Archive for the ‘Biology & Medicine’ Category

CHANGES: AN ESSAY

Monday, March 20th, 2017

As he had for more years than he cared to count, the elderly gentleman dressed in a three-pieced, dark-grey suit with white shirt; striped, grey-and-red tie; and black, wing-tipped shoes pushed through the revolving door to the old-style drugstore at the corner of Main and Grove. He removed a light-grey fedora from a head still covered with once-blonde, now silver-white hair parted neatly on the left. Clear, blue eyes surveyed a scene from generations before, a scene in which he had participated since opening his medical practice, a scene refusing to die.

The hour still was early. Slivers of first light were appearing. The soon-to-be bright Sun barely illuminated the dark nighttime sky.

Being a widower, Doctor Rufus Jenkins preferred not to breakfast alone. Years before, youthful passion had overcome prudence waiting to mature. Still a student, he could not afford to marry his sweetheart from high school.

Passion, however, screamed, Yes!”

Prudence murmured, “No.”

Passion ruled. Three months later, Emma fell ill. Acute leukemia. Weeks later, she died. In those days, effective treatments remained hidden beyond the medical horizon.

Grief never departed. Romance never returned. Marriage died with Emma.

Instead, he dedicated his life to his chosen calling, medicine. Medicine, not a job. Medicine, not an occupation. Medicine, not even a profession. For “Doc” Jenkins, medicine represented a calling like the clergy.

In an age of “healthcare” instead of medicine, “healthcare-plans” instead of insurance, and “providers” instead of physicians, such a man had become an historical relic.

Another historical relic was Parson’s Drug Store & Luncheonette. It clung to life, a symbol of a previous era, alone in a modern smorgasbord of homogenized, self-service “fast food” from cookie-cutter outlets filled with uncomfortable seating limiting long stays — factory-food served in an atmosphere of depersonalizing anonymity by human robots with empty minds expecting you, the unthinking customer, to fill their jars labelled “TIPS”. Reminder: Don’t forget to bus your own table, leaving your droppings for the next customer as the previous one did for you — droppings that rarely are cleaned. The sign on the trash will thank you for feeding it.

The town itself still existed only as a consequence of a former native-son’s having returned to buy a building left vacant by its previous owner, a manufacturing firm that had fled to China then to Viet Nam with headquarters relocated to Ireland. Revolutionary robotics of today instead of traditional textiles of yesterday. With the change, the once dismal future of the town suddenly seemed secure, at least for the moment. Chance and change would tell the tale.

As for the pharmacy, Abraham Parson had opened his apothecary in an age of bromides and enemas. His son, Ben, succeeded him. His grandson, Adam, maintained the now-profitless pharmacy still closed on Sundays with its luncheonette still open for breakfast and lunch. An old-fashion “phosphate”? Still available at Parson’s!

Yes, “chain-stores” selling everything from medicines to motor-oils had challenged the old-time pharmaceutical tradition. They offered longer hours and lower prices with the ubiquitous depersonalizing anonymity and sense of isolation increasingly prevalent in a society firmly ensnared electro-magnetically in a man-made web of radio-waves.

Alas, the independent pharmacy was receding into the past as was the traditional practice of medicine. Even the local supermarket offered not only a pharmacy but a “walk-in clinic” staffed by “Dr. Nurse”. Why should anyone want a physician in a medical office, anyway, when he can have a nurse in a supermarket? Quicker? Yes. Cheaper? Yes. Better?

Fortunately for those few customers who still preferred amiable social intercourse with a knowledgeable staff that knows you by name, Adam Parson had made a tidy sum trading foreign currencies via the Internet. Had he not done so, Parson’s Drug Store & Luncheonette would have become a distant memory among only the elderly losing theirs. Even so, many of his long-standing, loyal customers were departing for their final voyage. Destination? Unknown.

To be continued …

© Gene Richard Moss (2017)

CAN’T SLEEP?

Monday, February 13th, 2017

“To sleep, perchance to dream; aye, there’s the rub.” -from Hamlet by William Shakespeare (1564-1616)

Prince Hamlet was referring to death, but what if the rub refers to insomnia? What then to do?

insomnia n.: Prolonged or abnormal inability to sleep. -Taber’s Cyclopedic Medical Dictionary

So, insomnia comes in two forms. The first can be merely a prolonged inability to sleep, which per se may not be abnormal, dependent upon context. The second is abnormal, independent of context.

Environment
In the first case, the independent variable (controlling factor) is environmental. Some environmental stressor is eliciting a negative physiological response in the form of an inability to sleep, be it an inability to fall asleep, to stay asleep, or both.

Treatment? Simple! Remove the stressor, if possible, or at least try to diminish its potency.

How? There, too, lies a rub. The ability to meet that challenge is that which separates winners from losers in life — hugs, kisses, kind words, and other “warm fuzzies” notwithstanding.

Meanwhile, a simple set of procedures is available:
1) Use the bed only for sleeping or sexual activity. Do not lie awake in bed.
2) Avoid intake of stimulants such as caffeine with or after supper.
3) Avoid use of alcohol before bedtime, the rebound from which involves wakefulness.
4) Avoid stimulating activities directly before bedtime, including watching television; which, contrary to a widespread misconception, is not relaxing.
5) Practice meditation or Relaxation Procedure.

How detrimental is insomnia in healthy people? The answer remains unclear. Some claim that a lack of sleep per se never killed anyone — directly, that is; mishaps in the biological context of somnolence notwithstanding. In fact, forced wakefulness actually relieves depression, which does kill people. Two points: 1) worrying about insomnia promotes insomnia; and 2) best to avoid sleeping medications, if possible.

Biology
In the second case, the independent variable is biological. Some pathological condition is eliciting a negative physiological response in the form of an inability to sleep, be it an inability to fall asleep, to stay asleep, or both.

Treatment in this case depends upon the underlying diagnosis. What is the pathological condition? The answer may be complex if more than one condition is the cause.

In the elderly, for example, insomnia may herald the onset of dementia. Add to dementia delirium, and the combination can present a real medical challenge. By the way, delirium interfering with sleep may accompany dementia once manifest or other neurodegenerative diseases.

Regarding circadian rhythm, older insomniacs display advanced sleep-phase; whereas, young adults display delayed sleep-phase, often the consequence of simply remaining active past normal bedtime playing video-games. Treatment, especially for the elderly, may be use of a bright light possibly coupled with melatonin. Whatever the case, only a comprehensive medical evaluation by a competent physician can determine the underlying condition, if any.

That medical evaluation begins with a complete medical history, increasingly difficult to come by in this era of the Sovietization of American medicine when patients increasing are attended by “Doctor Nurse” instead of “Doctor Doctor” and even by the latter for diminishing periods of time. Often, the patient’s bed-partner provides the best information. Despite all the fancy and expensive technological innovations, 80% of medical diagnoses still are made by history, 10% by physical examination, and 5% by routine laboratory-tests.

Once diagnosed, the underlying condition can be treated as best as practicable. When such treatment proves inadequate, the physician can prescribe a pharmacological agent. Some newer agents are relatively safe even long term and maintain sleeping architecture; i.e., normal phases of the sleeping cycle. Avoid “over-the-counter drugs” because the benefit:risk ratio often is uncertain, at best.

Sleep is a natural function found in most vertebrates, if not all. It restores the neurochemical balance. Sweet dreams!

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“HEALTHCARE REFORM”: SOME HARD TRUTHS

Monday, January 23rd, 2017

Note (06FEB2017): More Republicans now plan not to repeal ObamaCare but to repair it. What would Mr. Peifer say (See below.)? Why? They have no credible replacement even though one has existed since 1994.

“But if thought corrupts language, language can also corrupt thought.” -George Orwell (1903-1950)

Elected and in-office, Republicans now face some hard truths associated with issues challenging this declining nation on fire. One is ObamaCare and the Republicans’ pledge to “repeal and replace” it. Words have power.

“Not on fire,” you say.

Witness the new President’s address at his inauguration; never mind the protests nationwide, some violent. Would you characterize it as conciliatory? Aggressive? Words have power.

“Healthcare”
In any debate, it is reasonable and appropriate to ask the opposition — the entrenched political establishment, Democrat and Republican — to define the terms that it uses; in this case, “healthcare”. Webster’s New Collegiate Dictionary (1977) does not list the term even. Whence cameth it?

What exactly is “healthcare”? As the term denotes, it is a governmentally concocted, pleasant-sounding euphemism that refers to caring for one’s health. (In contrast, “medicine” is not so pleasant-sounding because it denotes suffering.) “Healthcare”, however, is amorphous and includes everything from washing your hair to brushing your teeth to cutting your toenails. Simply put, “healthcare” is not synonymous with medicine. Words have power.

Another governmentally concocted euphemism, “healthcare-provider”, includes anyone and everyone who promotes himself as rendering advice, assistance, or instruction in the care of one’s health. It is intended to diminish the stature of the lynchpin in medical delivery, the physician. Words have power.

What is medicine? It the healing art based upon science the mission of which is the relief of suffering caused by disease and trauma. Its practitioners are known as physicians; those whom they diagnose and treat, patients. Words have power.

Repair Not Replace
Definitions notwithstanding, of “repeal and replace”, “repeal” is the easier; whereas, “replace”, the more difficult — the much more difficult. Accordingly, some Republican legislators now are talking about “repair” instead of “replace”. Surprised?

“An error lurking in the roots of a system of thought does not become truth simply by being evolved.” -John Frederick Peifer

The basis of this “repair” seems to be a new, politically concocted term — “Health Savings Accounts”, which are merely “Medical Savings Accounts” in new verbal clothing. Country-club Republicanism as its worst! The average American cannot afford a car, let alone a “Medical Savings Account” by whatever name.

“Catastrophic Coverage”?
Some opponents of ObamaCare, such as Tucker Carlson at Fox News, are promoting “Catastrophic Coverage” rather than basic medical coverage. “Catastrophic Coverage” may play well on television, but basic medical coverage offers the biggest bang for the medical buck.

Who most needs “Catastrophic Coverage”? The unproductive old.

It has been known for years, for example, that, during the last year of life, Medicare recipients spend 30-cents of every dollar expended on medical care during their entire lifetime. Of the 1% of Medicare beneficiaries with the highest costs in any given year, approximately 50% die. Of the 5% with the highest costs, approximately 40% die. Of the elderly who survive, 50% are demented by the age of eight-five. Therein lie the reasons that Medicare alone is bankrupting these United States of America. Hard truths!

PART TWO

Today, a major question facing physicians and the rest of American society is whether the consequence of past declines in mortality is an increase in active life-expectancy or merely an expanded and grotesque period of frailty, enfeeblement, and dependency. Apparently, the answer is the latter.

“Diaper, madam? Catheter, sir? Don’t worry. The young and productive will be paying tomorrow for the old and unproductive today.”

Not a pretty picture! Even physicians do not like looking at it. Chronic, debilitating illness — not dying — is becoming our worst medical enemy, individually and socially.

Meanwhile, who least need “Catastrophic Coverage”? The productive young who generally require only acute medical care for acute medical problems with occasional exceptions. Therein lies the reason that premiums would be so cheap to insure, really insure, all American young for serious medical events.

Fooling The Public
To paraphrase Abraham Lincoln, “You can fool all of the people some of the time and some of the people all the time, and them’s pretty darn good odds.”

Be not fooled by self-styled gurus on television or in the newspaper spinning misinformation. Be not fooled by power-hungry professional politicians seeking to retain control of medicine.

Remember Obama’s promises about the benefits of ObamaCare, such as keeping your doctor and your plan? Once again, those who direct public opinion are acting against the Public Good by promoting inefficient systems politically based and politically directed.

Science And Medial Delivery
A patient’s seeking medical care is a behavior. A physician’s providing medical care is a behavior.

There is a science that describes behavior as well as thoughts, feelings, and physiological responses. That science is Biobehavioral Science.

“What?” you say. “Biobehavioral Science? Never heard of it!”

Therein lies the problem not just for you but for nearly all humanity. Guess what? Ignorant about Biobehavioral Science themselves, were they not, the politicians would not want you to hear of it; especially its derivative, the Science of Human Behavior. To them, it would represent an anathema.

Were they willing to listen, they would screech in terror, “Specificity, Objectivity, and Accountability? Never! Never, I tell you!”

Any system not scientifically based and scientifically directed to deliver medical care to a population must be, by its very nature, fatally flawed and fated to failure — doomed to delivering care that is of decreasing availability and decreasing quality. Less availability. Lower quality.

“An ounce of prevention is worth a pound of cure.” ―Benjamin Franklin

Do you care? Actually, few do until they fall ill or become injured. Too late!

We already are suffering from the Sovietization of American medicine; whereby, for example, you see “Doctor Nurse” not “Doctor Doctor”. When you do see “Doctor Doctor”, he — or increasingly she — is looking mainly at the computer-screen not at you. Why? In order to fulfill the increasing regulatory demands of governmental bureaucrats for increasing documentation of decreasing care.

Meanwhile, a scientifically-based, scientifically-directed, detailed plan for delivery of universal medical care by a competitive private sector characterized by the following attributes is available and has been available for more than 20 years. It is characterized by the following:
1) Simple;
2) Straightforward;
3) Free of special taxes;
4) Minimal regulations;
5) Minimal bureaucracy;
6) Free of fraud at taxpayers’ expense; and
7) Acceptable to insurance companies.

No, it is not the failed ClintonCare. In fact, the opposite.

Will the politicians ever acknowledge it, let alone adopt it? Fat chance! Unless, of course, you make them. It’s your health. It’s your life.

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-End-

ZIKA: UPDATE

Monday, August 29th, 2016

Note (12SEP2016): The politicians and bureaucrats quibble while the mosquitos nibble. Consequence? Nobody knows. As time passes, however, the potential for a truly unfavorable outcome increases.

Compared to some other infectious diseases, the importance of Zika seemingly pales. Last year, for example, there were 214,000,000 reported cases of malaria. Adding diarrheal diseases, HIV, pneumonia, and tuberculosis yields the startling figure of one in five deaths per year. Zika? Fewer than 500,000 reported cases with fewer than 60,000 confirmed although the numbers likely are much higher.

The official version of the current epidemic of viral infection from Zika is that it is a mild disorder characterized by fever, arthralgia, myalgia, conjunctivitis; and rash. As many as 80% of those infected suffer no clinical signs or symptoms. A question arises whether that official version is valid.

The Virus
The virus itself is a mosquito-borne RNA-based flavivirus. It firstly was identified in a monkey in Uganda in 1947. For the next sixty years, only a few human cases were reported. Then, in 2007, an outbreak occurred in Micronesia on the island of Yap, where more than 70% of islanders older than age-three were exposed to the virus. In Autumn 2013, a large outbreak occurred in French Polynesia, where more than 30,000 were exposed to the virus. The genome of this more virulent virus in Micronesia and possibly others in Asia and now in the Americas very likely are different from that of their forbear, the relatively indolent virus in Africa.

How did Zika travel to the Americas? Most likely, via a traveller to Brazil from the South Pacific. During the past year or so, 47 countries have reported initial cases of Zika. One of the many wonders of modern travel!

Indeed, modern travel has become a boon to pathological agents and their vectors. Aedes, for example, remained confined to western Africa until the 15th-century, long before travel by jet-propelled aircraft. Also boons to pathological agents have been massive urbanization coupled with poor sanitation — trends likely to continue.

The Vector
The vector for this arbovirus is the female Aedes mosquito, which does not thrive in colder climates. Two species, different in their respective ecologies and activities, carry the virus — A. aegypti and A. albopictus. Although controversial, the former is believed active diurnally, feeds outdoors, and travels distances. The latter is believed active at dawn and dusk, feeds indoors, and remains more homebound. Both, however, bite multiple times; thereby, facilitating multiple transmissions by a single female. Unlike other mosquitos harboring other flaviviruses that can thrive in cold climates, Aedes remains confined to warmer climates although its populations can vary with the seasons.

The Infection
Despite the official version, infection might be more serious than currently broadcast. Officials acknowledge that, for pregnant women, contracting the virus appears linked to a peculiar form of microcephaly in the fetus; thereby, rendering the often-severely defective and deformed offspring requiring intensive and expensive care for the rest of their lives — care largely unavailable in much of the world. Moreover, even those without microcephaly may suffer blindness or deafness.

Those neurological defects result from the virus penetrating neuronal stem-cells in the brains of fetuses. These cells allow for neurogenesis. The question is, Do the viruses penetrate the neuronal stem-cells of adults? Recent evidence suggests that the answer may be yes. The consequence could be a slowly progressive form of neurological degeneration as old neurons die but are not replaced.

Adding to concern is the issue of transmission by means other than the mosquito. Evidence documents the virus in human semen; thereby, allowing for human-to-human transmission via sexual activity; let us not forget that we humans are the most hyper-sexual animals on Earth. “Let’s make love?”

Another recent finding of the virus in saliva and urine renders human-to-human transmission by those means also possible. “Kiss me, you fool?”

Diagnosis
Three, different laboratory-based tests can detect Zika. The tests for Zika, however, are neither entirely definitive nor reliable. A case of triple infection with Zika, dengue, and chicungunya has been reported, for example; the latter two also are carried by Aedes and can compromise the testing for Zika.

That blood contains the virus raises concerns for those receiving transfusions. Given that testing remains problematic, hopefully testing blood for presence of the virus will be as effective in preventing use of contaminated blood as in reässuring the public.

Treatment
No vaccine exists for prevention, nor is it likely one will exist during the next, few years. No specific medications exist for treatment, which remains supportive only. Recently, the government has issued statements promising hope for treatments in the near future. Fortunately, at this time the risk of fatality appears very low with hospitalization rarely required.

PART TWO OF TWO
Future Risk
Despite its seemingly benign character, Zika is a RNA-based virus. Such viruses can mutate rapidly even during a single infection in a single victim; becoming more mild or more virulent, as the case may be. Concern arises if the virus is mutating into a progressively more virulent form with possibly severe residua or sequelae.

Can we trust official reporting? Given the scenario with the recent epidemic of Ebola Hemorrhagic Fever, the answer for many is a resounding — no!

Accordingly, a question arises. Is the clinical picture murkier than that being reported by officials and the media? Possibly.

Dengue Fever
Consider a viral cousin to Zika; one spread by the same mosquito — Dengue Fever. The clinical presentation for Zika Fever is similar to that of Dengue Fever also common in the Caribbean and Latin America and returned to these United States of America after many years.

Consider the potential for clinical complications, neurological and auto-immunological. Fortunately, they remain infrequent.

Experts know much more about dengue than about Zika. The dengue-virus also is a flavivirus. It comes in three variants. Recovery from one variant provides no cross-resistance to the other two. Uncomplicated infection with dengue rarely is fatal although the symptoms are painful, resulting in the common label for the disorder being “Breaking Bones”. Reïnfection with a different strain, however, can cause Hemorrhagic Dengue — the auto-immunologic complication that carries a mortality of 50%, especially among the young. Should Zika mutate into acquiring similar characteristics, the consequences could be alarming.

There exists no approved vaccine for prevention of Dengue Fever although a vaccine now exists and might be converted into one for Zika. Then again, there is no vaccine for the common head-cold. No specific medications exist for treatment of Dengue Fever; treatment remaining supportive only.

Guillain-Barré Syndrome
One potential and disturbing sequel of both Dengue Fever and Zika Fever is Guillain-Barré Syndrome (GBS) — highly suggested but, as yet, unproven. What is GBS?

GBS is an auto-immunlogical disorder occasionally following viral infections and, rarely, vaccinations. Generally, the interval is from one to three weeks after the onset of the preceding, viral infection.

Typically, GBS presents with paresthesia followed by muscular weakness followed by paralysis. The signs and symptoms can spread from the extremities upwards to the head or from the head downwards to the extremities. The latter variant, especially, often is associated with respiratory distress. The loss of motoric function accompanied by pain can progress over two to three weeks followed by a period of stability for one to two weeks. Recovery usually requires several months to a year; in severe cases, it may be incomplete.

The pathology of GBS appears to involve the viral infection with its accompanying inflammation eliciting the production of antibodies that attack the myelin sheath of nerves; thereby, interfering with the conduction of electrical impulses from the Central Nervous System to muscles. The body attacks not only the virus but itself. Damage to the nerves is not continuous but segmental between the nodes of Ranvier; severe inflammation can destroy the nerve itself.

A potentially effective treatment for GBS is the use of high doses intravenously of immunoglobulin administered over a period of five days. Other immune-suppressing drugs may be useful. The use of corticosteroids remains more controversial.

The most severe cases of GBS require a high level of intensive and expensive nursing care over a prolonged period. Should the expected number of cases of Zika Fever actually occur and should a higher than expected number of them become associated with GBS, the consequence could overwhelm the American system of medical delivery. Whereas such an eventuality seems remote at the moment, it represents a potential risk of alarming dimensions.

Prevention
“An ounce of prevention is worth a pound of cure.” -Benjamin Franklin (1706-1790)

The obvious, immediate response to the threat from Zika is control of its vector, mankind’s second-greatest enemy — the mosquito. Mankind’s greatest enemy? Time, at least for the individual.

Two questions arise. If current methods of controlling mosquitos prove inadequate, would we and should we resume the use of DDT? A promising alternative, currently delayed by the Food & Drug Administration, is the use of genetically-modified mosquitos to decrease the population of viable offspring. In fact, it may be possible to exterminate all mosquitos worldwide.

The basic point of this posting is to describe in some detail the potential devastation wreaked by viral and bacterial pandemics. Consider the recent threats posed by Ebola, HIV, SARS, and influenza. Many others lurk beyond our awareness. Controversial man-made, global warming notwithstanding, our proven, ecologically irresponsible behavior as a species is making Mother Nature angry — very angry.

To paraphrase an old commercial, “It’s not nice to make Mother Nature angry.”

If we humans do not reform our ways, she will punish us — guaranteed! The next epidemic may be less controllable and more virulent than recent ones. By then, reform will be too late.

Consider the scenario of Zika mutating; thereby, becoming strikingly more virulent with airborne transmission. The consequences could be horrific.

Hopefully, Zika will not represent a major hazard to public health. Even so, if not Zika, it will be another microbial agent. As a species, we are living on increasingly borrowed time, an inescapable consequence of our own behavior.

Science tells us, “In any given context, behaviors — and deficits of behavior — have their consequences .

Shall we listen? Be past prologue, the answer is clear.

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