Later On

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

Archive for the ‘Medical’ Category

All In The [EpiPen] Family

leave a comment »

David Epstein reports in ProPublica:

If you notice the news and/or aren’t that guy in Plato’s favorite cave, you’ve probably already suffered rage-induced anaphylaxis while reading about the cool 600 percent price increase for EpiPens in recent years. In all the commotion about unaffordable lifesaving injections, however, you probably missed a USA Today story explaining how Mylan Specialty, maker of EpiPen, developed “a near monopoly in school nurses’ offices.” Your three W’s:

What?

USA Today reports that, in 2012, Gayle Manchin became head of the nonprofit National Association of State Boards of Education, and “spearheaded an unprecedented effort” to make schools purchase emergency treatments for allergic reactions. Manchin’s efforts were rewarded, as 11 states created laws to require epinephrine auto-injectors (i.e. EpiPens) in schools, and other states recommended schools get them. And we’re using the strong form of “recommend” here, since the 2013 “EpiPen Law,” as the White House called it, gave funding preference to schools stocking EpiPens. So this is the kind of “recommend” like when you’re playing make-believe and making “vroom” sounds on that Harley parked outside a bar and someone burly walks out and recommends you stop doing that.

What’s wrong?

Good question. Seems totally reasonable for schools to have emergency treatments handy. Did I mention that the CEO of Mylan is Heather Bresch? Did I mention that her maiden name is Heather Manchin? Did I mention that Gayle Manchin, who helped get schools to purchase EpiPens gave birth to Heather Manchin who runs the company that profits when schools purchase EpiPens? (Oh and Gayle’s husband and Heather’s dad is Sen. Joe Manchin, D-W.Va.) USA Today mentioned all of that stuff. This might take supportive parenting to a heretofore unseen plane of existence.

What now?

According to The Guardian, on Wednesday . . .

Continue reading.

Written by LeisureGuy

23 September 2016 at 4:16 pm

More on the contemptible response of the FBI, Department of Justice, and prosecutors to unwelcome facts

leave a comment »

Those who dedicate their lives and careers to winning convictions are not interested in anything, valid or not, that makes winning a conviction the least bit more difficult. It seems that the majority of the FBI, prosecutors, and DoJ do not really care whether the evidence they use is accurate or not: their sole focus is on winning convictions, and to hell with evidence.

Our criminal justice system has just put on public display the degree of its corruption, and it’s an ugly sight. Daniel Denvir writes in Salon:

Under fire yet again, law enforcement is fighting back. Facing heavy criticism for misconduct and abuse, prosecutors are protesting a new report from President Obama’s top scientific advisors that documents what has long been clear: much of the forensic evidence used to win convictions, including complex DNA samples and bite mark analysis, is not backed up by credible scientific research.

Although the evidence of this is clear, many in law enforcement seem terrified that keeping pseudoscience out of prosecutions will make them unwinnable. Attorney General Loretta Lynch declined to accept the report’s recommendations on the admissibility of evidence and the FBI accused the advisors of making “broad, unsupported assertions.” But the National District Attorneys Association, which represents roughly 2,5000 top prosecutors nationwide, went the furthest, taking it upon itself to, in its own words, “slam” the report.

Prosecutors’ actual problem with the report, produced by some of the nation’s leading scientists on the President’s Council of Advisors on Science and Technology, seems to be unrelated to science. Reached by phone NDAA president-elect Michael O. Freeman could not point to any specific problem with the research and accused the scientists of having an agenda against law enforcement.

“I’m a prosecutor and not a scientist,” Freeman, the County Attorney in Hennepin County, Minnesota, which encompasses Minneapolis, told Salon. “We think that there’s particular bias that exists in the folks who worked on this, and they were being highly critical of the forensic disciplines that we use in investigating and prosecuting cases.”

That response, devoid of any reference to hard science, has prompted some mockery, including from Robert Smith, Senior Research Fellow and Director of the Fair Punishment Project at Harvard Law School, who accused the NDAA of “fighting to turn America’s prosecutors into the Anti-Vaxxers, the Phrenologists, the Earth-Is-Flat Evangelists of the criminal justice world.”

It has also, however, also lent credence to a longstanding criticism that American prosecutors are more concerned with winning than in establishing a defendant’s guilt beyond a reasonable doubt.

“Prosecutors should not be concerned principally with convictions; they should be concerned with justice,” said Daniel S. Medwed, author of “Prosecution Complex: America’s Race to Convict and Its Impact on the Innocent” and a professor at Northern University School of Law, told Salon. “Using dodgy science to obtain convictions does not advance justice.”

In its press release, the NDAA charged that the scientists, led by Human Genome Project leader Eric Lander, lack necessary “qualifications” and relied “on unreliable and discredited research.” Freeman, asked whether it the NDAA was attempting to discredit scientific research without having scientists evaluate that research, demurred.

“I appreciate your question and I can’t respond to that,” he said.

Similarly, Freedman was unable to specify any particular reason that a member of the council might be biased against prosecutors.

“We think that this group of so-called experts had an agenda,” he said, “which was to discredit a lot of the science…used by prosecutors.”

The report, “Science in Criminal Courts: Ensuring Scientific Validity of Feature-Comparison Methods,” was the result of a comprehensive review or more than 2,000 papers and produced in consultation with a bevvy of boldfaced names from the legal community. It found that there is no solid scientific basis to support the analyses of bite marks, firearms, biological samples containing the DNA of multiple individuals and footwear. The report also found that the certainty of latent fingerprint analysis is often overstated, and it criticized proposed Justice Department guidelines defending the validity of hair analysis as being grounded in “studies that do not establish [its] foundational validity and reliability.”

The new report is comprehensive but hardly the first time that scientific research has cast doubt on the reliability of evidence used in trials — everything from eyewitness identification to arson investigations. The report cites a 2002 FBI reexamination of their own scientists’ microscopic hair comparisons and found that DNA testing showed 11 percent of the samples that had been found to match in reality came from different people. A 2004 National Research Council report cited found there was an insufficient basis upon which to draw “a definitive connection between two bullets based on compositional similarity of the lead they contain.”

One of the most important developments in recent decades has been DNA science, which has not only proven that defendants have been wrongfully convicted but also raised questions about the forensic evidence used to win those convictions.

In the Washington Post, University of Virginia law professor Brandon L. Garrettdescribes the case of Keith Harward, who was exonerated on April 8 for a Newport News, Virginia rape and murder that DNA evidence later showed someone else committed. His conviction, for which he spent 33 years behind bars, hinged on the false testimony of two purported experts who stated that his teeth matched bite marks on the victim’s body.

“Of the first 330 people exonerated by DNA testing, 71 percent, or 235 cases, involved forensic analysis or testimony,” Garrett writes. “DNA set these people free, but at the time of their convictions, the bulk of the forensics was flawed.”

In an interview, Garrett called the NDAA response “juvenile.”

“The response seems to be you say that certain forensic sciences are unscientific, well you’re unscientific,” said Garrett. “To call a group of the leading scientists in the world unscientific, it’s just embarrassing….I really doubt that they speak for most prosecutors.”

Many cases, the report found, have “relied in part on faulty expert testimony from forensic scientists who had told juries incorrectly that similar features in a pair of samples taken from a suspect and from a crime scene (hair, bullets, bitemarks, tire or shoe treads, or other items) implicated defendants in a crime with a high degree of certainty.”

Expert witnesses have often overstated the certainty of their findings, declaring that they were 100-percent certain when in fact 100-percent certainty is scientifically impossible.

Forensic science has largely been developed within law enforcement and not by independent scientists, said Medwed. In the case of bite mark analysis, the report concludes that the method is basically worthless. But by and large, the report calls not for the science to be thrown out forever but to be improved so that it is in fact reliable.

“The NDAA response strikes me as a bit defensive to say the least and puzzling because my hope is that in looking at this report the reaction of prosecutors would be, how do we improve the system,” said Medwed. “Even if they believe that some of these disciplines are legitimate, how do we further test them, and refine them so they can be better?”

The NDAA, however, not only dismisses the scientific research in question but asserts that scientific expertise has no role to play in determining what kind of evidence judges decide to admit into court. . .

Continue reading.

Ignorance is bad, stupidity is worse, and combination is deadly. It’s a bad sign that so many in law enforcement and among prosecutors seem to embrace ignorance with enthusiasm.

Written by LeisureGuy

23 September 2016 at 1:57 pm

DEA Is Banning a Little Known Medicinal Plant Called Kratom. Why? Because they can.

leave a comment »

They don’t have to provide a reason, which is handy when you don’t have a reason. The reason is probably the same reason the DEA keeps marijuana as a Schedule I drug: they can, so they do. Let’s face it: the more things the DEA makes illegal, the more work there is for them to do. Having the DEA in charge of deciding whether medical plants should be made illegal is like having a paving contractor deciding whether or not citizens should replace their driveway.

Madison Margolin reports in MOtherboard:

The US government is set to ban kratom, a medicinal plant and painkiller, even though researchers say it might not be dangerous.

Native to Southeast Asia, kratom has traditionally been brewed in tea, or ground up and encapsulated as powder. Historically, Thai laborers would use it to help them work longer hours without pain. But the drug has gone from subtle roots to becoming a Schedule I drug, akin to heroin in the eyes of the Drug Enforcement Administration. The DEA’s temporary ban will go into effect on September 30.

Kratom is most commonly used to treat chronic pain. The chemicals in kratom bond to the brain’s opiate receptors, making it the drug of choice for some patients with conditions like fibromyalgia or multiple sclerosis. Sometimes, it’s also a treatment for opiate addicts undergoing withdrawal—the medical journal Addiction featured one such pain patient who switched from Dilaudid pills to kratom tea.

In low doses, it acts as a slight stimulant, and in higher doses it acts like more of a sedative, one reason kratom has also been hailed as an anti-anxiety drug. But lately, as Motherboard reported earlier, kratom pills sold online have become a sort oflovechild between adderall and oxycontin.

The relatively unknown drug has received some sporadic media attention the past few years, as it eventually made its way into the awareness of the Drug Enforcement Administration. In an emergency action this past August, the DEA placed kratom temporarily into the Schedule I category, which states it has “no accepted medical use.” The move was reminiscent of our marijuana legislation.

As kratom has no history of being particularly popular, or problematic, surprised vendors have rushed to remove it from their shelves before the DEA moves toward a permanent ban. And they aren’t happy about it.

“If kratom becomes a Schedule I drug, America will see what a true epidemic looks like, all the while denying American citizens of the only substance that eases their pain, depression, anxiety, PTSD, etc.,” said Robert McMahan, head of the online kratom vendor Blue River Wellness, in an email. He said kratom has been a much safer alternative to other opiates and drugs like meth and heroin. . .

Continue reading.

Written by LeisureGuy

22 September 2016 at 4:27 pm

Inside NFL’s Backwards Marijuana Policy

leave a comment »

Ross Benes reports in Rolling Stone:

At the conclusion of North Dallas Forty wide receiver Phil Elliott, played by Nick Nolte, gets blackballed by his team owner for “smoking a marijuana cigarette.” After being presented with a photo that shows Elliott toking up, the team owner patronizes Elliott and says, “Illegal drugs are forbidden by the league rules Phil, you know that.” To which Elliott replies: “Jesus, smoking grass, what are you kidding me? If you nailed all the ballplayers who smoked grass, you wouldn’t even be able to field a punt return team. Besides that, you give me the hardest stuff in Chicago just to get out of the goddamn locker room. Hard drugs!”

Though North Dallas Forty is technically fictional and came out nearly 40 years ago, its story is a classic example of the same-shit-different-day phenomenon. In recent weeks, Bills linemen Marcell Dareus andSeantrel Henderson were each suspended four games for using marijuana. And Cowboys running back Ezekiel Elliott caused a scandalby simply walking into a legal weed-friendly establishment. Meanwhile, the NFL was busy knuckling players into “cooperating” with a doping investigation based on scant and recanted evidence.

Given America’s growing acceptance of cannabis, the bad press the NFL gets when it punishes marijuana use more harshly than domestic abuse, and the personal tragedies and lawsuits that have stemmed from team doctors overprescribing opioids, it seems a little peculiar that the NFL continues to retain an authoritarian stance on marijuana use while team doctors simultaneously dole out powerful and addictive painkillers. Especially considering that the league is mired in concussion suits and there’s a possibility that cannabis could reduce the impact of head trauma.

To get a better grasp of this dissonance, let’s take a look at the changing national perception of marijuana, possible incentives the NFL has for maintaining its marijuana policies, upcoming football-related cannabis research initiatives, and what it might take to get the NFL to stop punishing players for using marijuana.

Changing Context
As Kevin Seifert of ESPN pointed out, during the hysteria of the War on Drugs in the 1980s it was “politically and socially necessary” for the NFL to discipline marijuana users. But after the war on drugs proved to be a massive failure, people began viewing certain drugs more tolerantly, and now polls show that a majority of Americans support legalizing marijuana. As public support increased so did legalization, and today more than 60 percent (20 of the 32 teams) of NFL teams play in states that allow medical marijuana. Come November that percentage could grow as there are a plethora of state ballot initiativespushing for medical and recreational marijuana legalization.

There are also bills in the Senate and House aimed specifically at cannabinoids such as cannabidiol (CBD), which is a compound found in cannabis that doesn’t get people high. CBD is typically taken orally and it includes only trace amounts of THC, the psychoactive component of cannabis. A group of vocal ex-players are pushing the league to allow players to use CBD as a pain reliever. Because as the league’s policy currently stands, a player taking CBD could potentially surpass the league’s testing threshold and test positive.

“The risk [of testing positive for using CBD] is very low compared to the people using high-THC cannabis,” said Joel Stanley, CEO of hemp extracts producer CW Hemp. “But there certainly is a risk. But when you have something that you know is non-toxic, non-psychoactive, and non-addictive, and if you are in those high-impact situations, why not [allow players to] take that product?”

The NFL declined interview requests for this story. But a league spokesperson sent over the following statement:

Independent medical advisors to the league and the National Football League Players Association are constantly reviewing and relying on the most current research and scientific data. The league will continue to follow the advice of leading experts on treatment, pain management and other symptoms associated with concussions and other injuries.

It went on to say: . . .

Continue reading.

Written by LeisureGuy

22 September 2016 at 3:28 pm

Why police offers do not render first aid to shooting victims

with one comment

The policy should, I think, be to render first aid to all shooting victims as soon as it is safe to do so: all victims, whether police, by-standers, or perpetrators. Instead, police often simply stand by and watch as gunshot victims bleed out. Richard Pérez-Peña reports in the NY Times that this response is generally not a policy but the default action when there is no policy:

After the police in Tulsa, Okla., released video footage of an officer fatally shooting an unarmed man, and then standing back rather than tending to the man’s wounds, many people had the same reaction as a local activist, Marq Lewis, who voiced outrage that “they let him lay there two-plus minutes, bleeding.”

Anger at the treatment of the man, Terence Crutcher — not only his shooting last Friday, but also how officers behaved afterward — echoed concerns over other recent cases, mostly involving black males who died at the hands of the police. Notably, when Tamir Rice, a 12-year-old boy with a pellet gun, was shot to death in 2014 in a park in Cleveland, officers stood around for several minutes, waiting for an emergency medical team and offering no first aid.

So what should officers do? Experts in policing agree that the way officers respond, or fail to, is often a problem, but they say that such failures are not necessarily the fault of the officers, and that law enforcement agencies are starting to address them.

“It is reasonable for people to assume that when it is safe for the officers to do so, that they would render first aid to somebody they’ve just shot,” said Jim Bueermann, a former police chief who is president of the Police Foundation, a research group that advises law enforcement agencies. “But a lot of departments do not have policies that clearly articulate the officer’s responsibilities in that situation, and some have no policy at all.”

This year, the Police Executive Research Forum, another research group, issued a list of 30 use-of-force policies that police departments should adopt, including a requirement that officers render first aid when they can. Officials and rank-and-file officers have raised objections to other recommendations on the list, but not to that one, said Chuck Wexler, the group’s executive director.

“Cops have to be able to pivot immediately from using deadly force to trying to save a life,” said Mr. Wexler, a former police officer. “That is tough, we know that, but it’s what’s needed, and it’s not happening.”

Officers get first-aid training at police academies, but experts say it is often rudimentary, and not reinforced through their careers. A New York City officer, Peter Liang, who was convicted of manslaughter for fatally shooting a man in an apartment house stairwell, said he did not give the man CPR because he had not been properly trained in the procedure, a claim the department upheld.

Even when agencies do instruct officers to give first aid, as many police departments in large cities do, officers often lack the training or equipment to handle gunshot wounds.

“It’s typically geared toward, you come across an auto accident, or someone is having a heart attack or choking,” said William Johnson, executive director of the National Association of Police Organizations, a coalition of police officer unions. “If there’s a gunshot wound, the typical training is for the officer to call for medical help.”

Some agencies have increased medical training in recent years, and others, like the police departments in Cleveland and Los Angeles, have equipped officers with trauma kits that contain items such as tourniquets, bandages and sterile gloves. . .

Continue reading. Regarding the last paragraph, it’s unclear why the police officers who shot Tamir Rice, age 12, did not use their trauma kits.

Interest that Alice Speri, in her article in The Intercept that lists eight essential policies on the use of force, does not include any police on aiding victims. The eight policies she names:

  • Require officers to de-escalate situations before resorting to force
  • Limit the kinds of force that can be used to respond to specific forms of resistance
  • Restrict chokeholds
  • Require officers to give verbal warning before using force
  • Prohibit officers from shooting at moving vehicles
  • Require officers to exhaust all alternatives to deadly force
  • Require officers to stop colleagues from exercising excessive force
  • Require comprehensive reporting on use of force

Written by LeisureGuy

22 September 2016 at 10:27 am

The EpiPen Outrage Continues

with one comment

Good editorial in the NY Times.

And see this report in the Washington Post.

Written by LeisureGuy

21 September 2016 at 8:43 pm

Drug-resistant infections have become much worse over the past 15 years: No program to deal with it.

leave a comment »

I suppose the idea is that the weak will die and if you survive, good for you. That seems to be the only plan. David Epstein reports in ProPublica:

You have the flu. You also have an important deadline coming up, and the slave-driving editor at the non-profit investigative newsroom where you work is breathing down your butterfly collar. You have to get it together, or risk your editor trying to write much more incoherent things into your story to get it done in time. To make the deadline, you pop some penicillin … Ok, joke’s on you, because the flu is a virus, not a bacterial infection, and you just took an antibiotic. (Don’t do that.) But let’s say you had an infection, so you take an antibiotic to get back to work. While you’re convalescing, evolution is happening. A few of the microbes the antibiotic are attacking happen to have some gene mutation that allows them to survive the attack. The surviving enemy microbes spawn a new population, all of which have the gene mutation for laughing in the face of your puny antibiotic. Now multiply that scenario by millions of people taking antibiotics when they probably don’t really need them, and you begin to understand how we’ve created “superbug” infections via the overuse of antibiotics. A new Reuters investigation shows that 15 years after drug-resistant infections were declared a “grave threat,” the situation is far worse, and the country has no system in place to track the tens of thousands of deaths that occur each year. (Editors, however, manage to track exactly how long I, I mean you, procrastinate.) Your five Ws:

What is the death toll?

Great question. Wish someone had an answer. While every state tracks AIDS-related deaths, Reuters reports that only about half track deaths related to antibiotic-resistant infections, and those that do generally track only a few different types of infections. In a survey, the tracking states reported about 3,300 deaths from resistant infections between 2003 and 2014. Meanwhile, Reuters found a slightly higher number recorded on death certificates during that period: 180,000. So close! The Centers for Disease Control and Prevention estimates that around 23,000 people die each year from 17 of the most common antibiotic-resistant infections, but, Reuters says, that number is “mostly guesswork.” Ya know, give or take a few tens-of-thousands of deaths. I think this is one of those situations for the ironic use of the phrase, “close enough for government work.”

What else?

The words that CDC officials used with Reuters to describe the agency’s death toll estimate are truly confidence inspiring: “jerry rig,” “ballpark figure,” “a searchlight in the dark attempt;” and, my personal favorite because I love 19th Century art, from Michael Craig, the CDC’s senior adviser for antibiotic resistance coordination and strategy, “an impressionist painting rather than something that is much more technical.” Excuse you, Mike, do you know how much technical skill it took to create Waterloo Bridge, Effect of Fog? … Art before science, I bet Mr. Craig was a star pupil in Miss Jean Brodie’s class.

Why?

… are drug-resistant infections often left off of death certificates? . . .

Continue reading.

Written by LeisureGuy

16 September 2016 at 2:31 pm

%d bloggers like this: