the sake of cheap immigrant labor now and future Democratic votes later (like 2016 via voter fraud enabled by Democratic Party opposition to Voter ID laws).

    Posted in Current Events, Ebola, Health Care, Immigration, Politics | 10 Comments »

    3rd Ebola Case in Dallas, Texas

    Posted by Trent Telenko on 15th October 2014 (All posts by )

    There is a 3rd case of Ebola in Dallas among the 70 health care workers (HCW) that treated Thomas Eric Duncan at Texas Health Presbyterian Hospital, AKA “Presby” as it is known here in Dallas This makes it 1 on 35 of the HCW exposed to Ebola getting it using the inadequate “any hospital in American can care for an Ebola patient” Center for Disease Control (CDC ) protective personal equipment (PPE) standards, which were not well implemented at “Presby” in any case, see article In statement, nurses at Presbyterian Dallas describe confused response to Ebola case

    Short form, it was SNAFU from the word go at Presby and it is likely that Presby is currently facing huge legal liabilities because the CDC ignored the experience of Doctors Without Borders and the health care systems in West Africa which showed that Ebola must be treated by Ebola specialists in separate healthcare facilities.

    The Ebola epidemic isn’t a matter of “Medical infrastructure” or “local cultural practices” — the two phrases being liberal terms of art for racism against West Africans in the Obama Administration public health community — it is a matter of treating a biohazard level four pathogen like a biohazard level four pathogen. Bio-hazard four pathogens require a separate medical system to deal with them, prolonged detention for medical screening, travel controls to support those medical detentions and further involuntary quarantine for a positive diagnosis, in other words, a positively controlled, 100% medical screening and detention, border immigration policy a ‘la Ellis Island.

    Only a magical thinking “Open Borders” ideological cultist would do any different in ignoring the experience of the one medical organization that has treated the majority of Ebola cases in human history. Which the head of the CDC Dr Frieden now appears to be, in keeping with Obama Administration Central American minor immigration/Public Health Policies (See also the “Unattended Child Border Crisis” and the outbreak of Central American EVD68 in American public schools).

    The Obama Administration is risking further epidemics of Ebola because it has done so already with EVD68, in order to increase the number of future Democratic Party voters.

    I predict based upon the above, we will see we are going to see Frieden’s firing and/or the cut off of commercial air travel from West Africa to the USA as President Obama’s “Rumsfeld Replacement Moment,” after Republican’s take over the Senate in November 2014. Just in the way that the 2006 Congressional election results moved President George W. Bush to change Iraq War policy with the public disposal and replacement of Secretary of Defense Rumsfeld.

    The proximate reason for this is that the “R0” of the Ebola virus in Dallas is 2.0, even with CDC recommended PPE. “RO” — pronounced “ARRH Awwght” in public health speak — means the rate of infection for each newly infected person getting even more people sick. An “RO of 2.0,” causes the doubling of Ebola cases every three weeks (24 Sept to 15 Oct is exactly 3-weeks). That “RO” in Dallas will be higher, and the doubling time will be shorter, as more HCW who attended Thomas Eric Duncan come down with Ebol…thus keeping Ebola and policy for dealing with it as “front page news” or “attracting a lot of eyeballs” right through the 2014 Congressional election.

    Sad, but true, the Obama Administration is not as concerned with controlling the Ebola outbreak in Dallas as much as it is concerned with “Controlling the Narrative” about the Ebola epidemic.

    Obscuring the reality of the Ebola in Dallas means far more to them in terms of retaining political power, this close to the November Congressional election, as the policy/people/political contradictions of Obama’s Ebola policies are being shown to the low information voters Democrats count on far better than anything Saul David Alinsky ever thought of. As the news of the CDC scrambling to contract 132 airline passengers in Ebola Case #3’s Cleveland to Dallas flight yesterday makes abundently clear.

    Posted in Big Government, Civil Society, Current Events, Ebola, Elections, Health Care | 32 Comments »

    2nd Ebola Case in Dallas Texas

    Posted by Trent Telenko on 12th October 2014 (All posts by )

    One of the health care workers (HCW) that treated Thomas Eric Duncan on in Dallas during the period of 28th thru 30th of September has tested positive for Ebola after coming down with a fever Friday night. Heath care workers at Texas Health Presbyterian Hospital intubated and placed Duncan on dialysis as a part of his palliative treatment schedule. The HCW were in personal protective equipment (PPE) level two or “droplet level” protection at the time.

    It is notable that in the laboratory environment that Ebola is treated as a full bio-hazard level four or “inhalation” threat. Especially when you see circular thinking in public by CDC .

    “I think the fact that we don’t know of a breach in protocol is concerning because clearly there was a breach in protocol. We have the ability to prevent the spread of Ebola by caring safely for patients.”

    The statement said the CDC had NO IDEA how the protocol was breached, but protocol must have been breached because there was a an infection.

    There was no mention as to why there was a two tier PPE protection level structure with widely different infection rates by routes other than Ebola virus injection accidents.

    There is a huge no confidence vote in the CDc coming. One that will take the form we are seeing in Spain — HCW no-shows for hospitals caring for Ebola outbreaks.

    Posted in Big Government, Bioethics, Current Events, Ebola, Health Care | 54 Comments »

    Treatment of the Ebola contact.

    Posted by Michael Kennedy on 3rd October 2014 (All posts by )

    The early information of the Ebola patients in Dallas seems to suggest that competence has not been high on the list of priorities. First, the patent seems to have known about his illness before he got on the plane to the US. He lied to the authorities in Liberia but that is not that unusual. All it takes is ibuprofen to evade the screening at the airport.

    Second the treatment of the relatives Has finally become humane after days of cruel treatment including quarantine in a contaminated apartment.

    The initial treatment was not a model of infectious disease protocol. Why he was sent home with a GI illness and a history of travel to Liberia is still not explained. My medical students are all told to take a history of travel with any GI illness symptom. It’s not clear who he saw but many ERs use Nurse practitioners or PAs to see ER patients.

    He is not doing well and he seems to be declining. We will see how he does but his relatives are still in serious trouble. We are still in trouble.

    The promised treatment program is still inadequate. Tomorrow will bring more bad news.

    A CDC official said the agency realized that many hospitals remain confused and unsure about how they are supposed to react when a suspected patient shows up. The agency sent additional guidance to health-care facilities around the country this week, just as it has numerous times in recent months, on everything from training personnel to spot the symptoms of Ebola to using protective gear.

    This is only the first case.

    UPDATE: More news from Bookworm.

    Ebola can transmit through people’s skin. It’s not enough to keep your hands away from your nose and mouth. If someone’s infected blood, vomit, fecal matter, semen, spit, or sweat just touches you, you can become infected. Even picking up a stained sheet can pass the infection. Additionally, scientists do not know how long the virus will survive on a surface once it’s become dehydrated. The current guess is that Ebola, unlike other viruses, can survive for quite a while away from its original host.

    Oh oh. This explains the infection of hospital workers in Nigeria from urine.

    The good news, if any, is this:

    If patients get Western medicine that treats the symptoms — drugs to reduce fever and to control vomiting and diarrhea, proper treatment if the body goes into shock, and blood transfusions — the mortality rate is “only” 25% — which is still high, but is significantly lower than the 70%-90% morality in Africa, where patients get little to no treatment.

    I will update this as news becomes available.

    UPDATE #2

    Now we have a possible case #2

    A patient with Ebola-like symptoms is being treated at Howard University Hospital in Washington, D.C., a hospital spokesperson confirmed late Friday morning.

    The patient had traveled to Nigeria recently.

    That person has been admitted to the hospital in stable condition, and is being isolated. The medical team is working with the CDC and other authorities to monitor the patient’s condition.

    “In an abundance of caution, we have activated the appropriate infection control protocols, including isolating the patient,” said hospital spokesperson Kerry-Ann Hamilton in a statement. “Our medical team continues to evaluate and monitor progress in close collaboration with the CDC and the Department of Health.”

    No final word yet. Then, of course, we have the NBC case.

    Thursday, news broke that a freelance NBC cameraman covering the outbreak in Monrovia, Liberia had tested positive for Ebola after experiencing symptoms of the disease.

    The cameraman, Ashoka Mukpo, had been working with chief medical correspondent Dr. Nancy Snyderman. NBC News is flying Mukpo and the entire team back to the U.S. so Mukpo can be treated and the team can be quarantined for 21 days.

    Posted in Ebola, Health Care, Immigration, Medicine, Science | 21 Comments »