"When many cures are offered for a disease, it means the disease is not curable" -Anton Chekhov
''Once you tell people there's a cure for something, the more likely they are to pressure doctors to prescribe it.'' -Robert Ehrlich, drug advertising executive.
"Opinions are like sphincters, everyone has one." - Chris Rangel
We stink. My god how we hate to be reminded of it and my god how much that reluctance to face it should tell us about its centrality to our existecne. We shower, we smear and spray ourselves with product, we defecate into artfully designed porcelain which takes away the ordure invisibly and more or less odourlessly. When we die we are embalmed, burned or interred before we have time to pong. Take away the sewage systems, take away the running water, take away the morticians and within days our stink is beyond that which can be endured. Every cell of our body is composed of stuff so malodorous than one whiff of it will empty stomachs at fifty paces. It doesn't matter whether we are white, black, rich, poor, virtuous, vicious, healthy or addled. We all stink.
It's true. Take away civilization and we're left with little but stink (and he didn't even mention body odor.) Still, I couldn't read his post without imagining the words coming from an English valet. posted by Sydney on
9/06/2005 02:33:00 PM
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Everything in Moderation: A new study, presented at a European conference of cardiologists, suggests that vitamin B12 and folic acid aren't all they're cracked up to be when it comes to preventing heart disease:
Folic acid and vitamin B pills do not ward off heart attacks or strokes and may even be harmful when combined, new research suggests.
Studies showing that the vitamins lower levels of a substance in the blood suspected of playing a role in the development of heart disease have prompted hundreds of thousands of heart patients in the developed world to take them.
However, the first large study of the question, presented Monday at a meeting of the European Society of Cardiology, found that although the supplements dramatically lowered the levels of homocysteine, they offered no heart protection.
It's impossible to analyze the details because it was presented at a conference, not published in a journal, but here's the report:
In the latest study, led by Dr. Kaare Harald Bonaa, a professor of cardiology at the University of Tromso in Norway, 4,749 heart attack survivors were divided into four groups. In addition to standard heart medicines, one group took high-dose vitamin B pills every day for three years. Another took high-dose folic acid. A third group took both pills every day and the fourth group took fake pills.
There was no difference in the groups taking fake pills, vitamin B or folic acid when it came to new heart attacks or strokes. However, there were 20 percent more heart attacks and strokes among the group that took both pills.
Those who fared worst were patients who also had kidney problems, and those who reported they also take other vitamin supplements, the study found.
The recommendation to take folic acid or vitamin B12 grew out of the observation that homocysteine levels were higher in people who had heart disease. Both folic acid and vitamin B12 help lower homocysteine levels. The thinking was that lowering the homocysteine levels would lower heart disease risk, but no cause and effect between homocysteine levels and heart disease was ever observed. It's always been a recommendation that's weak on evidence, but its saving grace was that taking extra B12 or folic acid wouldn't be harmful. This, however, suggests otherwise. So little we know.
UPDATE: From a nurse practitioner in cardiology:
The link mentions vitamin B-6 wheras your summary says vitamin B-12. B-12 would make more sense since if you are deficient in it, then homocysteine levels are elevated. However this article seems to indicate that B-6 was supplemented, not B-12. Would like to know their hypothesis for using B-6 vs B-12.
The comment about "other supplements" is interesting as well. There was an article in the NEJM a couple of years ago - can't give you the reference right now as I am at home and don't have online access - but it looked at progression of CAD in patients who took simvastatin along with Vit C and E supplements vs simva alone. Those taking the Vit C and E had more progression of dz. I now tell all my patients on statins (since we use mostly simva at the VA) to stop taking Vit C and E supplements and recommend only a multivitamin.
I re-read the story, and it doesn't say which B vitamin the researchers studied. The only reference to B-6 is from a British physician who was not involved in the study saying he wouldn't recommend B-6 vitamins for his patients now. That could be because he went to the conference and knows they studied B-6, or it could be because in Britain, they favor B-6 while here we tend to go for B-12. In the end, it probably doesn't make much difference which B-vitamin your talking about. They're both involved in homocysteine metabolism. And we don't know if homocystiene actually plays a role in causing heart disease or if it's just serves as a marker of something else. (See here.)
Food and Water: Instapundit has some advice on keeping water potable in an emergency. Here's the CDC version:
# Boiling water, when practical, is the preferred way to kill harmful bacteria and parasites. Bringing water to a rolling boil for 1 minute will kill most organisms. Boiling will not remove chemical contaminants. If you suspect or are informed that water is contaminated with chemicals, seek another source of water, such as bottled water.
# If you can't boil water, you can treat water with chlorine tablets, iodine tablets, or unscented household chlorine bleach (5.25% sodium hypochlorite). If you use chlorine tablets or iodine tablets, follow the directions that come with the tablets. If you use household chlorine bleach, add 1/8 teaspoon (~0.75 milliliter [mL]) of bleach per gallon of water if the water is clear. For cloudy water, add 1/4 teaspoon (~1.50 mL) of bleach per gallon. Mix the solution thoroughly and let it stand for about 30 minutes before using it. Treating water with chlorine tablets, iodine tablets, or liquid bleach will not kill many parasitic organisms. Boiling is the best way to kill these organisms.
Texas Aid: Sounds like the local authorities in Texas are on the ball when it comes to disaster preparedness. A medical team from Georgia was sent there and found things already taken care of (emphasis mine):
They came to Texas after a call from Dallas Mayor Laura Miller, who was pleading for medical backup as soon as she got word that Katrina evacuees were headed in her direction.
Mary Hudac, spokeswoman for FEMA in Atlanta, said Sunday that the Georgia team and others have been caught in a situation where needs changed.
Either local resources have become available, the need has diminished or some other outside group has arrived such as private groups of doctors and nurses who work outside of the government's coordination, Hudac said.
"We know that the Georgia medical professionals desperately want to contribute. ... There is still tremendous requirement for the resources that the Georgia team brings, and we are sure there will be a venue for their expertise," Hudac said.
Georgia Team Commander Judy Edwards had been told by FEMA officials to expect between 10,000 and 14,000 refugees at Reunion Arena that had not seen a doctor, nurse or pharmacist for days.
What she found on Sunday morning was about 300 evacuees at Reunion and about 4,000 evacuees at the nearby Convention Center.
And at the Convention Center, county officials, along with local hospitals, had set up a state-of-the-art medical facility with separate areas for pediatrics and emergency care.
"It was beautiful in there," said Mark Spradlin, who is in charge of logistics and planning for the Georgia team. "If they had shut down and we had moved in, the level of medical care would have gone down."
Late Sunday night, they awaited a FEMA official to come and survey the medical needs situation in Dallas himself, to determine if they should go elsewhere.
First Medical Shelters Up: The HHS has gotten the first ten medical shelters up for hurricane survivors:
HHS Secretary Mike Leavitt announced today that the first ten Federal Medical Shelters (FMCs) will be located at Department of Defense (DoD) facilities throughout the Gulf region to provide basic health care services for Hurricane Katrina victims.
Additionally, Secretary Leavitt noted that nearly 100 tons in vital medications and supplies have been shipped since last weekend and currently are being distributed. For example, a 12-hour Push Package was delivered to Mississippi this morning that contained a broad spectrum of medical supplies and 100,000 doses of antibiotics.
?The health care needs in the region are immense, and we are working as quickly as we can to get the medical care and supplies to the people who so desperately need them,? Secretary Leavitt said. ?These facilities augment the medical services being provided and nearly 100 tons of supplies this Department has shipped already to the Gulf region. Additional shelters we will open in the coming days.?
The first ten shelters will be located at Fort Polk, La. (4 Federal Medical Shelters); Eglin Air Force Base, Fla. (2 Federal Medical Shelters); Meridian Naval Air Station, Miss. (2 Federal Medical Shelters); and Mississippi National Air Guard Facility (2 Federal Medical Shelters). Each shelter has a 250-bed capacity, and HHS will provide the equipment and supplies needed to support each shelter. Up to 40 medical shelters will be created.
Five hundred US Public Health Service Commissioned Corps officers are traveling over Friday night to the medical shelters. Each shelter will require three large semi-trucks of equipment and supplies. HHS, DoD, the Department of Veterans? Affairs, and the National Disaster Medical System (NDMS) will staff the shelters with the necessary healthcare and support personnel. Each shelter will require a staff of 150. posted by Sydney on
9/04/2005 08:29:00 PM
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Doc in a Semi: The Carolinas Medical Center's disaster response team - they've got hospitals on wheels ready to go. That's impressive. (via Hugh Hewitt.)
UPDATE: Looks like they're having trouble getting through:
The North Carolina mobile hospital stranded in Mississippi was developed through the Office of Homeland Security after the September 11, 2001, terrorist attacks. With capacity for 113 beds, it is designed to handle disasters and mass casualties.
Equipment includes ultrasound, digital radiology, satellite Internet, and a full pharmacy, enabling doctors to do most types of surgery in the field, including open-chest and abdominal operations.
It travels in a convoy that includes two 53-foot trailers, which as of Sunday afternoon was parked on a gravel lot 70 miles north of New Orleans because Louisiana officials for several days would not let them deploy to the flooded city, Rich said.
Uncle Sam Wants You: The Department of Health and Human Services and the office of the Surgeon General is looking for healthcare volunteers for the Gulf Coast.
UPDATE: Odd. I just read through the list and realized they don't list doctors, only "Physician Chiefs of Staff," dentists and veterinarians and lots of ancillary personnel. Guess it's a good thing I decided to volunteer locally by accepting any hurricane patients that might be transferred up here to our local hospitals.
That is incorrect, a doctor who volunteered through the website pointed out to me. They list doctors under "clinical physicians." Sure enough. I misread it as "clinical psychologists." Reading too fast and making too many free associations.
Hurricane Katrina: There's a lot of angry blame casting going on in the wake of the hurricane. It's a little cruel and heartless to criticize people in the midst of a disaster of the proportion of Hurrican Katrina, but I've been reading the newspaper coverage, and my husband has NPR on in the kitchen, and think I've been infected by the blame bug. Reading the news reports of hospitals and nursing homes that seemed to have been caught off-guard by the hurricane leaves me wondering whether they had any contingency plans in place for an emergency evacuation. Anyone who has ever worked in a hospital or doctor's office knows that OSHA requires emergency preparedness plans. If a facility was in a hurricane zone and below sea level at that, you would think they would be required to have plans for flood and hurricane evacuation, wouldn't you? Turns out they were. From the City of New Orleans policy for emergency preparedness:
Nursing Facilities Hurricane Plan
Evacuation Host Facility: This designates arrangements with a host facility outside the risk area where nursing facility clients and staff will shelter during a hurricane evacuation. This facility must be outside the risk area, and signed agreements must be current.
Patient Transport Company: The transportation method that will be used to transport patients and staff to the out-of-town facility in case of evacuation. Signed and current contracts are necessary to fulfill these criteria.
Supply Transport Company: The supply transport is the method by which the supplies will be taken to the out-of-town host facility. A signed and current contract is required or an addendum saying that patient and supply transportation is the same.
Supply Listing: A complete list of the a) Supplies being transported to host site; b) Supplies to be delivered to host site; c) Supplies host facility will provide.
Vendor Agreements: Vendor agreements are necessary to ensure delivery of emergency supplies, food provisions, nursing equipment and laundry needs to host site. These agreements must be current and must include all supplies that might be needed.
Emergency Generator Testing: The number of hours the facility's generator can operate. Accurate Emergency Telephone Numbers: A complete and accurate list of emergency phone numbers which includes the City of New Orleans Office of Emergency Preparedness number and fax number.
Did anyone ever enforce these requirements, or did they just exist on paper?
The city also had a detailed plan for emergency sheltering of those living at home with special medical needs who were unable to get out of the city in time. That's the kind of shelter the Superdome became, but again, the city doesn't seem to have followed their plans. Note point #7 under getting the facility ready:
7. Port-o-lets must be on site in the event of rest room failures or disruption.
The bathrooms, clogged and overflowing since Monday, announced the second level of hell, the walkway ringing the entrance level. In the men's, the urinal troughs were overflowing. In the women's, the bowls were to the brim. A slime of excrement and urine made the walkway slick. 'You don't even go there anymore,' said Dee Ford, 37, who was pushed in a wading pool from her flooded house to the shelter. 'You just go somewhere in a corner where you can. In the dark, you are going to step in poo anyway.
Maybe they had them, but no one used them. Or maybe they underplanned. But the presence of port-o-lets would have eliminated scenes like that described above. Granted, no one could come and clean them or haul them away in the middle of a flood for clean-up, but their contents could certainly be emptied into the raw sewage of flood water, couldn't they?
This is a natural disaster of incredibly heart-breaking scope. No response is going to be perfect or without problems given the level of destruction. Sometimes, events overtake us. But there is such a disparity between actual events and the hurricane evacuation plan, one has to wonder if anyone in the city's government actually read the thing.
I can't emphasize enough what a bad decision I think it is for New Orleans Mayor Ray Nagin to delay the mandatory evacuation order until tomorrow morning.
and a bit later that day:
Okay, so let me get this straight: the governor calls the mayor during dinner, and basically says "HEY, IDIOT, CALL THE F***IN' HURRICANE CENTER!" It took a phone call from the governor to convince him to make this call?!? Well anyway, the mayor calls the NHC, and they basically tell him, "GET EVERYONE OUT OF YOUR CITY NOW!!!" So now, finally, the mayor is apparently planning to order first mandatory evacuation in city history tomorrow morning. About damn time.
UPDATE III: And Brendan Loy also explains why the nursing homes didn't evacuate - not enough notice:
Fellow blogger Matt Drachenberg of Overtaken by Events is deeply worried about his mother-in-law, who is trapped in a nursing home just west of New Orleans. He writes:
I just had a very frank conversation with the administrator of Jefferson Healthcare, (where my mother-in-law is trapped). They were forced to make a decision yesterday as far as evacuation. Mr. Ray was honest enough to tell me that, had he had all of the information, he would have made a different decision, but as it stands, my wife's mother will be riding out Katrina in a one-story bulding, with a broken pelvis, requiring a serious regimen of prescription medication.
I really wanted to get angry about this conversation. However, once I realized that, should my wife lose her mother, Mr. Ray would also be dead, I found it impossible to be upset. I thanked him for his service and his commitment and said that he'd be in our prayers. There are people in that facility that make less in a year than a lot of people make in a week of Blogads, but they're staying with the patients to which they've made a commitment.
Read that again -- they made their decision yesterday, and would have decided differently if they had better information -- and explain to me again how the mayor of New Orleans didn't completely f**k this up. Does anyone doubt that, if he had ordered a mandatory evacuation yesterday morning, the nursing home would have made a different decision, and Matt's mother-in-law would be safe now?
You know, there's more to being a mayor than eating at fancy restaurants and getting special parking privileges. posted by Sydney on
9/03/2005 04:49:00 PM
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Coping with the Strain: The bioterorrism preparedness arm of the Department of Health and Human Services sent out a guide on how to open up former hospitals in the event of a patient surge, such as the current disaster.
It's a plan that was developed in the aftermath of 9/11. It was published this month. Why did it take four years to come up with these very basic guidelines? posted by Sydney on
9/03/2005 11:58:00 AM
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The hypothesis — which has little hard evidence to support it — is published this week in The Lancet by Alan Colchester, a medical professor at the University of Kent, Canterbury, and his daughter Nancy, a veterinary medicine specialist at the University of Edinburgh.
They suggest that haphazard Hindu funeral practices led to contamination in India of animal bone meal with human bones. Some may have come from people who died of vCJD and whose partially cremated bodies had been cast into the Ganges, only to be scavenged and recycled. If so, bone meal contaminated with vCJD could have entered the animal food chain in Britain, caused the outbreak of BSE in cattle, and then transferred to people as vCJD, the human equivalent of BSE.
They concede that evidence is circumstantial, but say it is strong enough to justify further research. Indian experts are sceptical, saying that scientists must “proceed cautiously when hypothesising about a disease that has such wide geographic, cultural and religious implications”.
It is a tense scene inside. I came across a maternity ward of women holding their newborn babies. Every woman was holding a newborn baby except for one woman who had only a picture of her child.
She said her baby had been taken to the intensive care unit. As she was readying to board an aircraft for Ft. Worth, Texas, she told me she didn't know where to find her baby. posted by Sydney on
9/01/2005 10:15:00 PM
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Words Fail II: Evacuees from Charity Hospital in New Orleans come under fire:
"We were coming in from a parking deck at Tulane Medical Center, and a guy in a white shirt started firing at us," Curiel said. "The National Guard [troops], wearing flak jackets, tried to get a bead on this guy. "
The first incident happened around 11:30 a.m. (12:30 p.m. ET) as Curiel and his National Guard escorts headed back to the hospital after dropping off several patients at nearby Tulane Medical Center to be evacuated by helicopter.
Charity shares a helipad with Tulane Medical Center, which is across the street.
They were traveling in a convoy of amphibious vehicles, and Curiel said the vehicle behind him was targeted.
About an hour later, another gunman opened fire at the back of Charity Hospital.
"We got back to Charity Hospital with with food from Tulane and we said, 'OK the snipers are behind us, let's move on,' " Curiel said. "We started loading patients [for transport] and 20 minutes later, shots rang out."
I've always been anti-gun, but I think I'd want one in a situation like this when armed lunatics are running rampant. posted by Sydney on
9/01/2005 10:10:00 PM
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Working with its federal partners, HHS is helping provide and staff 250 beds in each shelter for a total of 10,000 beds for the region. Ten of these facilities will be staged within the next 72 hours and another 10 will be deployed within the next 100 hours after that. In addition, HHS is deploying up to 4,000 medically-qualified personnel to staff these facilities and to meet other health care needs in this region.
Already, HHS has helped set up a medical shelter with up to 250 beds at Louisiana State University (LSU) in Baton Rouge to help provide health care for those fleeing New Orleans in Katrina’s wake. As of late this morning, the facility had already screened 300 patients and admitting 45 for in-patient care.
HHS and its Centers for Disease Control and Prevention also are providing the region with public health personnel and expertise to address the potential for disease outbreak in the aftermath of Katrina.
“We’re delivering medical supplies, facilities and professionals into the Gulf Region to provide health care to those evacuating from New Orleans as well as victims of the hurricane throughout the region,” Secretary Leavitt said. “We’re focused on the immediate health care needs of people in the region, augmenting state and local efforts. And we’re also preparing for public health challenges that may emerge such as disease and contamination.
They're also asking hospitals nationwide to send supplies and volunteers. From an e-mail alert:
In a conference call yesterday, Mike Leavitt, Secretary of Health and Human Services, asked the nation's hospitals for their help. HHS is setting up 40 250-cot medically enhanced shelters. These shelters will be able to provide temporary shelter for patients who are being evacuated from devastated hospitals and will also be able to stabilize patients who may experience an acute need now and in the days to come.
Providers are being asked to help in 2 ways:
--Send staffing for the medical shelters (each will require about 100 people)
--Provide services for any inpatients who may need to be transported out of the region.
Our local hospital is gathering volunteers to staff the shelters, and has volunteered to accept patients from the hurricane area if needed.
posted by Sydney on
9/01/2005 08:32:00 PM
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From Worse to Worse: Authorities are having trouble getting supplies to stranded hospital patients in New Orleans:
"Hospitals are trying to evacuate," said Coast Guard Lt. Cmdr. Cheri Ben-Iesan, spokesman at the city emergency operations center. "At every one of them, there are reports that as the helicopters come in people are shooting at them. There are people just taking pot shots at police and at helicopters, telling them, 'You better come get my family.'"
Richard Zuschlag, president of Acadian Ambulance Service Inc., described the chaos at a suburban hospital.
"We tried to airlift supplies into Kenner Memorial Hospital late last evening and were confronted by an unruly crowd with guns, and the pilots refused to land," he said.
"My medics were crying, screaming for help. When we tried to land at Kenner, my pilots got scared because 100 people were on the helipad and some of them had guns. He was frightened and would not land."
