Later On

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

Archive for the ‘Medical’ Category

The Cynicism Behind Graham-Cassidy Is Breathtaking

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Kevin Drum notes:

It’s hard to know how to react to the cynicism of the Graham-Cassidy health care bill. For starters, of course, it’s as bad as all the other Republican repeal bills. Tens of millions of the working poor will lose insurance. Pre-existing conditions aren’t protected. Medicaid funding is slashed. Subsidies are slashed.

But apparently that’s not enough. Republican senators (and President Trump, of course) obviously don’t care what’s in the bill. Hell, they’re all but gleeful in their ignorance. Nor is merely repealing Obamacare enough. Graham-Cassidy is very carefully formulated to punish blue states especially harshly. And if even that’s not enough, after 2020 it gives the president the power to arbitrarily punish them even more if he feels like it. I guess this makes it especially appealing to conservatives. Finally, by handing everything over to the states with virtually no guidance, it would create chaos in the health insurance market. The insurance industry, which was practically the only major player to stay neutral on previous bills (doctors, nurses, hospitals, and everyone else opposed them) has finally had enough. Even if it hurts them with Republicans, Graham-Cassidy is a bridge too far:

The two major trade groups for insurers, the Blue Cross Blue Shield Association and America’s Health Insurance Plans, announced their opposition on Wednesday to the Graham-Cassidy bill….“The bill contains provisions that would allow states to waive key consumer protections, as well as undermine safeguards for those with pre-existing medical conditions,’’ said Scott P. Serota, the president and chief executive of the Blue Cross Blue Shield Association.

….America’s Health Insurance Plans was even more pointed. The legislation could hurt patients by “further destabilizing the individual market” and could potentially allow “government-controlled single payer health care to grow,” said Marilyn B. Tavenner, the president and chief executive of the association. Without controls, some states could simply eliminate private insurance, she warned.

Literally nobody in the health insurance industry likes this bill. The chaos and misery it would unleash are practically undebatable. It’s being passed for no reason except that Republicans have screwed up health care so epically that they have only a few days left to pass something, and Graham-Cassidy is something.

If there’s any silver lining at all to this mess, it comes from AHIP’s Marilyn Taverner:  . . .

Continue reading.

Written by LeisureGuy

21 September 2017 at 8:26 am

Montana residents desperate now for clean air to breathe

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Sarah Coefield, an air quality specialist with the Missoula City-County Health Department, writes in the Washington Post:

It’s late August when I get a call from a grandmother. She lives in Seeley Lake, and she’s heard we have air filters that can help with smoke. She needs one for the baby’s room. I explain we don’t have any and tell her how to purchase one. She coughs and goes silent before asking how much they cost. Almost every person I talk to in Seeley Lake has this cough. The family doesn’t have much money, she says, but she promises to order a filter for the child. The next day, the wildfire moves closer, and the county sheriff’s office evacuates her neighborhood. I wonder if the filter will be there when the family returns home. I know the smoke will be.

As an air quality specialist with the county health department here, my job is to understand air pollution, control it as much as possible and help people protect themselves from its effects. I focus on smoke management: issuing permits for outdoor burns and updates about what to expect from the smoke when wildfires send it our way. In a typical wildfire season, my smoke-related responsibilities end when I hit “send” on twice-daily media updates.

If my job were only about fires and how the smoke moves, it would be simple. Not easy, mind you: Wildfire smoke is flashy and weird, and if anyone tells you they can reliably predict its behavior, they’re lying. It’s just that purely focusing on the science would be fun for a smoke nerd like me.

But in July, thunderstorms trekked across western Montana, igniting a ring of fires around Missoula County. One by one, they started blowing up, smothering small towns in smoke. The massive Rice Ridge Fire burns directly above the community of Seeley Lake, and every night, smoke fills the valley, building by the hour and creating dangerous breathing conditions the likes of which we have never seen. To our south, the Lolo Peak Fire sends daily smoke to the Bitterroot Valley, creating frequently hazardous, unbreathable air for its residents. Never have we seen so many wildfires so close to home for so many weeks.

As with most mountain valley communities, Missoula County’s most worrisome and prevalent air pollutant is the fine particulate in wood smoke, so tiny it can enter your bloodstream when you breathe it in. It’s a cumulative pollutant: The more you’re in it, the worse it is for you. The particulate aggravates asthma symptoms and causes reduced lung function and wheeziness. It increases the risk of heart attack and stroke and can damage children’s developing lungs. The elderly, people with heart or lung disease, pregnant women, and children are most at risk. Wildfire health studies are still part of a growing science, but we know the smoke is dangerous. We know there will be more emergency-room visits, more hospital stays and, probably, more deaths. We don’t know its long-term health consequences, and no one knows what six weeks in the worst smoke we have ever seen will mean for the people in Seeley Lake.

At monitoring stations scattered around the county, we measure the mass of fine particulate in the smoke. The National Ambient Air Quality Standard for fine particulate matter averaged over 24 hours is 35 micrograms in a cubic meter of air. Our monitor in Seeley Lake is registering 1,000, as high as the machine goes. It was built without the expectation of ever measuring such concentrations.

When smoke descends on the valley, the world shrinks. Anything more than a block away disappears behind a white wall of smoke. The birds are quiet.

Smoke makes its way through door and window cracks. It follows ventilation systems into homes. Without a filtration system, the indoors provides no refuge. And in rural Montana, where air conditioning is rare, most residents open their windows at night to seek relief from the hot, stuffy summer air, even amid the smoke. . .

Continue reading.

Written by LeisureGuy

16 September 2017 at 8:38 pm

Hillary Clinton used ‘alternate nostril breathing’ after her loss. Here’s why you should, too.

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Kim Weeks writes in the Washington Post:

Hillary Clinton revealed this week she turned to an esoteric breathing technique popular among yogis to heal from her devastating election loss.

She has spoken in the past about using meditation and yoga for calm and balance, but during an interview with CNN’s Anderson Cooper on Wednesday night to promote her new campaign memoir she explained and demonstrated alternate nostril breathing, or nadi shodhana in Sanskrit. She said the practice is “very relaxing” and urged Cooper to try it.

By bringing this kind of breath work into the mainstream, Clinton has introduced the world to a practice that has both proven mental and physical health benefits.

Yoga in general, and yoga breathing practices such nadi shodhana, calm the mind and the body. In nadi shodhana, the process of literally alternating breathing between the right and left nostril also helps balance the right and left brain, the right and left lungs, and the right and left sides of the body. Alternate nostril breathing has been shown to slow down a rapid heart rate and to lower blood pressure. It can clear toxins and respiratory systems — shodhana translates to purification and nadi to channels, so the intent of the practice is to cleanse different systems of the mind and body.

Research has also shown that this type of breathing exercise can significantly increase the effectiveness of the parasympathetic nervous system, or the “rest-and-digest” system that automatically kicks in when we relax or sleep to help restore our body’s equilibrium. But in our hectic, daily lives, when our bodies are in a perpetual state of fight or flight, this calmer part of ourselves is harder to activate.

It’s particularly challenging to access during times of extreme stress, which is why Clinton told Cooper he probably wouldn’t be able to do it in the middle of covering a hurricane. But for everyday stresses, taking the time to breath this way is calming and grounding.

The demands of daily life act on the body the same way, whether you’re running for political office or running late to pick up your toddler at day care. In almost all cases, the body doesn’t register the difference. It just knows that it is stressed, deprived of its need to disengage from activity and be still. So instead we look to power, money, career, relationships and thousands of other things outside ourselves in hopes they will bring us contentment and calm. But life doesn’t work that way. . .

Continue reading.

Later in the article:

Here’s how to try it yourself

1. Take a seat. Sit cross-legged on the floor or use a chair.

2. Curl your right forefinger and middle finger into your palm. You’re getting these two out of the way. Your thumb, ring finger, and pinky finger will be sticking out. You will use your thumb and ring finger to do alternate-nostril breathing.

3. Put your thumb on the right nostril where the nose bone meets cartilage. Put your ring finger on the left nostril in the same place. Rest them there lightly.

4. Breathe normally, but do not breathe through the mouth. Keep it closed. Take a long, slow, deep inhalation through both nostrils. Before exhaling (don’t really pause, just go with it), push in/depress the right nostril to close it off completely. Exhale fully through the left nostril only.

5. Keep the right nostril closed off. Inhale through the left nostril. Before exhaling again (again, no pausing, just keep going), press the left nostril with the ring finger and release the thumb from the right.

6. Exhale through the right nostril only, and then inhale through the right nostril only.

7. Repeat steps 5 and 6 until you’re ready to finish (for maximum benefits do at least 10 rounds). The finishing breath will be an exhale through the left nostril.

8. Take a long, slow breath in through both nostrils, and then exhale through both nostrils.

Written by LeisureGuy

15 September 2017 at 7:40 pm

A set of articles on the heroin crisis. Read about it. It’s worse than you think.

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From David Pell’s newsletter NextDraft:

“Once a bustling industrial town, Huntington, West Virginia has become the epicenter of America’s modern opioid epidemic, with an overdose rate 10 times the national average. This flood of heroin now threatens this Appalachian city with a cycle of generational addiction, lawlessness, and poverty.” The new Netflix documentary Heroin(e) (produced in collaboration with my friends at the excellent Center for Investigative Journalism) tells the story of three women on the front lines of the battle to save small towns from the perfect storm of America’s opioid/heroin disaster. It’s only thirty minutes. Take the time to watch it. Below, I’ve shared a collection of articles to frame this pressing story.

+ Cincinnati Enquirer: Seven days of heroin: This is what an epidemic looks like.

+ “Often omitted from the conversation about the epidemic is the fact that it is also inflicting harm on the American economy, and on a scale not seen in any previous drug crisis.” Even if politicians are not moved by the moral issue, they should be moved by the economic factors. The New Yorker on the cost of the opioid crisis.

+ “Distributors have fed their greed on human frailties and to criminal effect. There is no excuse and should be no forgiveness.” From the Charleston Gazette-Mail: Drug firms poured 780M painkillers into WV amid rise of overdoses.

+ What can a company like Purdue Pharma do to make ends meet when the domestic market finally gets hit with regulations? The family behind the company decided to follow in the deadly footsteps of big tobacco. From the LA Times: OxyContin goes global.

+ Bloomberg: Big Pharma’s Tobacco Moment as Star Lawyers Push Opioid Suits.

+ When American states started to legalize marijuana, drug cartels saw the writing on the wall. They knew they’d need a new source of income, and the opioid crisis provided them with a market of addicts suddenly facing a legal crackdown on pain pill mills. From the great Don Winslow: El Chapo and The Secret History of the Heroin Crisis.

+ And for a look at the rise of pill mills (a hurricane that hit Florida long before Irma), check out the book American Pain, by John Temple.

Written by LeisureGuy

13 September 2017 at 2:00 pm

The media gets the opioid crisis wrong. Here is the truth.

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Anne Case, the Alexander Stewart 1886 professor of economics and public affairs emeritus at Princeton University, and Angus Deaton, the Dwight D. Eisenhower professor of economics and international affairs emeritus at Princeton University and the 2015 Nobel laureate in economics, write in the Washington Post:

Lawmakers and the media have devoted much of their attention recently to deaths from opioid overdoses, as well as to the broader “deaths of despair” that include suicides and deaths from alcoholic liver disease and cirrhosis. But despite the intense focus on the topic, misinformation about the epidemic runs rampant.

By conventional wisdom, tackling this crisis would require extending Medicaid and improving how it functions, cracking down on prescription painkillers and getting more health-care resources into rural communities.

But that’s not exactly right. To correct the record, here are four points to bear in mind:

Medicaid isn’t the problem (and isn’t the solution). Critics of Medicaid argue that the program enables the epidemic by paying for prescription opioids. In fact, Princeton University researchers Janet Currie and Molly Schnell calculate that only 8 percent of all opioid prescriptions from January 2006 to March 2015 were paid for by Medicaid, based on data from QuintilesIMS, a leading health-care information company.

Medicaid can help addicts by providing a range of evidence-based therapies. This is correct and, like many others, we think treatment is a good idea. As such, we are also concerned about the effects that reductions in Medicaid could have on the epidemic. But Medicaid proponents often greatly overstate what can be expected from treatment in general, and Medicaid in particular. Many addicts deny their addiction and either do not seek or do not adhere to treatment once started. “Evidence-based” typically means there has been a randomized, controlled trial that has demonstrated effectiveness. But trials include only those who seek treatment — and say nothing about those who avoid it. A trial is deemed successful when the treatment is proved better than nothing (or at least a placebo) — even if only a few people end up benefiting from it.

It is not all about opioids. Policymakers often speak as if the epidemic will be over as soon as we tackle both legal and illegal opioids. Better control of opioids is essential, but, even without opioid deaths, there would still be as many or more deaths from suicide and liver diseases. Opioids are like guns handed out in a suicide ward; they have certainly made the total epidemic much worse, but they are not the cause of the underlying depression. We suspect that deaths of despair among those without a university degree are primarily the result of a 40-year stagnation of median real wages and a long-term decline in the number of well-paying jobs for those without a bachelor’s degree. Falling labor force participation, sluggish wage growth, and associated dysfunctional marriage and child-rearing patterns have undermined the meaning of working people’s lives as well.

The crisis has hit men and women about equally.  . .

Continue reading.

Also note: “Here’s How Big Pharma Helped Set New Pain Guidelines,” by Kevin Drum, on the origins of the crisis we now face.

Written by LeisureGuy

12 September 2017 at 3:44 pm

Old obsession continued: knives and knife-sharpening

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For some reason I’ve always been interested in knives. I am struck that you could take, say, a Randall knife and put it into the paw of a very early member of genus Homo, and she or he would immediately know what it was for and would doubtless prize it as the best sharp rock they’ve ever found and even better than the sharp rocks they are just learning how to make.

I like pocket knives, and I have a large collection of those, but I think I like fixed-blade knives even more: no moving parts.

The first thing you learn once you’re fond of knives and paying attention to them is that they will require sharpening, and sharpening is definitely a skill that must be learned. I’ve always liked the shortcut of sharpening systems that use some device to allow even a novice to keep a constant angle. There is still skill to be learned and experience to be gained, but a good sharpening system makes an enormous difference.

I started with a Lansky system, as many do, and in packing I found I still have it along with a GATCO sharpening system that I forgot I had: it’s been storage for quite a while.

I got an EdgePro Apex, but in that system the knife is not clamped but just held in place. After you get a certain amount of experience, this seems to work well, but I wanted the knife to be clamped securely.

After the EdgePro Apex, I got a KME system, which I liked a lot. It can do a very fine job, and my oldest grandson has it now. Still, it has some drawbacks. Changing the stones on the KME is a bit of a pain because it interrupts the workflow (and the same is true of the EdgePro Apex and the Lansky), and for me I could never get a secure clamp on a knife with a distal taper (in which the thickness of the blade tapers from relatively thick near the handle to a thin foible). This is a chronic problem and the best solution is to use two clamps rather than one. If you use one clamp, the blade is clamped mostly on the side where it’s thickest, so the blade tends to swivel under pressure: a line through a point can rotate about the point.

With two clamps, though, even though the clamps may be holding only on the thicker side, the blade is still secured: two points fix a line, so no rotation. And the TSProf sharpening system does indeed have two clamps for the blade. However, you still face the fuss of changing the sharpening stones. I learned about this sharpening system before they were really doing US sales, and I got no reply to a a query, but I did like the two-clamp solution to the problem of a distal taper.

But then I saw this video of the Wicked Edge sharpening system:

Did you notice the ease of changing sharpening stones? I was won over at once, but what with one thing and another was not moved to take action until recently—and I’m glad I waited. In the intervening years, Allison and his colleagues have continued to improve the device and now we have the Wicked Edge Gen 3 Pro 2017 Edition. It has many nice features, but one important one for me is that it has a two-pronged clamp that, according to reports, is enough to vanquish the distal-taper problem.

It comes fairly complete, but if you’re going to sharpen knives of small width (e.g., pocket knives), you’re going to need the Low-Angle Adapter, and with those the longer guide rods are desirable.

I haven’t really used it yet—waiting on getting settled for that—but I wanted to summarize my obsession status. And I have to say that the customer service at Wicked Edge (it’s in Santa Fe NM) is exemplary. They are very accommodating, answer their email, and are good to talk to on the phone.

In furtherance of the obsession, I have joined Edge Snobs™, and they often post good tips. (Wicked Edge also has its own forum on the company website.)

Stay keen, and stay tuned.

BTW, you search YouTube and find videos on all of these.

UPDATE: I realize that I did not include the two Chef’s Choice electric sharpeners I tried. Avoid at all costs. Bad for knives. There are also some manual sharpeners, not very costly, with stones or rods mounted at an angle and you draw the knife down the rod/stone while keeping the blade vertical, which defines the cutting angle (which is thus fixed). Nah.

Basically, the only sharpening systems I recommend are those listed in the original post above. The others I did not think of because I have blocked them from my memory.

Written by LeisureGuy

12 September 2017 at 11:26 am

A week of the heroin epidemic in Cincinnati

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Good God. Read it if you can.

Written by LeisureGuy

11 September 2017 at 4:44 pm

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