Morning Ed: Health {2017.03.27.M}

This actually reminds me of how low the threshold for “Maybe an alcoholic” actually is within the medical community. I met the criteria at one point and I’ve always been the farthest thing from an alcoholic imaginable.

Wait, we have a treatment for Sepsis?

Benjamin Mercer argues that “plain packaging” on cigarettes is pointless. I wish we would do more to delineate between “no branding” packaging and grotesque imagery packaging. I’m interested in the effectiveness of the former, and don’t care about the effectiveness of the latter.

Saad Omer and Sara Despres argue against politicizing (or, more accurately, partisaning) vaccination, because the health impact is just too important.

It does seem like SES is something you want to control for on questions about whether moderate drinking is good for you. As a practical matter, the data never showed a sufficient difference worth altering your lifestyle over, in my opinion.

Optometrists and Opthalmologists are facing off in Florida.

New York is loosening its restriction on residents’ hours. This strikes me as wise and it has begun to appear that the pendulum swung too much in the other direction. Doctors have a lot to learn in a short time, but that could mean some have poor practice, so just in case you get a treatment you weren´t supposed to get, make sure to contact some medical negligence solicitors to have your complaints handled. Continuity is relevant, and if working more than 16 hours straight is unacceptable they’re going to need to change a lot more than just residencies.

Eat healthy, don’t smoke, exercise, get cancer anyway


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Will Truman is a former professional gearhead who is presently a stay-at-home father in the Mountain East. He has moved around frequently, having lived in six places since 2003, ranging from rural outposts to major metropolitan areas. He also writes fiction, when he finds the time. ...more →

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64 thoughts on “Morning Ed: Health {2017.03.27.M}

  1. How do doctors decide whether somebody “maybe an alcoholic”?

    I’m in agreement on plain packaging for cigarettes. Everybody knows how damaging tobacco is for your health. The people who are going to smoke are going to do so regardless of how clear and unpleasant you make cigarette packages.

    Good luck trying to prevent the partisanization of vaccination.

    Optometrists and opthalmologists: Que Western gun fight music.

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  2. Eye docs: The article mentions that another state allows optometrists to do minor procedures after training, so it should be pretty easy to examine the public safety claims of the opthalmologists.

    Unless that is not the point.

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  3. That Addict Aide stunt is a joke. I’m all for taking addiction seriously but acting as though it can be diagnosed by social media and trying to shame people for ‘liking’ images of an attractive, scantily clad coed with drinks in her hand seems likely to have the opposite effect. The puritanical undertones are also embarrassingly absurd.

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    • I sort of get it, but really don’t. I’m not on social media, but I assume part of the point of posting vacation shots is to show how relaxed and awesome your life is; here I am on the beach or on a yacht chilaxing; aren’t you cubicle people jealous? I would never assume that these are representative shots.

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      • Many people’s photos are going to be naturally biased towards parties, meals, group activities…

        The things they enjoy, not necessarily the things that make up the majority of their lives.

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              • That’s well over a hundred cups a day. The LD50 for caffeine is like 150mg/kilo.

                A 90 pound person pounding red bull could probably do it, but….

                I mean don’t get me wrong, you start getting sick a lot earlier than the LD50 dose clearly.

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                  • In terms of how big a fraction of the LD50 you’re consuming, by far the most dangerous thing in drip coffee is the water – if you just keep drinking coffee until something kills you, it’ll be water toxicity.

                    With strong enough espresso, you might be able to flip the ratio, I’m not sure. It would still require drinking a heroic amount, and forging on beyond your body’s every warning.

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    • There needs to be a study in the atavism of memes.

      My sixth grade teacher complained about how she received some champagne flutes as a wedding gift. She doesn’t drink, she told us. She can’t drink 7-Up or ginger ale in them, because someone might see her and think that she drinks!

      Well, now we shouldn’t “like” pictures of someone drinking 7-Up out of a champagne flute because, hey, maybe we’re enabling them.

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      • I feel this issue is somehow tied in with the “cigarettes in plain package/horrific medical warning package” thing.

        In my state, they’ve released ads – made with ‘tobacco settlement’ money that effectively shame parents if they permit their children to drink soda.

        I get that people tend to drink it out of any moderation (like, 8 20-ounce sodas every day), but…..extreme asceticism is itself a form of immoderation. (I “don’t drink” sodas, but once a month or so when I go out for barbecue, I sometimes get a root beer…..)

        I don’t like this brave new world, where apparently everyone is either my parent or my doctor and can tell me what I should and should not be consuming.

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        • “Old-School Cigarette Case Sales Up 300%”

          I don’t like this brave new world, where apparently everyone is either my parent or my doctor and can tell me what I should and should not be consuming.

          A shiver just went down my spine.

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  4. “A lot of you don’t drink, no smoke. Some people here tonight, they don’t eat butter; no salt, no sugar, no lard. Cause they want to live, they give up that good stuff. You gonna feel like a damn fool laying at the hospital dying of nothing” – Redd Foxx

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    • I have reached an age where, if I allow the medical profession to measure enough things, they are certain to find things that are “wrong”. For example, in order to get the GPs off my back about my low bone density — every time I have a different GP, they look through my history and say, “Oh! Low bone density! We can fix this!” — I had the tests a world-class specialist wanted run. His final report can be summed up as “Mike has low bone density. It’s just the way he is. You can’t fix it.” But the tests turned up a good-sized symptom-free kidney stone. I’m sure there are other things getting out of whack. After all, I’ve pretty much reached the end of the design life.

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  5. Regarding the story about 2/3 of cancer being purely a matter of luck, note that this is based purely on a mathematical model of whether cancer-causing mutations arise in the first place. But the human body has cancer-control mechanisms that can prevent cancer from spreading or even completely destroy it. It seems plausible that these would work better in people with healthier lifestyles, so it’s possible that luck plays a smaller role when it comes to clinically significant cancer.

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    • I’m not sure I call it “luck” so much as a recognition that the longer you live, the more likely replication errors are to occur. Back in the day fewer folks died of cancer as they all died of other stuff like dysentery.

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      • To occur, or in the case of slow-spreading cancers, to spread far enough to kill you.

        Prostate cancer being one example – I understand it’s more common to die with it than of it.

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    • Yes, cancer-control mechanisms will probably work better in people with healthier lifestyles. But please note the ‘probably’. There is no guarantee.

      Agreed: live healthily, and your chances of getting cancer is lower. But it’s not 90% lower. It’s not 70% lower. It’s perhaps 30% lower. I don’t know; give or take 20%/30%/70% depending on the type of cancer (big caveat, that one). So all these messages about watching your weight, not smoking, not drinking too much, do your boob checks etc certainly saves lives, many lives, and are very important.

      But please don’t assume that following all rules will guarantee that the big C won’t pick you from the crowds for special attention. It just improves your chances by a statistically significant figure.

      That’s particularly relevant if you take into account that there’s really so such thing as ‘cancer’. ‘Cancer’ is like ‘head ache’ – it’s a meaningful symptom but the different types of cancers – and their causes and treatments – are so different that it’s not really useful, from a medical point of view, to talk about either a ’cause’ or a ‘cure’ for cancer.

      Let’s take Hodgkin’s Lymphoma; a rather common cancer of the lymph nodes, luckily quite curable given you’ve got access to the expensive chemo but deadly otherwise.

      There’s strong correlation with previous infection with Epstein-Barr. Have a look at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1186979/ for some insight into the complexity of the relationship.

      Now, quoting from wikipedia: “In the United States, about half of all five-year-old children and about 90 percent of adults have evidence of previous infection”. What life style choices are your 5YO going to make to prevent him from getting that Epstein-Barr that will result in his Hodgkin’s when he’s 38? What choices are *you* going to make for him?

      And I get what you mean with your body’s capability to fight the cancerous cells also improve with a better life style; but walk into a oncologist’s practice and chat to the people sitting there on their chemo drips and check out how many of them have done absolutely everything right and their bodies still didn’t manage the fight. These people aren’t statistical anomalies; they are the general case.

      There’s a moral component to being diagnosed with cancer that’s very nasty; you have to prove that somehow you didn’t ‘deserve’ getting cancer because of the life that you’ve lead.

      This is problematic for two reasons.

      Firstly, it leads to much scientifically baseless guilt. When the wife of a friend got breast cancer her husband immediately tried to almost excuse it ‘but she never smoked, she’s fit, we really can’t explain it – oh sh*t she did overdo the alcohol a bit during varsity’ You shouldn’t have to go through that; not just because it’s sad but also because it’s not science-based.

      But secondly, it also lead to complacency; ‘I lead a healthy life style so I can’t get cancer’ – this attitude drops your vigilance in spotting tell-tale signs which could save your life..

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      • Blomster,
        I’ve seen the graphs. When you’re looking at epidemic levels of cancer — levels that weren’t present 100 years ago… You’d better be looking for environmental causes.

        Just because we don’t know what caused XYZ doesn’t mean that there isn’t something that caused it.

        And are you really going to tell me that none of those people ingested carcinogens? Because the list of “commonly consumed carcinogens” is rather long…

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        • I did not say that none of these people ingested carcinogens. I said, or meant to say but perhaps it didn’t come across clearly, that many/most of these people made quite respectable life style choices and still got cancer.

          Certainly I agree that our environment is more carcinogenic than what it used to be. But we don’t have much control over much of that environment. I’m talking about people feeling that wise life style choices will keep them from getting cancer. There is no such guarantee because most cancer (I agree, not all) is caused by environmental, genetic and random mutational factors that you have no control over.

          As an aside, part of the reason why we see higher levels of cancer today compared with before is that you have to die of something and we’ve sorted out many of the other reasons people used to die of before – pneumonia, for instance. But I accept fully that this is only part of the story

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      • You’re joking, but actually, part of the issue with the both the rising right wing populism in various places and stuff like anti-immunization is all the people in power or even within communities who can say, “I was alive during these times and this is a bad idea” are all dying off.

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        • THIS.

          My mom was v. much a “caboose baby” and all my aunts were a good bit older….I heard stories of the fear of polio for their children. I heard stories of how unpleasant having measles was. The doctor I went to growing up, one of her nurses had had polio and still wore braces.

          Those aunts are gone now. (My mom is still around and she had measles)

          I’d be less concerned about anti-vaxxers if it was just them and their families who suffered, but herd immunity is a thing, and also people with immune issues (or taking chemo) and not being able to be vaccinated is a thing. And loss of immunity is a thing, apparently – pertussis outbreaks.

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        • Back in the 1950s before the Salk vaccine parents lived in fear of their children catching polio. There were clinics at schools when the vaccine became available, and folks lined up to get the vaccine. The same thing happened after the Sabin vaccine was released, although the sugar cube was better than the shot, In both cases at the time it was 3 doses (I got both being born in 1950). To reinforce this message consider that the measles vaccination rate went up after the epidemic in Ca a couple of years ago and the state cracked down on exemptions, to now be either those who can’t handle the vaccine or those like christian scientists, no longer that the parents think vaccine is a bad idea. Of course if your willing to homeschool you can avoid vaccines, so it is clearly a public health rather than individual health matter.

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    • For Left wingers: Do not screech about anti-vaccine religious and hyper-liberty-obsessed freaks on the right without forthrightly admitting that purity of essence helicopter parents nutcases and hippie “mother Gaia will take care of everything” idiots are basically the same thing on the left.

      For right wingers: See above, just reverse the order.

      For both: do not try and pretend anti-vaccine barbaric selfish parasitism is solely a left or right wing phenomena. Do not feed that meme and push back on it when your cohorts try and peddle it.

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      • Do left wingers pretend it’s solely a right wing thing? I thought it was pretty well accepted about the liberal anti-vax hippies and Whole Foods denizens, it’s the folks on the right that were less publicized. Though I suspect the reason for this is that the right side of the anti-vaxxers tend to be rural and in less dense areas, where the media covers and cares about things less. Also, since the liberal side disproportionately travels and lives in cities, they are more likely to cause and exacerbate outbreaks.

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        • Yeah, I’m a liberal and thought it was pretty much a liberal embarrassment. Even if it’s not just liberals…I agree with Mo that the liberal anti-vaxxers would have a disproportionate effect on herd immunity.

          Although maybe the current administration is fanning the flames of “gubment can’t tell me what to do”? Ugh. Just what we need.

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  6. RE: Sepsis treatment.

    Marik agrees.

    He wants there to be a comprehensive study, and he said that Stanford University has expressed some interest. But he said it will be difficult to fund because it uses drugs that have been on the market for decades: “We are curing it for $60. No one will make any money off it.”

    Studies take money, and that money often comes from pharmaceutical companies.

    “By the time it’s done, it could be three years and the number of people who will die of sepsis by that time will be ginormous,” Marik said.

    Those darn pharmaceutical companies, always wanting to do studies and stuff. Why can’t they understand that people are literally dying and just start letting doctors use this treatment? Bastards just want their money.

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    • Man, if only we had a large, public source of funding that could be used in cases like this, where the public benefit would be high, but the profit motive is low enough to not be attractive to private business…

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      • So you agree that this needs to be extensively tested and studied, with years of double-blind activity where some sepsis patients get vitamins and some get sugar water, with PhD statisticians writing reports on the outcomes of who died and when and how, before we can decide that maybe this might actually work and we’re ready to start human trials of an actual treatment regimen?

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        • No clue. I’m just saying that if the reason this treatment is not being used is because it needs study, and it isn’t getting study because there is no profit motive, then someone should apply for an NIH grant.

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        • I wonder if there’s some way one can have written into an advance directive “If I have some horrible disease I’m likely to die of, and there’s an experimental intervention that might cure it, I want the experimental intervention”

          (Also thinking that maybe adding big bottles of Vit. C and Thiamine to the “end of the world as we know it” kit would not be a bad idea)

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          • depending on the state you live in, and how strict they are in terms of ad/hc proxy rules, you can certainly include that in your documents, so your proxy/advocate can take that into consideration. some places this can be done either via personal statement or an actual segmented clause – some states have this kind of tiered, multiple choice thing like:

            “if you’re mostly a veggie, do you want to
            a) cash it in
            b) don’t like, yank the tube or whatever but unless something awesome happens let me eventually sail on without too much work
            c) keep this thing going for as long as possible because this is the most metal response to a loss of function possible

            i’m personally a straight up no code / no heroics / f the world kinda hc proxy guy.

            PLEASE NOTE: as always use the advice of an actual trusts and estates lawyer and not some schmoe like me.

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          • You would have to add the following clause I wave on behalf of myself and my heirs and assigns any and all rights to sue for damages caused by or related to the use of these drugs.

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    • “We are curing it for $60. No one will make any money off it.”

      This shows an astounding lack of imagination. A system that can bill you $500 for giving you a dose of Tylenol can almost certainly find a way to make money off of this procedure.

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      • A system that can bill you $500 for giving you a dose of Tylenol can almost certainly find a way to make money off of this procedure.

        “What happened to my co-pay, Doc? It’s thru the roof!”
        “Sorry dude. You got Shkrelied.”

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    • Doc’s can use the treatment. They need more studies to find out what is happening and if it really works. Pharma companies have little to benefit from studying things they aren’t going to make big money from. Gov research funds usually cover basic research not applied use. But what they need is a big NIH grant. It’s a good thing there aren’t big planed cuts to gov research funds……oops.

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      • It’s a good thing there aren’t big planed cuts to gov research funds……oops.

        Sure if we had an unlimited amount of money we could fund everything. Oh wait we can just raise taxes and solve everything.

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        • Science research is far, far from the biggest gov expense and brings huge benefits (IMHO of course). We can can afford to do plenty of research without giant tax increases or bankrupting the nation.

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            • Near as I can tell from a quick search, non-defense R&D is about 1.7% of our budget. We could do more and we could do less, but unless we’re talking about doubling it or eliminating it entirely, it doesn’t make a huge difference. But given that R&D is one of the major thing that drives economic growth over the long haul, it seems like we can afford it.

              It reminds me of the exchange between Matt Lauer and Neil deGrasse Tyson over the cost of the Cassini-Huygens probe when deGrasse Tyson noted that Americans spent more money on lip balm over the same period of time. These numbers seem big, but they’re really not. If it were possible to double the federal R&D budget without telling anybody, not a lot of taxpayers would notice.

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    • Time for what, exactly?
      Are you really celebrating that the slavers get to go unpunished while the cities that don’t harbor that many illegal aliens, in proportion, get punished?

      Where will you get your hotdogs when they come for those illegals, I wonder?

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        • And the Republican Party delivers ANOTHER crushing blow to its old friend Federalism. Down Goes Federalism!

          No, wait, it’s back on its feet with Roberts’ equal sovereignity doctrine. The States are battling back! The States have standing! Federal powers are limited even in the area of grants to States! The AG is staggering under the litigation burden! Who will prevail!!??

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