Later On

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Archive for the ‘Medical’ Category

What we were told about eat fats was wrong, and now: Rule that patients must finish antibiotics course is wrong, study says

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Sarah Boseley reports in the Guardian:

Telling patients to stop taking antibiotics when they feel better may be preferable to instructing them to finish the course, according to a group of experts who argue that the rule long embedded in the minds of doctors and the public is wrong and should be overturned.

Patients have traditionally been told that they must complete courses of antibiotics, the theory being that taking too few tablets will allow the bacteria causing their disease to mutate and become resistant to the drug.

But Martin Llewelyn, a professor in infectious diseases at Brighton and Sussex medical school, and colleagues claim that this is not the case. In an analysis in the British Medical Journal, the experts say “the idea that stopping antibiotic treatment early encourages antibiotic resistance is not supported by evidence, while taking antibiotics for longer than necessary increases the risk of resistance”.

There are some diseases where the bug can become resistant if the drugs are not taken for long enough. The most obvious example is tuberculosis, they say. But most of the bacteria that cause people to become ill are found on everybody’s hands in the community, causing no harm, such as E coli and Staphylococcus aureus. People fall ill only when the bug gets into the bloodstream or the gut. The longer such bacteria are exposed to antibiotics, the more likely it is that resistance will develop.

The experts say there has been too little research into the ideal length of a course of antibiotics, which also varies from one individual to the next, depending in part on what antibiotics they have taken in the past.

In hospital, patients can be tested to work out when to stop the drugs. “Outside hospital, where repeated testing may not be feasible, patients might be best advised to stop treatment when they feel better,” they say. That, they add, is in direct contravention of World Health Organisation advice.

Other experts in infectious diseases backed the group. “I have always thought it to be illogical to say that stopping antibiotic treatment early promotes the emergence of drug-resistant organisms,” said Peter Openshaw, president of the British Society for Immunology.

“This brief but authoritative review supports the idea that antibiotics may be used more sparingly, pointing out that the evidence for a long duration of therapy is, at best, tenuous. Far from being irresponsible, shortening the duration of a course of antibiotics might make antibiotic resistance less likely.”

Alison Holmes, a professor of infectious diseases at Imperial College London, said a great British authority, Prof Harold Lambert, had made the same point in a Lancet article entitled “Don’t keep taking the tablets” as early as 1999.  . .

Continue reading.

Written by LeisureGuy

27 July 2017 at 2:00 pm

Posted in Daily life, Medical, Science

Don’t Worry About New Alabama Mad Cow, Says CDC, but Facts Suggest Otherwise

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The USDA is supposed to inspect meat, but in order to reduce taxes (and government) they are underfunded and understaffed (thanks to the GOP), so instead of inspecting meat they have meat producers go on the honor system. Of course, producers are rewarded for the amount they ship, and rejecting animals and the meat from them costs them money, which presents an obvious conflict of interest. So we all just agree not to look at that.

Martha Rosenberg reports in AlterNet:

Don’t worry, eat your hamburger. That’s what the CDC is saying as another “mad cow” was found in Alabama in July. The cow suffered from an “atypical” version of Mad Cow (BSE), says the CDC, which occurs spontaneously and cannot harm humans. Sounds good until you read that the atypical assertion is merely a CDC “theory” and the agency admits “transmission through feed or the environment cannot be ruled out.”

There is a reason government officials are quick to defend the safety of the U.S. beef supply. Within hours of the first mad cow discovered in the U.S. in 2003, China, Mexico, Russia, Brazil, South Africa, Hong Kong, Japan, Singapore, Taiwan, Malaysia, South Korea and 90 other countries banned U.S. beef. Ninety-eight percent of the $3 billion overseas beef market vanished. It has taken 14 years for the U.S. to re-establish its beef exports and other beef-exporting countries have had similar woes. If an atypical version of BSE that threatened no one didn’t exist, governments might want to invent one. In fact, the research behind the atypical theory is primarily floated by government ag departments.

In addition to losing exports, before atypical BSE was described, beef producers were forced to quarantine their ranches, search for tainted food sources and detain herdmates and offspring in a BSE outbreak. They lost huge amounts of money. The debut of atypical BSE means they can just say “these things happen,” and keep doing business.

Mainstream media sources are cooperatively repeating the government statement that, “the Alabama cow was not slaughtered, never entered the food supply and presents no risk to human health in the United States or anywhere else.” But food reporters who have covered BSE since 2003 remember that the same thing was said about the first U.S. BSE cow until both the San Francisco Chronicle and the LA Times reported otherwise.

“In an interview, Alameda County health officer Dr. Anthony Iton recalled that in early January 2004 almost a month after the initial discovery [of a BSE cow], state health officials informed him that five restaurants in the Oakland area had received soup bones from the lot of tainted beef,” reported the Times. “It immediately dispatched inspectors to the restaurants. But it was too late; soup made from the bones had been eaten. He was particularly disturbed to learn that none of the restaurant owners had received written notice of the recall and that federal inspectors did not visit them until 10 days after the recall.”

And there was more government BSE bumbling. A cow, born and bred in Texas, found less than a year after the first one (born in Canada) was suspected of having BSE, but ruled “negative” by government testers for seven months. Phyllis Fong, the inspector general at the time, ordered the more precise “Western blot” over the head of then Ag Secretary Mike Johanns and the cow was diagnosed with BSE.

After the Texas BSE cow, a BSE cow born and bred in Alabama was found. Extensive government investigations were conducted on both to find the source of the deadly disease and there was no mention of the current atypical BSE. Disturbingly, the government protected the identifies of the ranches that produced the BSE cows from food consumers, placing the interests of meat producers above the endangered public.

Government Prion Research Not to Be Trusted

BSE is transmitted by prions, invisible infectious particles that are not viruses or bacteria, but proteins. Though prions are not technically “alive” because they lack a nucleus, they are almost impossible to “kill” because they are not inactivated by cooking, heat, ammonia, bleach, hydrogen peroxide, benzene, alcohol, phenol, lye, formaldehyde or radiation. Yet government research into prion diseases—which include chronic wasting disease found in deer and elk—is extremely inept.

In 2006, BSE research had to be delayed at the National Animal Disease Laboratory in Ames, Iowa because lab workers there accused the facility of failing to properly treat infectious wastes before they were sent to the city’s treatment plant which empties into the Skunk River. The lab, in charge of confirming BSE cases, was also charged with keeping rather than incinerating dead animals for months in containers.

Nor do government protocols for human victims inspire confidence.  . .

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Cutting taxes is all well and good provided everything always goes right, but in general we pay taxes so the government can do its job of protecting the public, among other things. Businesses do not like it when the public is protected (thus the strong drive to kill the Consumer Financial Protection Bureau: Wall Street and banks do not want consumers to have financial protection because it would cut into profits).

Written by LeisureGuy

27 July 2017 at 1:11 pm

How healthcare is delivered in the US

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Nicholas Kristof provides an example in the NY Times:

For a man who needed 18 teeth pulled, Daniel Smith was looking chipper.

Anxious, too, for he was facing a pair of forceps. But Smith, 30, a contractor with no health or dental insurance, who hadn’t seen a dentist in more than 20 years, was looking forward to an imminent end to the pain and rot in his mouth.

“I’ve always worked, since I was 14, but I’ve never had dental insurance,” Smith told me. After his teeth are out, he has a lead on low-cost dentures.

“I’d like to have a straight smile,” he said. “I’ve never had one in my life.”

All around Smith were uninsured patients receiving free dental or medical care, including dozens of men and women in side-by-side dental chairs in the open air. Organizers mercifully arranged the long line of people waiting to have teeth pulled so that they were facing away from those currently enduring extractions.

The patients swamped the county fairground here for a three-day health extravaganza of free care organized by Remote Area Medical, an aid group that holds these events across the country. This one involved about 1,400 volunteers serving 2,300 men and women who needed care of every kind.

Some patients camped out for three days at the fairground gate before the clinic opened to make sure they would be treated.

The health fair reminded me of scenes I’ve witnessed in refugee camps in South Sudan. But here in America?

The sight is a wrenching reminder of how many Americans slip through the cracks. No other advanced country permits this level of suffering — and if the G.O.P. health care plan goes through, millions more will lose their health coverage.

“Walking around, listening to people, it breaks your heart,” said Gov. Terry McAuliffe, a Democrat, whom I encountered on the fairground. “We need a healthy work force, and this is a disgrace.”

“Shame on us as a nation,” McAuliffe added. “This is an embarrassment to our country.”

That’s what I feel, too: humiliation that Americans need to be rescued by a group originally intended to help people in the world’s poorest countries (mixed with pride at the altruistic spirit that attracted so many volunteers, paying their own expenses to come here). To me, the fundamental lesson is that even under Obamacare, too many people don’t have coverage, and we urgently need a single-payer universal health care system along the lines of Medicare for all.

Remote Area Medical is the brainchild of Stan Brock, 81, a onetime British cowboy who in the 1950s managed one of the world’s biggest ranches, overseeing 50,000 cattle in Guyana in South America.

When he was badly injured by a wild horse, Brock was told it would be a 26-day hike to the nearest doctor. So he recovered on his own — but began to think about supplying health care to deprived areas.

Brock ended up founding Remote Area Medical to work in places like the Amazon, Haiti and Uganda. But then one day he had a call from Sneedville, Tenn., where the hospital had just closed and the dentist moved out. “Can you come here?” the caller asked.

Brock loaded a dental chair on the back of a pickup truck and brought in a dentist as well — and 150 people lined up, desperate for oral care. The result is that while it continues some international work, Remote Area Medical also treats people in the world’s superpower.

Brock is a character: He discovered a species of bat that is named for him, and today he has no home but unrolls a pad each evening and sleeps on the floor of Remote Area Medical’s permanent offices in Tennessee. At 5 a.m. on the first day here, Brock opened the gate and began admitting people eager for care.

As they surged past, many stopped to thank him; one man had tears in his eyes as he did so.

“I wish Mr. Trump would come,” Brock told me. “The health of these people is appalling.” . . .

Continue reading.

Written by LeisureGuy

27 July 2017 at 11:59 am

A Longtime Republican Senate Staffer, on John McCain

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James Fallows has an interesting post with remarks by Michael Logren:

I’ve had my say about John McCain’s decision to support the rushed consideration of the Republican drive to repeal Obamacare. Installment one was here, and two was here. The theme of both was that McCain missed a historic opportunity to match the scolding-and-uplift of his much-praised words, about the need to avoid simple fights for partisan victories, with the weight of his actual votes, which in the crucial showdown this week supported just such partisan warfare.

Now Mike Lofgren, who spent 28 years as a Congressional staffer mainly working for Republicans, and has since then become a noted author of The Party Is Overand The Deep State, writes in about the McCain he came to know from long observation on Capitol Hill. I’ve learned over the decades to take what Mike Lofgren says seriously, and in that spirit I invite close reading of what he has chosen to say:

Let us respectfully acknowledge John McCain’s past sacrifice to the United States and his present health struggles. Still, the media’s fawning over both his return to the Senate and his sanctimonious jeremiad against partisanship is difficult to bear. He rightly excoriated a grotesquely unfair Senate process, but then became the deciding vote allowing that process to move forward. Compounding his duplicity, he claimed he could not support the underlying legislation, but a few hours later voted in its favor—although nine of his Republican colleagues found the courage not to, defeating the measure.

Regardless of his vote on subsequent health care measures, should one of them pass and deprive millions of Americans of health insurance, McCain will have been the key enabling factor. The “Conscience of the Senate” would deny to those Americans the blessing which he takes for granted. But this chasm between his pretenses and his behavior has been a consistent feature of his Senate career.

His rhetorical denunciation of torture during the Bush years was loud and long—yet he never followed up, despite the fact that his moral prestige as a former POW would have carried great legislative weight. A ban on torture came only with Obama’s executive order. Likewise, a persistent feature of his career has been to bitterly scold pork-barrel spending in defense bills.

Yet, invariably, he fails to offer amendments to remove those offending provisions; nor does he vote against the underlying bill. As a staffer, I recall that almost all Senate Republicans, hardly a sensitive and swooning lot, really couldn’t stand his moral preening. But his tactics were a mechanism by which McCain got cheap credit from a lazy press looking for the One Righteous Republican they could lionize.

None of us vain creatures can bear scrutiny of the gap between our words and our deeds—but few, I fear, would suffer from that scrutiny more than John McCain.

His present obeisance to the reptilian Mitch McConnell, his strange non-reaction to Trump’s sliming of his wartime service, and his curious passivity towards the Bush campaign’s scurrilous attack on his family (later supporting Bush’s reelection as he stood by while Karl Rove defamed fellow Vietnam vet John Kerry), are all inexplicable incidents if one believes the standard narrative about McCain. The man who inflicted Sarah Palin on our suffering country and started us on the inevitable slide to the nightmare of Donald Trump is a far more complex, interesting, and fraught human being than the heroic caricatures depicted in the establishment media. . .

Continue reading.

Written by LeisureGuy

27 July 2017 at 10:20 am

John McCain Makes His Choice: To Eat the Cake, But He Wants to Have It, Too

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In the Atlantic James Fallows has an excellent column on McCain’s smokescreen to hide his actions behind a tapestry of words:

The effort to repeal Barack Obama’s health-care bill is not over, and neither presumably is the public career of John McCain. But each crossed an important threshold yesterday, and Senator McCain gave us a clearer idea of who he is and what he stands for.

The repeal effort isn’t over, because debate and further voting is now under way to determine whether the bill will pass and, more basically, to define what it would actually do. McCain will have more votes to cast, on this measure and others, and it’s possible that in the end he will turn against this bill because of its provisions (whatever they turn out to be) or because of the rushed and secretive process that led to it. Just this afternoon, McCain voted No on a “straight repeal” bill that would eliminate Obamacare without any replacement.

If in the end John McCain makes as decisive a stand against this proposal as he did in favor of it last night, then the historical verdict on this stage of his career will be more complex than it would be right now. As of the moment the story would be that McCain, soon after his diagnosis and treatment for aggressive brain cancer, responded to this memento mori by flying back to Washington to help take medical coverage away from other people.

There’s still time. But yesterday was important, for the bill and for McCain.

* * *

Not even U.S. senators are often in a position where just one of them, strictly on his or her own, can directly affect the welfare of tens of millions of people. John McCain was in that position yesterday. By definition, in a vote this close, every vote is the “decisive” one. But McCain built drama by holding his vote until the very end. He wanted to take center stage. And he did so—by voting Yes, to let this bill proceed.

He voted to keep alive a bill opposed not by some but by all major medical-professional and health-related groups. A bill that an organization of nuns called “the most harmful legislation to American families in our lifetimes.” A bill with absolutely no across-the-aisle Democratic amendments, as compared with well over 100 Republican amendments in the original Obamacare plan, and with virtually no open hearings or debates. A bill whose support level in opinion polls is roughly half that of Donald Trump himself. A bill—well, the litany is familiar, all leading up to the point that it’s a bill that John McCain could have chosen to stop yesterday, and didn’t.

If he had stayed home in Arizona, the bill would have died. If he had voted No, at least this effort at repeal would have ended. Of course, perhaps Senate Majority Leader Mitch McConnell could have squeezed either Susan Collins or Lisa Murkowski, the two Republican defectors, to switch their votes, so he could still eke out a 50-50 tie, allowing Mike Pence to make it 51-50. Perhaps if McConnell had failed yesterday, he would have kept looking for some other way to get an anti-Obamacare “win,” despite the distortion the crusade is causing in everything else the Senate has to do. Perhaps McCain thought he was saving his influence within the GOP for later—later stages of deliberation on this bill, later encounters with Trump. Perhaps, perhaps. For certain, McCain made a choice yesterday, and he did something no one looking back on this moment will admire.

(Whenever I hear about politicians saving influence “for later,” I cannot help thinking of the unfortunate Ricky Ray Rector, the man whose name is a shorthand for the most heartless thing Bill Clinton did in his drive for the presidency. Rector was a murderer who tried to blow his own brains out when about to be captured by police. He survived but with profound mental disabilities. An Arkansas jury nonetheless convicted him and sentenced him to death; the U.S. Supreme Court declined to hear his case. Young Arkansas governor Bill Clinton, then in a very tight contest in the Democratic primaries of 1992, and all too aware that only four years earlier Michael Dukakis had been badly hurt by a “soft on crime,” Willie Horton race-baiting campaign, approved the execution and went to Little Rock to be in the state when it occurred. When Rector was offered a last meal before being put to death, he told the jailers that he wanted to save his dessert “for later.” When politicians talk about “saving” their influence, this for later is what I hear.)

* * *

John McCain himself went out of his way to highlight why his choice was so sad, and so hypocritical. As David Graham noted yesterday, McCain immediately followed his vote with one of his trademark speeches on the need to take the high road in politics—the need to stop doing things in a rushed and secretive way, to stop simply looking for partisan wins. Elevated words, of the kind McCain is accustomed to being complimented on. But the words were entirely at odds with his actions of just minutes before—when he had the chance to stop a rushed and secretive push toward a partisan win, and he whiffed. Later that same evening, just hours after he somberly declared that “I will not vote for this bill as it is today,” McCain went right ahead and voted for that bill as it was yesterday, one of only 43 Republicans to do so.

And he didn’t need to do this, any of it.  . .

Continue reading.

McCain is a Republican. That is significant, and tells us a lot.

Written by LeisureGuy

26 July 2017 at 4:10 pm

A clear-eyed view of the Republicans in Congress

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Jennifer Rubin concludes a column today with this pointed remark:

In sum, the consolation for a meltdown in legislative order, rationality and responsible government is that we now know just how incapable the GOP is of governing. Years of antagonism toward government have made them cavalier about the harm they can do to ordinary citizens in their quest to avoid blame. What a shabby group they are. Let’s hope they don’t do real damage before they lose their majority.

Written by LeisureGuy

26 July 2017 at 10:39 am

Fascinating: Prescription video games to treat specific disorders (ADHD, Depression, …)

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Very interesting article (and video).

Written by LeisureGuy

25 July 2017 at 2:05 pm

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