Later On

A blog written for those whose interests more or less match mine.

Doctors Say Hospitals Do Not Allow Them To Wear Masks

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Leila Fadel reports for NPR:

Neilly Buckalew is a traveling doctor who fills in at hospitals when there’s need. So in the midst of this pandemic, she feels particularly vulnerable to contracting the coronavirus — not just in hospitals but in hotels and on her travels.

When she got an assignment last week at Saint Alphonsus Regional Rehabilitation Hospital in Boise, Idaho, she packed her own personal protective equipment and drove to town. She disinfected her hotel room and stayed away from other guests but worried about the coughing person in the room next door. So she donned her own fitted N95 mask that she uses for work.

“I wanted to protect myself,” she said. “I wanted to protect my patients.”

That first day at work, Buckalew said she was told to take off her mask.

When she asked hospital administrators why, the reasons kept changing. First Buckalew said she was told it was against hospital policy for health care workers to bring their own gear. Then, she said, administrators told her if she wore her own N95 mask, others would want to wear the masks as well and the hospital didn’t have enough. Finally, Buckalew said, it was that CDC guidelines don’t require the mask at all times.

“I said if I can’t wear it, then we have a problem,” she said.

Refusing to take off her mask, she said, got her terminated. Then, she said after complaining she was reinstated and then terminated again — all within three days.

“I’m raising a huge big stink because it’s wrong. It’s unsafe. We’ll never flatten the curve if hospital systems keep acting this way,” she said, adding that she’s speaking now because she’s already lost her assignment and wanted to speak on behalf of those who can’t. “A lot of people can’t speak out because they’re afraid, or they know that they’ll be fired.”

The rehabilitation hospital is a joint venture by the Saint Alphonsus Regional Medical Center and Encompass Health. A spokesman at the medical center referred NPR to Encompass Health. Repeated calls to Encompass Health for comment were not returned. Buckalew said she filed a formal complaint with the Occupational Safety and Health Administration.

Buckalew’s account lays bare tensions between some hospital systems and health care workers on the front lines of this disease. Many doctors, nurses and other hospital workers say they don’t feel protected and are afraid in the midst of a shortage of masks and other protective gear. Some are bringing their own supplies donated by friends and family or purchased at hardware stores. Meanwhile, some hospitals are instituting strict policies that bar medical workers from bringing their own personal protective equipment, or PPE, to work, or limiting how much protection a person can wear because of a shortage in supplies.

Leaders at the American Academy of Emergency Medicine says they have heard accounts like Buckalew’s from health care workers across the country.

“We’re hearing a lot of people saying that ‘I’m not getting adequate PPE at my job, so I was able to buy PPE and I’m using what I buy,'” said Dr. Lisa Moreno, the president-elect of AAEM.

But when they wear it to work, she says doctors have told her, “‘I’m being yelled at. I’m being told to take it off. I’m being told that I’m scaring patients and that I’m scaring other people.’ We’ve had people who had their jobs threatened.”

Moreno said about two dozen people have formally complained to her organization. She said they’ve also received hundreds of calls from health care workers who are afraid to lose their jobs if they complain, but also feel that hospitals aren’t letting them do what they need to do to protect themselves against an infectious and new virus. . .

Continue reading.

So hospitals are cutting benefits for doctors and nurses and now are not allowing them to wear masks. Perhaps soon we’ll see hospitals not allowing doctors and nurses on the premises — hospitals seem already to be doing everything they can to get them to stay away.

Written by LeisureGuy

2 April 2020 at 9:35 am

Reprise of the Fine slant

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I like the Fine slant so much, now that I dialed in the correct angle, that I had to use it again. A good lather from Wholly Kaw’s Monaco Royale, thanks in part to the Fine Classic brush, and then another wonderful shave. This really is a terrific slant. I know the design work was challenging, but the end result is a marvel (though not the Fine Marvel, a different razor). The key for the user is the angle: handle rather far from the face.

Three passes, a perfect result, and a splash of Hâttric to finish the job.

Written by LeisureGuy

2 April 2020 at 9:29 am

Posted in Shaving

The GOP makes excuses — weak excuses

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Judd Legum has a good column at Popular Information that destroys the GOP’s current excuses:

The federal government’s response to the COVID-19 epidemic in the United States has been a disaster. As of Tuesday, there were more than 170,000 confirmed infections, the most in the world. While the virus spread in China and elsewhere, the federal government conducted virtually no testing, allowing COVID-19 to spread within communities undetected. During these critical weeks, there was no effort to stockpile protective equipment for health care workers or ramp up production of critical medical devices like ventilators. Already, more than 3,400 people have died. And it’s projected to get much worse.

How did this happen?

Appearing on the radio with conservative media personality Hugh Hewitt, Senate Majority Leader Mitch McConnell said the federal government was distracted because the House of Representatives impeached Trump. “[I]t came up while we were tied down on the impeachment trial. And I think it diverted the attention of the government because everything every day was all about impeachment,” McConnell said.

If the federal government failed to respond to an imminent pandemic because it was too concerned about the political fate of Trump, it would be an outrage. But the reality is even worse.

Years before Trump was impeached, he decimated the government’s capacity to respond to a pandemic. Moreover, . . .

Continue reading.

Written by LeisureGuy

1 April 2020 at 8:11 pm

Dr. Greger on diet vs. exercise in the obesity epidemic

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Written by LeisureGuy

1 April 2020 at 6:49 pm

What Is “Public Health” and What Does It Mean for the Coronavirus and COVID-19?

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A comment from The Eldest pointed out that calling a medical anthropologist an expert in public health is incorrect. So I thought that this article by Omar Saeed would be of interest:

The coronavirus-related shutdown of schoolsworkplaces, community events, and mass gatherings can be summarized with one increasingly desperate plea: “Please take this seriously!” During a confusing time for young people across the country and the world, we can turn to the field of public health to understand why the COVID-19 pandemic merits such a drastic response.

The fact that no one in our generation has ever dealt with anything like this makes it difficult to wrap our heads around it. Many students who learned that their universities were moving online found themselves with ample time and took the situation as an excuse to party. The urge to celebrate the shutdown of live classes and partake in an extended spring break is a natural response from those who don’t understand the severity of the public health impact.

So what can the field of public health teach us about what’s going on? I’m a current medical student who’s also pursuing a masters of public health. To help explain how our officials are responding to COVID-19, let’s take a look at the history of my field of study and how it’s relevant right now.

What is public health?

At its core, public health is quite literally just about the health of the public; it’s about community-level care and — most importantly — prevention, especially of disease, injuries, infections, and other negative health outcomes. Public health is often promoted by the government through educational programs, like anti-smoking campaigns; public policies, like anti-pollution laws; services, like community health screenings; and research, like work that tracks the spread of disease.

To put it simply, think of it in terms of big pictures and close-ups: While medicine treats individuals within communities, public health focuses on communities as a whole.

COVID-19 has been labeled a pandemic by the World Health Organization (WHO), the organization rooted within the United Nations whose responsibility it is to direct international public health responses. So what does that mean? First, drawing on the basics of public health, we must understand the phases of disease spread. We can look to epidemiology, the subcategory within public health that studies disease, for guidance. An outbreak is when there is a sudden spike in disease transmission within a certain region. Outbreaks that occur over a widespread area (i.e., within a country) are considered epidemics, as explained by the United States Centers for Disease Control and Prevention (CDC). An epidemic [click that link — LG] that has spread around the world is technically considered and often labeled a pandemic.

Pandemics don’t occur often, but when they do, they are often deadly. One major example is the 1918 Spanish Flu, which has been referenced regularly as people discuss COVID-19. As noted by the CDC, it was “the most severe pandemic in recent history.” It’s been estimated that the 1918 influenza infected nearly one-third of the world’s population and caused at least 50 million deaths. Back then, there were no national public health agencies to mitigate the damage, but the flu gave rise to a revolution in public health so that, today, we can at least control part of that narrative.

What can public health teach us about COVID-19?

Public health has a lot to teach us about how to fight COVID-19, both medically and as community members.

Previous pandemics like the 1918 Spanish Flu and the 2009 H1N1 Flu (aka the swine flu) have reinforced the notion that antiviral treatments (to treat the illness) and vaccines (to prevent infection) are two of the most important medical interventions for reducing illness during pandemics. But there hasn’t been a chance to develop these interventions when it comes to COVID-19 because it’s caused by a novel strain of coronavirus that was not discovered in humans until recently.

That means public health measures must be emphasized right now, including social distancingself-quarantining, and handwashing. Notably, long before the COVID-19 outbreak, way back in 2003, public health research estimated that 1 million deaths a year could be prevented if everyone just washed their hands.

We can look to the Substance Abuse and Mental Health Service Administration (SAMHSA) for definitions of these other key terms. Social distancing means  . . .

Continue reading. There’s more. And check out the links.

Written by LeisureGuy

1 April 2020 at 5:58 pm

How Bad Antitrust Enforcers Kill People

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Matt Stoller comments in BIG on a NY Times story I blogged recently:

How A Merger Killed the Ventilator Market

The New York Times had an important story about the ventilator market a few days ago, with Nicholas Kulish, Sarah Kliff and Jessica Silver-Greenberg reporting why a government effort to stock up on the machines after the SARS epidemic failed.

In 2006, in attempt to learn from what might happen should a SARS-like disease hit here, civil servants in government decided to stockpile ventilators. They wanted both more ventilators and better ventilators than were on the market. So government officials found a small innovative corporation called Newport Medical, and contracted with the corporation to design a cheaper and better version.

Ventilators at the time typically went for about $10,000 each, and getting the price down to $3,000 would be tough. But Newport’s executives bet they would be able to make up for any losses by selling the ventilators around the world.

“It would be very prestigious to be recognized as a supplier to the federal government,” said Richard Crawford, who was Newport’s head of research and development at the time. “We thought the international market would be strong, and there is where Newport would have a good profit on the product.”

At first the project seemed on track. Newport built a working prototype, and the government was on track to order 40,000 ventilators to put into the national stockpile. Newport would then be able to sell additional units into the health care market, as well as abroad. But in 2012, Covidien, a large medical device manufacturer and distributor, bought up Newport Medical, canceled the Federal contract, and shut down Newport’s ventilator line of business.

The result, in 2020, is that we don’t have enough ventilators in a pandemic.

There are three failures of policy here. I’ll start with the simplest, which is that the merger should have been blocked.

Antitrust Failure

The merger by any standard was a clear-cut antitrust violation. There are two theories as to why Covidien sought to buy Newport. First, Covidien already had a ventilator product, and didn’t want to compete with a lower priced and better version. Covidien bought Newport to take its competitive product out. That’s called a ‘killer acquisition,’ meaning that the goal is to undermine a potentially innovative or lower prices product line.

The second is that roll-ups were part of a broader consolidation trend in the industry in general. “Manufacturers,” as the Times reported, “wanted to pitch themselves as one-stop shops for hospitals, which were getting bigger, and that meant offering a broader suite of products.”

Both theories are likely true. Covidien from 2008-2014 bought 17 other corporations. Covidien pitched itself not just as a device maker, but as a device distributor to hospitals. It even called itself a platform, saying in its press release bleating about the acquisition that the acquisition would strengthen its “ventilation platform” for patients around the world. In other words, Covidien was both trying to take out a potential competitor *and* strengthen its own bargaining posture against hospital purchasers, who were themselves getting bigger.

The merger should have and could have been blocked on many different grounds, the simplest being the killer acquisition theory. Yet the Federal Trade Commission, led by Jon Leibowitz, just waved the illegal merger through without even asking any questions. Now there are calls, by both FTC Commissioner Rebecca Kelly-Slaughter, and antitrust thinkers across the board, to reexamine this merger. In Congress, Antitrust Committee Chairman David Cicilline made this point on Twitter. . .

Continue reading. There’s much more, and it shows the degree to which the US is out of whack. Later in the column:

The roll-up of device makers that Covidien was pursuing was part of a longstanding consolidation in the medical industry that correlated to consolidation more broadly. Because our antitrust laws focus on low consumer prices, what has happened across the economy is the creation of ‘power buyers.’

Most people look at monopolies who made commodities, say, steel, and believe a monopoly manifests by how much that company can raise the price of what it sells. But monopolies can operate on the buying side too. Walmart is a buying monopoly, able to use its market power to push prices down against suppliers and workers. I mean if you sell a large chunk of your product to Walmart, they can tell you what price to take. The price to consumers may be low, but that’s because Walmart is using market power against the supplier and not the consumer. But because our antitrust enforcers don’t see anything but consumer prices, corporations like Walmart became far more powerful from the 1980s to the 2000s.

As Olivia Webb noted, there was a Walmart-ization of the medical industry as well, as hospitals combined purchasing power in cartels called Group Purchasing Organizations. GPOs buy supplies for hospitals, and they are supposed to get better prices. But they often don’t. In 1986 Congress exempted them from anti-kickback laws, so there are huge conflicts of interest in how they operate. GPOs are also big. In 1996, the Clinton administration basically said GPOs wouldn’t be subject to antitrust prosecution. Today, for context, just four GPOs account for 90% of generic pharmaceutical purchasing. GPOs also handle medical devices.

Throughout the 2000s and 2010s, one of the results of these choices, as well as the refusal to enforce merger law or antitrust, was the concentration in these corporations that sell things to hospitals, everything from syringes to software. During the HIV epidemic, a corporation called Retractable Syringes developed a safer syringe that doctors and nurses wanted to prevent accidental needlesticks, but GPOs prevented them from selling their product to hospitals. None of this went unnoticed. Congress held hearings, to no avail, on all sorts of innovative medical devices that couldn’t make it into hospitals. Retractable won a private antitrust lawsuit, but more recently it lost one on appeal. Without legal redress, much of the medical device industry consolidated. Covidien itself was bought by Medtronic a few years ago.

Written by LeisureGuy

1 April 2020 at 5:36 pm

Stanford Encyclopedia of Philosophy on Confucius

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Mark Csíkszentmihályi (though he seems to have dropped the diacritics) writes in the Stanford Encyclopedia of Philosophy:

At different times in Chinese history, Confucius (trad. 551–479 BCE) has been portrayed as a teacher, advisor, editor, philosopher, reformer, and prophet. The name Confucius, a Latinized combination of the surname Kong 孔 with an honorific suffix “Master” (fuzi 夫子), has also come to be used as a global metonym for different aspects of traditional East Asian society. This association of Confucius with many of the foundational concepts and cultural practices in East Asia, and his casting as a progenitor of “Eastern” thought in Early Modern Europe, make him arguably the most significant thinker in East Asian history. Yet while early sources preserve biographical details about Master Kong, dialogues and stories about him in early texts like the Analects (Lunyu 論語) reflect a diversity of representations and concerns, strands of which were later differentially selected and woven together by interpreters intent on appropriating or condemning particular associated views and traditions. This means that the philosophy of Confucius is historically underdetermined, and it is possible to trace multiple sets of coherent doctrines back to the early period, each grounded in different sets of classical sources and schools of interpretation linked to his name. After introducing key texts and interpreters, then, this entry explores three principal interconnected areas of concern: a psychology of ritual that describes how ideal social forms regulate individuals, an ethics rooted in the cultivation of a set of personal virtues, and a theory of society and politics based on normative views of the family and the state.

Each of these areas has unique features that were developed by later thinkers, some of whom have been identified as “Confucians”, even though that term is not well-defined. The Chinese term Ru (儒) predates Confucius, and connoted specialists in ritual and music, and later experts in Classical Studies. Ru is routinely translated into English as “Confucian”. Yet “Confucian” is also sometimes used in English to refer to the sage kings of antiquity who were credited with key cultural innovations by the Ru, to sacrificial practices at temples dedicated to Confucius and related figures, and to traditional features of East Asian social organization like the “bureaucracy” or “meritocracy”. For this reason, the term Confucian will be avoided in this entry, which will focus on the philosophical aspects of the thought of Confucius (the Latinization used for “Master Kong” following the English-language convention) primarily, but not exclusively, through the lens of the Analects.

1. Confucius as Chinese Philosopher and Symbol of Traditional Culture

Because of the wide range of texts and traditions identified with him, choices about which version of Confucius is authoritative have changed over time, reflecting particular political and social priorities. The portrait of Confucius as philosopher is, in part, the product of a series of modern cross-cultural interactions. In Imperial China, Confucius was identified with interpretations of the classics and moral guidelines for administrators, and therefore also with training the scholar-officials that populated the bureaucracy. At the same time, he was closely associated with the transmission of the ancient sacrificial system, and he himself received ritual offerings in temples found in all major cities. By the Han (202 BCE–220 CE), Confucius was already an authoritative figure in a number of different cultural domains, and the early commentaries show that reading texts associated with him about history, ritual, and proper behavior was important to rulers. The first commentaries to the Analects were written by tutors to the crown prince (e.g., Zhang Yu 張禹, d. 5 BCE), and select experts in the “Five Classics” (Wujing 五經) were given scholastic positions in the government. The authority of Confucius was such that during the late Han and the following period of disunity, his imprimatur was used to validate commentaries to the classics, encoded political prophecies, and esoteric doctrines.

By the Song period (960–1279), the post-Buddhist revival known as “Neo-Confucianism” anchored readings of the dialogues of Confucius to a dualism between “cosmic pattern” (li 理) and “pneumas” (qi 氣), a distinctive moral cosmology that marked the tradition off from those of Buddhism and Daoism. The Neo-Confucian interpretation of the Analects by Zhu Xi 朱熹 (1130–1200) integrated the study of the Analects into a curriculum based on the “Four Books” (Sishu 四書) that became widely influential in China, Korea, and Japan. The pre-modern Confucius was closely associated with good government, moral education, proper ritual performance, and the reciprocal obligations that people in different roles owed each other in such contexts.

When Confucius became a character in the intellectual debates of eighteenth century Europe, he became identified as China’s first philosopher. Jesuit missionaries in China sent back accounts of ancient China that portrayed Confucius as inspired by Natural Theology to pursue the good, which they considered a marked contrast with the “idolatries” of Buddhism and Daoism. Back in Europe, intellectuals read missionary descriptions and translations of Chinese literature, and writers like Gottfried Wilhelm Leibniz (1646–1716) and Nicolas-Gabriel Clerc (1726–1798) praised Confucius for his discovery of universal natural laws through reason. Enlightenment writers celebrated the moral philosophy of Confucius for its independence from the dogmatic influence of the Church. While at times he was criticized as an atheist or an advocate of despotism, many Europeans viewed Confucius as a moral philosopher whose approach was in line with rationalism and humanism.

Today, many descriptions combine these several ways of positioning Confucius, but the modern interpretation of his views has been complicated by a tendency to look back on him as an emblem of the “traditional culture” of China. In the eyes of some late nineteenth and twentieth century reformers who sought to fortify China against foreign influence, the moral teachings of Confucius had the potential to play the same role that they perceived Christianity had done in the modernization of Europe and America, or serve as the basis of a more secular spiritual renewal that would transform the population into citizens of a modern nation-state. In the twentieth century, the pursuit of modernization also led to the rejection of Confucius by some reformers in the May Fourth and New Culture movements, as well as by many in the Communist Party, who identified the traditional hierarchies implicit in his social and political philosophy with the social and economic inequalities that they sought to eliminate. In these modern debates, it is not just the status of Confucius in traditional China that made him such a potent symbol. His specific association with the curriculum of the system of education of scholar-officials in the imperial government, and of traditional moral values more generally, connected him to the aspects of tradition worth preserving, or the things that held China back from modernization, depending on one’s point of view.

As legacies of Confucius tied to traditional ritual roles and the pre-modern social structure were criticized by modernizers, a view of Confucius as a moral philosopher, already common in European readings, gained ascendancy in East Asia. The American-educated historian Hu Shi 胡適 (1891–1962) wrote an early influential history of Chinese philosophy, beginning with Laozi 老子 and Confucius, explicitly on the model of existing histories of Western philosophy. In it, Hu compared what he called the conservative aspect of the philosophy of Confucius to Socrates and Plato. Since at least that time, Confucius has been central to most histories of Chinese philosophy.

2. Sources for Confucius’s Life and Thought

Biographical treatments of Confucius, beginning with . . .

Continue reading. There’s much more.

Written by LeisureGuy

1 April 2020 at 2:13 pm

Posted in Education

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