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  • Archive for the 'Medicine' Category

    Obamacare = Medicaid

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

    emergency

    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 )

    myopia

    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 »

    A Brave Author

    Posted by Carl from Chicago on 29th March 2015 (All posts by )

    I remember reading an article a long time ago about advice that an experienced journalist gave a new writer in the newsroom. He said to “never write anything bad about cats” because the paper would be bombarded with letters from irate cat owners in response.

    I thought of this as I read a NYT article titled “Pregnant, Obese and in Danger” by Claire Putnam (a doctor at a Kaiser Permanente hospital). From the article:

    One recent night on my delivery shift, 8 out of 10 of my laboring patients were too heavy, with 2 weighing over 300 pounds… obese pregnant patients are more likely to have elevated blood pressure, gestational diabetes and babies with birth complications. The are more likely to need cesareans. And the are more likely to have serious complications from the surgery, such as infections, hernias, or life-threatening bleeding.

    An extended family member of mine was a medical EMT and he mentioned how many of his co-workers were hurt while moving and assisting the obese and morbidly obese. This doctor agrees.

    In the last year alone, three of the doctors I work with have been significantly injured while treating severely obese women. One even dislocated his shoulder while performing a cesarean on a 400-pound patient.

    This author is incredibly brave because I can only imagine the vitriol that this sort of analysis will generate in the comments and on social media. They will say that you are making fun of women for whom their weight is out of their control! You are contributing to negative body image in the media!

    The story of the negative impact on health care workers of the obese and the extra costs on society should be factually driven and discussed openly. In the same way that the addicts in Drugs, Inc pose huge challenges on the system through their lifestyle choices (which are universally panned, unlike the obese), these sorts of behaviors should be questioned as well.

    Cross posted at LITGM

    Posted in Medicine | 12 Comments »

    Lovescanning

    Posted by David Foster on 14th February 2015 (All posts by )

    Especially for Valentines Day,  GE posts a video about Stanford University’s MRI-based “love contest.”

    It’s not quite a cold and clinical as it sounds, on account of the individual stories told by the participants.

    Posted in Human Behavior, Medicine, Science, Tech | 2 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 GotNews.com.

    The CDC Epidemiology Fellowships are http://www.cdc.gov/eis/index.html 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 »

    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 »

    Old Source, Old Complaint, New Op

    Posted by Ginny on 19th September 2014 (All posts by )

    Lancet Letter – City Magazine’s take.

    Posted in Israel, Medicine, Middle East | 5 Comments »

    Is Ebola airborne ?

    Posted by Michael Kennedy on 13th September 2014 (All posts by )

    Ebola has become an uncontrolled epidemic in Africa. I have previously posted on Ebola.

    UPDATE: A new CDC report has now been provided on precautions. Somebody is worried. The document, itself, is here (pdf)

    Now, we are going to send 3,000 military personnel to Africa to help. I sure hope none of these US people are infected. They did not volunteer for this and the training to protect themselves will take time.

    Now the German epidemiology community has concluded that Liberia and Sierra Leone are lost.

    Jonas Schmidt-Chanasit of the Bernhard Nocht Institute for Tropical Medicine in Hamburg told DW that he is losing hope, that Sierra Leone and Liberia will receive the neccessary aid in time. Those are two of the countries worst hit by the recent Ebola epidemic.

    “The right time to get this epidemic under control in these countries has been missed,” he said. That time was May and June. “Now it will be much more difficult.”
    Schmidt-Chanasit expects the virus will “become endemic” in this part of the world, if no massive assistence arrives.

    With other words: It could more or less infect everybody and many people could die.

    This, of course, is from a German site and our own CDC is unwilling to say it.

    For Sierra Leone and Liberia, though, he thinks “it is very difficult to bring enough help there to get a grip on the epidemic.”

    According to the virologist, the most important thing to do now is to prevent the virus from spreading to other countries, “and to help where it is still possible, in Nigeria and Senegal for example.”

    Of course, it is already in Nigeria.

    In the balance therefore, the probability is that the virus is not airborne — yet — but it is more dangerous than its predecessors. This would account for its ability to slip through the protocols designed for less deadly strains of the disease. It’s not World War E time, but it’s time to worry.

    And: This may be a new strain with more virulence.

    The results of full genetic sequencing suggest that the outbreak in Guinea isn’t related to others that have occurred elsewhere in Africa, according to an international team that published its findings online in the New England Journal of Medicine (NEJM). That report was from April 2014.

    Now, we have more news. From 2012, we know transmission in animals may be airborne.

    While primates develop systemic infection associated with immune dysregulation resulting in severe hemorrhagic fever, the EBOV infection in swine affects mainly respiratory tract, implicating a potential for airborne transmission of ZEBOV2, 6. Contact exposure is considered to be the most important route of infection with EBOV in primates7, although there are reports suggesting or suspecting aerosol transmission of EBOV from NHP to NHP8, 9, 10, or in humans based on epidemiological observations11. The present study was design to evaluate EBOV transmission from experimentally infected piglets to NHPs without direct contact.

    The study of this potential explosive development showed:

    The present study provides evidence that infected pigs can efficiently transmit ZEBOV to NHPs in conditions resembling farm setting. Our findings support the hypothesis that airborne transmission may contribute to ZEBOV spread, specifically from pigs to primates, and may need to be considered in assessing transmission from animals to humans in general.

    Now we have more articles appearing about this.

    The second possibility is one that virologists are loath to discuss openly but are definitely considering in private: that an Ebola virus could mutate to become transmissible through the air. You can now get Ebola only through direct contact with bodily fluids. But viruses like Ebola are notoriously sloppy in replicating, meaning the virus entering one person may be genetically different from the virus entering the next. The current Ebola virus’s hyper-evolution is unprecedented; there has been more human-to-human transmission in the past four months than most likely occurred in the last 500 to 1,000 years. Each new infection represents trillions of throws of the genetic dice.

    If the New York Times is publishing this, somebody is worried.

    Read the rest of this entry »

    Posted in Civil Society, Ebola, Health Care, Immigration, Medicine, Science | 31 Comments »

    Why Ebola will not stay in Africa.

    Posted by Michael Kennedy on 8th August 2014 (All posts by )

    Today’s Belmont Club has a good explanation of why Ebola will not stay in Africa.

    UPDATE: Patrick Sawyer was planning to visit Minnesota when he got sick.

    UPDATE #2: More from Belmont Club.

    In the balance therefore, the probability is that the virus is not airborne — yet — but it is more dangerous than its predecessors. This would account for its ability to slip through the protocols designed for less deadly strains of the disease. It’s not World War E time, but it’s time to worry.

    And: This may be a new strain with more virulence.

    The results of full genetic sequencing suggest that the outbreak in Guinea isn’t related to others that have occurred elsewhere in Africa, according to an international team that published its findings online in the New England Journal of Medicine (NEJM). That report was from April 2014.

    His wife, Decontee Sawyer, said that she had spoken to him a week earlier and that he had made plans to be stateside in early August to celebrate the birthdays of two of his three young daughters. She said the couple had been separated.

    He is believed to be the first American to have died from the current outbreak, which has killed 672 people since March, according to World Health Organization figures.

    He was American, not African.

    The man who brought the Ebola virus to Nigeria probably knew he was infected. Surveillance video of Patrick Sawyer before boarding his flight at Liberia’s James Sprigg Payne’s Airport showed “Mr. Sawyer lying flat on his stomach on the floor in the corridor of the airport and seemed to be in ‘excruciating pain.’ The footage showed Mr. Sawyer preventing people from touching him.”

    He collapsed upon arrival in Nigeria, after a layover in Togo and was rushed to a Nigerian hospital. Upon being told he had Ebola, he acted with what the Nigerians called “indiscipline”; a burst of rage and despair against the world and everyone in it.

    Upon being told he had Ebola, Mr. Sawyer went into a rage, denying and objecting to the opinion of the medical experts. “He was so adamant and difficult that he took the tubes from his body and took off his pants and urinated on the health workers, forcing them to flee.

    Amazingly, he was even then in the process of being sprung by his political connections before death intervened. Had he lived Sawyer might have gotten out and protected by the juju of expensive watches and status symbols, mingled among the muckety-mucks of ECOWAS.

    Read the rest of this entry »

    Posted in Current Events, Ebola, Health Care, Medicine, Science | 56 Comments »

    Medicine as a government benefit.

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

    Obamacare is having serious trouble as I have discussed. The success stories, like California, are an example of what I have called Medicaid for All.

    “It’s a total contradiction in terms to spend your public time castigating Medicaid as something that never should have been expanded for poor people and as a broken, problem-riddled system, and then turn around and complain about the length of time to enroll people,” said Sara Rosenbaum, a member of the Medicaid and CHIP Payment and Access Commission, which advises Congress.

    Most of the new enrollees are Medicaid members and those enrolled in “private insurance” learn that they have severely restricted choice of doctor or hospital.

    Now we have a new development.

    Read the rest of this entry »

    Posted in Big Government, Economics & Finance, Health Care, Medicine, Political Philosophy, Science | 5 Comments »

    What next for health reform ?

    Posted by Michael Kennedy on 26th July 2014 (All posts by )

    It looks to me that the Supreme Court will have little justification for continuing the Obamacare program as it exists. The Halbig decision should kill it off. It is clear that the IRS subsidies to federal exchange subscribers are illegal.

    The only statement anyone has found in the legislative history that addresses this point comes from the Act’s lead author, who affirmed that Congress did intend to withhold tax credits in federal Exchanges. During a September 23, 2009, mark-up of his bill, which ultimately became the PPACA, Senate Finance Committee chairman Max Baucus (D-MT) refused to consider a Republican amendment regarding medical malpractice on the grounds it fell outside the Committee’s jurisdiction. Sen. John Ensign (R-NV) protested, asking how Baucus’ bill could do other things that lie outside the Committee’s jurisdiction, like direct states to create Exchanges. Baucus responded the bill creates tax credits, which are within its jurisdiction, and makes eligibility for those tax credits conditional on states creating Exchanges. Conditional necessarily means that Baucus intended to withhold tax credits in states that did not create their own Exchanges.

    I just don’t see how the Court can ignore that history. The political left has been on a rant about Congressional intent since the decision was announced.

    Read the rest of this entry »

    Posted in Economics & Finance, Health Care, Leftism, Medicine, Politics, Taxes | 10 Comments »

    An Update on healthcare reform.

    Posted by Michael Kennedy on 21st July 2014 (All posts by )

    Cash medical practice or, in the phrase favored by leftists critics, “Concierge Medicine,” seems to be growing.

    Becker is shifting to a new style of practice, sometimes called concierge or retainer medicine. With the help of a company that has been helping physicians make such shifts for over 13 years, he will cease caring for a total of 2,500 patients and instead cut back to about 600. These patients will pay an annual fee of $1,650. In exchange, they will receive a two-hour annual visit with a complete physical exam, same-day appointments, 24-hour physician phone access, and personalized, web-based resources to promote wellness.

    The article suggest that all these doctors choosing to drop insurance and Medicare are primary care. Many are but I know orthopedists and even general surgeons who are dropping all insurance.

    The concierge model of practice is growing, and it is estimated that more than 4,000 U.S. physicians have adopted some variation of it. Most are general internists, with family practitioners second. It is attractive to physicians because they are relieved of much of the pressure to move patients through quickly, and they can devote more time to prevention and wellness.

    Read the rest of this entry »

    Posted in Big Government, Bioethics, Crony Capitalism, Health Care, Medicine, Politics, Science | 23 Comments »

    “Do doctors understand test results?”

    Posted by Jonathan on 7th July 2014 (All posts by )

    The short answer in many cases is “no”:

    In one session, almost half the group of 160 gynaecologists responded that the woman’s chance of having cancer was nine in 10. Only 21% said that the figure was one in 10 – which is the correct answer. That’s a worse result than if the doctors had been answering at random.
     
    The fact that 90% of women with breast cancer get a positive result from a mammogram doesn’t mean that 90% of women with positive results have breast cancer. The high false alarm rate, combined with the disease’s prevalence of 1%, means that roughly nine out of 10 women with a worrying mammogram don’t actually have breast cancer.
     
    It’s a maths puzzle many of us would struggle with. That’s because, Gigerenzer says, setting probabilities out as percentages, although standard practice, is confusing. He campaigns for risks to be expressed using numbers of people instead, and if possible diagrams.
     
    Graphic showing “false positives” in mammogram tests
    Even so, Gigerenzer says, it’s surprising how few specialists understand the risk a woman with a positive mammogram result is facing – and worrying too. “We can only imagine how much anxiety those innumerate doctors instil in women,” he says. Research suggests that months after a mammogram false alarm, up to a quarter of women are still affected by the process on a daily basis.
     
    Survival rates are another source of confusion for doctors, not to mention journalists, politicians and patients. These are not, as you might assume, simply the opposite of mortality rates – the proportion of the general population who die from a disease. They describe the health outcomes of people who have been diagnosed with a disease, over a period of time – often five years from the point of diagnosis. They don’t tell us about whether patients die from the disease afterwards.

    The linked article is worth reading despite its implicit pro-NHS boosterism. See also this. The poor education in statistical analysis of doctors, lawyers, journalists and members of other influential groups in our society is a significant problem.

    (Via Mangan RT by heartiste on Twitter.)

    UPDATE: Gerd Gigerenzer’s Books

    Posted in Book Notes, Health Care, Human Behavior, Medicine, Statistics | 7 Comments »

    Quote of the Day

    Posted by Jonathan on 5th July 2014 (All posts by )

    From an Instapundit comment thread re genetic testing of newborns to confirm/disconfirm parentage:

    Carl Pham
    Come on. Who do you think calls himself “an expert in ethics?” Would you? Would I? Of course not. Anybody with a trace of common sense and humility understands that no mere son of Adam can possible be considered competent in ethics, let alone an expert. Isn’t the next article up about Native American torture? And then there’s the one on terrorists murdering five-month olds? No sane member of the H. sapiens species would consider it plausible that any one of us could be a mini-Christ, prepared to judge right from wrong, separate the sheep from the goats.
     
    So, ipso facto, who are the “ethicists?” They are those who lack genuine empathy, humility, or any deep awareness of the challege and subtlety of moral judgment. They are the narcissists, the borderline personalities, the grandiose who imagine themselves fit to be the stewards of God. In another age, they would join the Inquisition.

    There is something to this argument.

    Posted in Bioethics, Deep Thoughts, Medicine, Morality and Philosphy | 1 Comment »

    It Is Great, Until It Isn’t

    Posted by Dan from Madison on 25th April 2014 (All posts by )

    Living in Madison, I associate with a larger than typical number of lefties, liberals, and others who lean to the left of the political spectrum. Oddly, being a leftist seems to be associated with anti-science and other oddities.

    When at parties and having discussions with locals, I always stay out of politics. I always shift the subject. Most of the people I deal with are extremely nice, good folks, but they are true believers, and nothing I say will do anything but make situations uncomfortable. But one subject I never hold back is not getting your kids vaccinated. My wife always cringes if it comes up because she knows the bazooka is coming out.

    I use the big words too, like “bullshit”, “nonsense” and interesting catch phrases like “have you ever seen a child with whooping cough?” or “I hope your kids don’t get measles because mine won’t”. It does fall on deaf ears, but with the anti-vaccers (is that a word?) I don’t care.

    Separately, my wife, while not a squishy leftist, does have a soft spot for marketing buzzwords like “organic”, “natural” etc. She typically spends more money than need be to offer food choices to my kids that are pesticide free, purchases “safer” chemicals and does other things like that – things that I offer to you are probably nonsensical. However, I have chosen not to “die on that hill”. Besides denting my wallet a bit, I don’t think that it is harming anything, so I let it go. I don’t have many complaints about my wife and I am probably way ahead of most husbands in that department (she puts up with me so that pretty much overrides any of my tiny complaints).

    But. Lice. Several years ago, both of my children got lice from school. Fortunately (?) I lost my hair a long time ago so was not in the loop, but my wife was mortified. I will never forget the moment – she said (and I am almost quoting) “get down to Walgreens and get the nastiest, strongest chemical you can find and get back here and help me with this”. I almost fell over and stumbled out to the car in a daze, wondering how my wife could have made such a radical change in the five minutes since my kids came home from school.

    But I did learn something. When the excrement hits the air conditioning, people want this crap solved. Now.

    Back to the anti vaccination folks.

    Everything is great and works until it doesn’t. Today I note this story about a famous anti-vaccination group, the Amish. Funny how one’s religion doesn’t seem that important when your kids contract a terrible disease. All of a sudden, vaccines look pretty good.

    More than 135 people crowded into a local woodworking business Thursday where nurses used up every available dose of vaccine — and then ordered 300 doses more, said Pam Palm, a spokeswoman for the Knox County, Ohio, Health Department.
     
    “Not getting immunizations has been the way the Amish have felt in the past, but they certainly have responded in this situation,” Palm said.
     
    The outbreak was detected this week when four unvaccinated Amish community members showed evidence of measles infection following a March trip to the Philippines to offer humanitarian aid to typhoon victims. More than 20,000 people have caught measles in the Philippines and at least 50 have died in a severe ongoing outbreak.
     

    I think this might be a good example of stated preferences vs. revealed preferences. Revealed in a most uncomfortable manner. I assume most of my left leaning friends here in the Madison area would do the exact same thing in the circumstances.

    My wife, while succumbing to some of the marketing for organic and natural products, thankfully didn’t fall for the vaccine scares that were prevalent when our children were born.

    I think if anyone were going to a third world place that was under duress (like the typhoon ravaged Philippines) that they would be REQUIRED to get boosters for measles, cholera, and whatever else I could think of. And why wouldn’t you anyways? But I guess that is my Midwestern common sense sneaking through again, and heck, what do I know.

    I do know this. Kids with measles = parents getting measles vaccines for everyone.

    Posted in Leftism, Medicine, Personal Narrative, Politics | 16 Comments »

    More Obamacare News

    Posted by Michael Kennedy on 18th January 2014 (All posts by )

    The CMS has a new contractor for Obamacare, not just the web site. The previous contractor, CGI Federal, has been replaced rather suddenly.

    “Accenture, one of the world’s largest consulting firms, has extensive experience with computer systems on the state level and built California’s large new health-insurance exchange. But it has not done substantial work on any Health and Human Services Department program.
    “The administration’s decision to end the contract with CGI reflects lingering unease over the performance of HealthCare.gov even as officials have touted recent improvements and the rising numbers of Americans who have used the marketplace to sign up for health coverage that took effect Jan. 1.”

    CGI Federal is the company connected with Michelle Obama through her classmate, a fellow Princeton alumna.

    Read the rest of this entry »

    Posted in Big Government, Economics & Finance, Health Care, Management, Medicine, Politics | 18 Comments »

    My health care posts from 2013

    Posted by Michael Kennedy on 2nd January 2014 (All posts by )

    David has a good idea. I often read the archives of my personal blog to see how I did in forecasting the future or understanding the present. A major concern of mine is, of course, health care and what is happening. When I retired from surgery after my own back surgery, I spent a year at Dartmouth Medical School’s center for study of health care. My purpose was to indulge an old hobby. How do we measure quality in health care ? I had served for years on the board of a company called California Medical Review, Inc. It was the official Medicare review organization for California. For a while I was the chair of the Data Committee. It seems to have gone downhill since I was there. First, it changed its name in an attempt to get more business from private sources. Then it lost the Medicare contract.

    Lumetra, which lost a huge Medicare contract last November, is changing its name and its business model as it seeks to replace more than $20 million in lost revenue.
    The San Francisco-based nonprofit’s revenue will shrink this year from $28 million last fiscal year, ending in March 2009, to a projected $4.5 million, CEO Linda Sawyer told the Business Times early this week.
    That’s in large part because it’s no longer a Medicare quality improvement contractor, formerly its main line of work. And in fact, the 25-year-old company’s revenue has been plummeting since fiscal 2007, when it hit $47 million.

    I see no sign that it is involved with Obamacare which is being run from Washington with a state organization that seems no better run than the parent organization.

    Beginning Jan. 1, 2015, the Affordable Care Act no longer will provide federal grants to fund state health exchanges. In addition, California law prohibits using the state’s general fund to pay for the exchange.

    Anyway, for what it is worth, here are the links to the 2013 health posts.

    The Lost Boys

    Alternatives to Obamacare.

    Why the Obamacare Site Isn’t Working.

    Where Healthcare May be Going.

    Conservatives Invented the Mandate; say the Democrats.

    A Critical Insight.

    A Rolling Catastrophe.

    Why Health Care is in Trouble.

    Where Do We Go Now ?

    Building the Airplane During Takeoff.

    Posted in Blogging, Current Events, Health Care, Medicine, Obama, Politics, Systems Analysis | 17 Comments »

    “Three things to keep in mind about Obamacare”

    Posted by Jonathan on 22nd November 2013 (All posts by )

    A great post by J. E. Dyer:

    1. The problem with Obamacare is that it fundamentally changes the relationship of government to the people. The change is wholly malign. There is no way to operate the Obamacare system and also force the government to respect the people’s rights. Obamacare will, at every step, increase the risk at which government holds our rights.
     
    We’re already seeing that with the roll-out, which has promptly violated the president’s best-known and most categorical promises – an indication of his complete lack of respect for us – as well as the people’s rights to decide what to do with their own property (in this case, their earnings), and to execute private contracts according to their own preferences.
     
    What matters about Obamacare is that it has forced so many people to do so many things involuntarily. It will continue to do so. Obamacare is about government force, about limiting people’s options, and about constraining the people to do or not do certain things. That’s what government is about, which is why it’s what Obamacare is about. Government is incapable of being about anything else.
     
    The public debate right now treats the Obamacare fiasco as if the central proposition is that taking over one-sixth of the economy is a technological challenge. The reality that matters is that government taking over the network of human decisions involved in “health care” is a moral outrage. Doing that is applying the model of regulatory force to a vast complex of human questions that have no universal, “right” answers. We might as well let the government tell us what to eat, what to wear, where to live, and what God to believe in – and if Obamacare stands, our government will eventually do just that.
     
    […]
     
    Quite frankly, I think the advice to Republicans to simply stand silent and “let Obamacare implode” is foolish. There is no hope of Obamacare imploding. It’s not a malformed bomb, governed by physical principles. It’s a man-made political arrangement. Its defenders will keep moving the goalposts and changing the rules to keep it on the field. It will get all the overtime it needs. The only way to defeat Obamacare is to actually counter it with a plan and a principled argument.

    Read the whole thing.

    Posted in Big Government, Health Care, Medicine, Obama | 2 Comments »

    “Can You Hear Me Now? Another Health Market that Really Works”

    Posted by Jonathan on 22nd November 2013 (All posts by )

    John Goodman:

    It has taken a long time, but the price of hearing aids is in the process of falling dramatically. How has this happened? Technological innovation, of course, but there is more. There’s no shortage of technological innovation in U.S. health care. However, because third-party payers, that is, health insurers and governments, determine prices, there is no mechanism for customers to signal value to providers.
     
    This is not the case for hearing aids: Although some states have mandated insurance coverage for hearing aids, this is usually limited to disabled children. The big market for hearing aids is seniors, and Medicare does not cover hearing aids.
     
    This is another case of a phenomenon observed elsewhere by NCPA Senior Fellow Devon Herrick: Where patients pay directly for medical care, prices fall like they do in every other market.

    (Via Leif Smith on Twitter.)

    Posted in Business, Economics & Finance, Health Care, Medicine | Comments Off on “Can You Hear Me Now? Another Health Market that Really Works”

    Medical Panic?

    Posted by Jonathan on 20th November 2013 (All posts by )

    Visited the orthopedist today with someone who recently decided, in part because of uncertainty about the future of the medical system, to go ahead with elective joint-replacement surgery. The orthopedist said that he had three other patients today who want to do the same thing and expressed the same reason. His surgical schedule is booked into January. I suspect we will start to hear many more such anecdotes.

    Posted in Medicine, Obama, Personal Narrative | 10 Comments »

    Building the airplane during takeoff.

    Posted by Michael Kennedy on 19th November 2013 (All posts by )

    Henry-Chao

    UPDATE: The Wall Street Journal on how to fix the Obamacare crisis.

    What can be done is Congress creating a new option in the form of a national health insurance charter under which insurers could design new low-cost policies free of mandated benefits imposed by ObamaCare and the 50 states that many of those losing their individual policies today surely would find attractive.

    What’s the first thing the new nationally chartered insurers would do? Rush out cheap, high-deductible policies, allaying some of the resentment that the ObamaCare mandate provokes among the young, healthy and footloose affluent.

    These folks could buy the minimalist coverage that (for various reasons) makes sense for them. They wouldn’t be forced to buy excessive coverage they don’t need to subsidize the old and sick.

    Who knows ? Maybe Jenkins reads this blog. It’s so obvious that the solution should be apparent even to Democrats.

    We are now learning that a large share of the Obamacare structure is still unbuilt. This is not the website but the guts of the system.

    The revelation came out of questioning of Mr. Chao by Rep. Cory Gardner (R., Colo.). Gardner was trying to figure out how much of the IT infrastructure around the federal insurance exchange had been completed. “Well, how much do we have to build today, still? What do we need to build? 50 percent? 40 percent? 30 percent?” Chao replied, “I think it’s just an approximation—we’re probably sitting between 60 and 70 percent because we still have to build…”

    Gardner replied, incredulously, “Wait, 60 or 70 percent that needs to be built, still?” Chao did not contradict Gardner, adding, “because we still have to build the payment systems to make payments to insurers in January.”

    This is the guy who is the chief IT guy for CMS.

    If the ability to pay the insurance companies is not yet written, how can anybody sign up ?

    Gardner, a fourth time: “But the entire system is 60 to 70 percent away from being complete.” Chao: “There’s the back office systems, the accounting systems, the payment systems…they still need to be done.”

    Gardner asked a fifth time: “Of those 60 to 70 percent of systems that are still being built, how are they going to be tested?”

    The answer was the same way the rest was tested.

    Read the rest of this entry »

    Posted in Big Government, Health Care, Medicine, Obama, Politics, Systems Analysis | 8 Comments »

    Where do we go now ?

    Posted by Michael Kennedy on 13th November 2013 (All posts by )

    I don’t want to wear out my welcome with posts but this is a topic that has interested me for many years. When I retired from practice, I spent a year at Dartmouth trying to learn how we can improve health care delivery and reduce cost without reducing quality.

    The Obamacare web site now has lost its happy photo of the Obamacare girl. The fact that she is a non-citizen seems appropriate. The web site is supposed to be fixed by November 30. Will that happen ? Well, maybe not.

    On Friday, the man tasked with the digital fixes said the site “remains a long way from where it needs to be” as more and more problems emerge.

    “As we put new fixes in, volume is increasing, exposing new storage capacity and software application issues,” Jeff Zients told reporters on a conference call.

    And at Tuesday’s White House Press Briefing, Press Secretary Jay Carney again said there was “more work to be done” on repairing HealthCare.gov.

    Carney, along with Zients and other administration officials, have repeatedly said the November 30 deadline is to get the health care website working for a “vast majority” of Americans looking to enroll in the Obamacare exchanges.

    So, what happens December 2, the Monday after the “glitches” are fixed ? First, they won’t be fixed. The contractor that designed the program, not just the web site, has a terrible record.

    Read the rest of this entry »

    Posted in Advertising, Big Government, Civil Society, Economics & Finance, Health Care, Leftism, Medicine, Obama, Politics | 11 Comments »