<- From
Instead of simply limiting the number of wheels that the child has, we could allow her to have the wheels, but not allow her to use them to make cars. We can do this in a few ways.
First, we can sequester the wheels, perhaps by putting them all in a bag that she can’t open. Second, we can stick something to each of the wheels so that they won’t fit into the cars. Finally, we can stick something into the cars so that the wheels no longer fit. The body uses each of these methods as well.
Showing posts with label healthcare. Show all posts
Showing posts with label healthcare. Show all posts
Friday, November 26, 2010
The Lego® Model of Pharmacology
In understanding drugs and how they work, it can be helpful to think of the body and its atoms as a giant set of Lego® bricks[1]. A child can use Lego® bricks to make buildings, space ships, cars, etc; and the body can use its atoms to build muscles, bones, signaling molecules, etc. Moreover, just as the child can disassemble her building and then use the bricks to make a car, the body can disassemble its muscle and build bone. Of course, the car requires special bricks (e.g. wheels) which aren’t needed to make a building, and bone needs special atoms (e.g. calcium) which aren’t needed to make a muscle: the number of cars the child can make is limited by the number of wheels she has, and the amount of bone the body can make is limited by the amount of calcium available.
This last point is important. It means that if we want to regulate the number of cars that the child makes, we only need to regulate the number of wheels we allow her to use. We might do this because we have too many cars, and don’t want any more, or we might do so because we don’t have enough buildings (or space ships, or bridges) and want to conserve our bricks to make those instead of cars.
In the body, if we want to regulate the amount of bone we make, we can regulate the amount of calcium there is to make it with. We might do this because we have too much bone, and don’t want any more, or we might do so because we don’t have enough of something else, and want to conserve building materials to make, say, muscle.
Pharmacology (the science of drugs) manipulates the body by interfering with the way it uses its atoms. Continuing with the Lego analogy, drugs are the equivalent of another person adding or removing bricks to the buildings, cars, space ships, etc as they’re being built or after they’re finished; or adding or removing bricks from the box of unused bricks.
[1] Lego® is a registered trademark of the LEGO® Group of companies, which does not sponsor, authorise, or endorse this site
This last point is important. It means that if we want to regulate the number of cars that the child makes, we only need to regulate the number of wheels we allow her to use. We might do this because we have too many cars, and don’t want any more, or we might do so because we don’t have enough buildings (or space ships, or bridges) and want to conserve our bricks to make those instead of cars.
In the body, if we want to regulate the amount of bone we make, we can regulate the amount of calcium there is to make it with. We might do this because we have too much bone, and don’t want any more, or we might do so because we don’t have enough of something else, and want to conserve building materials to make, say, muscle.
Pharmacology (the science of drugs) manipulates the body by interfering with the way it uses its atoms. Continuing with the Lego analogy, drugs are the equivalent of another person adding or removing bricks to the buildings, cars, space ships, etc as they’re being built or after they’re finished; or adding or removing bricks from the box of unused bricks.
[1] Lego® is a registered trademark of the LEGO® Group of companies, which does not sponsor, authorise, or endorse this site
Sunday, April 4, 2010
Smoke Assassin Customer Service Phone Number
Since I commented on the Smoke Assassin in a previous post, I've gotten several visitors looking for the phone number for their customer service. So, here it is:
Smoke Assassin Customer Service
Unfortunately, the reports I read on the quality and caring of their customer service are uniformly bad. Be prepared for long waits, and expect to have to speak with a manager.
Good luck!
- B
1-800-604-9575
Unfortunately, the reports I read on the quality and caring of their customer service are uniformly bad. Be prepared for long waits, and expect to have to speak with a manager.
Good luck!
- B
Thursday, November 12, 2009
Why we're asked about eggs when we get the flu shot
When we receive the flu shot (influenza vaccination) we're typically asked a few things, such as are we currently sick, have we ever had Gullian Barre' Syndrome (GBS), and are we allergic to eggs. We're asked if we're sick because the vaccine triggers our immune system, and if we're sick, our immune system is already busy. Depending on how sick we are, perhaps it's better to allow our immune system to finish off our illness before presenting it with the vaccine. We're asked about GBS because having it once suggests that we may get it again. I discuss GBS and the flu vaccine in more detail here. Eggs are my focus on this post, and that explanation requires a little bit of background on how a virus (such as the flu) reproduces (copies itself).
A Little Virology (Study of Viruses)
A cell, whether it's one of the cells in our bodies, or a cell from our pet cat or dog, or whether it is a bacterium (1 bacterium + 1 bacterium = 2 bacteria, and each bacterium is a single cell) contains everything it needs to reporduce. All we need to do is feed the cell, and it does the rest - it repproduces its DNA and all of its internal parts, and then splits into two new cells.
A virus can't do this on its own. It lacks some of the machinery needed to reproduce, and needs to break into a cell and trick the cell's internal machinery into reproducing the virus.
Making the Vaccine - the Chicken Egg Connection
The flu vaccine works by showing a weak or inactivated copy of the flu virus to our immune system, so that if we later see the real flu virus, the immune system can quickly pounce on it and kill it off. As I've said before (see this post for details), the vaccine is kind of like a test prep course for our immune system, where the flu is the actual test: taking the vaccine leaves our immune system better able to take the flu.
The point for this post is that in order to make the vaccine, we need to make a lot of copies of the flu virus, and the easiest way for us to do that is to put the virus in a cell and let the virus do its thing, hijacking the cell and making lots of copies of itself. The cell we use for this is a chicken egg (a chicken egg is a cell).
Since we grow the virus up in a chicken egg, we can end up with some egg in the vaccine itself. So, if someone is allergic to egg, then perhaps the vaccine isn't for them.
A Little Virology (Study of Viruses)
A cell, whether it's one of the cells in our bodies, or a cell from our pet cat or dog, or whether it is a bacterium (1 bacterium + 1 bacterium = 2 bacteria, and each bacterium is a single cell) contains everything it needs to reporduce. All we need to do is feed the cell, and it does the rest - it repproduces its DNA and all of its internal parts, and then splits into two new cells.
A virus can't do this on its own. It lacks some of the machinery needed to reproduce, and needs to break into a cell and trick the cell's internal machinery into reproducing the virus.
Making the Vaccine - the Chicken Egg Connection
The flu vaccine works by showing a weak or inactivated copy of the flu virus to our immune system, so that if we later see the real flu virus, the immune system can quickly pounce on it and kill it off. As I've said before (see this post for details), the vaccine is kind of like a test prep course for our immune system, where the flu is the actual test: taking the vaccine leaves our immune system better able to take the flu.
The point for this post is that in order to make the vaccine, we need to make a lot of copies of the flu virus, and the easiest way for us to do that is to put the virus in a cell and let the virus do its thing, hijacking the cell and making lots of copies of itself. The cell we use for this is a chicken egg (a chicken egg is a cell).
Since we grow the virus up in a chicken egg, we can end up with some egg in the vaccine itself. So, if someone is allergic to egg, then perhaps the vaccine isn't for them.
Thursday, October 15, 2009
The flu vaccine and GBS
In 1976, a study showed a possible connection between influenza vaccination (the flu shot) and Guillain-Barré Syndrome (GBS). In GBS, the body attacks its own nervous system, causing weakness and paralysis. Most people recover completely over several weeks or months, but some do have permanent problems, and about five percent of people who get GBS die. So, a connection between influenza vaccination and GBS alarmed a lot of people (and rightly so) because we don't want to be giving people GBS when we vaccinate them against the flu. Since 1976, many other studies have looked for a connection between influenza vaccination and GBS.(1)
Only one study has found a connection: it stated that for every one million people vaccinated against the flu, one person "may be at risk of GBS associated with the vaccine." Not "will get GBS," but "may be at risk." And again, no other studies have found any connections between the vaccine and GBS.(1) (See also (3))
What this means is that there may have been a real connection between the vaccine and GBS. Unfortunately, we cannot rule this out absolutely. there is a chance - a very small chance, but a chance - that today's vaccine is somehow connected to GBS.
Does this mean that we shouldn't get vaccinated against influenza? Not necessarily. To decide whether or not to get the vaccine, we need to look at what might happen if we do get the shot and compare it to what might happen if we don't get the shot. We've already looked at the biggest potential negative of the shot. The smaller negatives include things like redness at the injection site, soreness, headache, etc, most no different from the results of placebo treatment. For a small group of people there is an additional negative - if you’re allergic to something in the vaccine, the vaccine can give you an allergic reaction. (This is why they ask you if you’re allergic to eggs, for instance, since eggs are used in the preparation of the vaccine).
There have also been concerns regarding vaccines and autism. This originated with the MMR vaccine. Hilton, Hunt and Petticrew, writing in 2007, note that
Next, we need to look at the positives of getting the vaccine, and then the positives and negatives of not getting the vaccine. Then we’ll be able to make an educated decision on whether or not to get the vaccine.
The benefits of the vaccine are that it provides protection from the flu, as I discuss in this post. Some readers may also be aware of the study that showed that people who received a flu shot are less likely to die - from any cause - over the following year, but I suspect that this is because that those who receive a flu shot are also receiving better all-around medical care - I doubt that the flu shot is a panacea (a cure for all ills). So for our discussion, we’ll focus on the flu, which means we need to talk about what the flu actually can do to us.
Next up: the flu
Also: Why do we need a flu shot every year?
Edited 16 Oct, 4:40 pm Eastern)
SOURCES:
(1) Centers for Disease Control and Prevention, “Seasonal Flu and Guillain-Barré Syndrome (GBS)” at http://www.cdc.gov/flu/about/qa/gbs.htm, on 13 October 2009
(2) Hilton, Hunt and Petticrew, “Autism: a Focus Group study: MMR: marginalised, misrepresented and rejected?” Archives of Disease in Childhood. downloaded 21 March 2008 from adc.bmj.com
(3) World Health Organization, "Influenza vaccines: WHO position paper." downloaded form http://www.who.int/entity/wer/2005/wer8033.pdf on 16 October, 2009
Only one study has found a connection: it stated that for every one million people vaccinated against the flu, one person "may be at risk of GBS associated with the vaccine." Not "will get GBS," but "may be at risk." And again, no other studies have found any connections between the vaccine and GBS.(1) (See also (3))
What this means is that there may have been a real connection between the vaccine and GBS. Unfortunately, we cannot rule this out absolutely. there is a chance - a very small chance, but a chance - that today's vaccine is somehow connected to GBS.
Does this mean that we shouldn't get vaccinated against influenza? Not necessarily. To decide whether or not to get the vaccine, we need to look at what might happen if we do get the shot and compare it to what might happen if we don't get the shot. We've already looked at the biggest potential negative of the shot. The smaller negatives include things like redness at the injection site, soreness, headache, etc, most no different from the results of placebo treatment. For a small group of people there is an additional negative - if you’re allergic to something in the vaccine, the vaccine can give you an allergic reaction. (This is why they ask you if you’re allergic to eggs, for instance, since eggs are used in the preparation of the vaccine).
There have also been concerns regarding vaccines and autism. This originated with the MMR vaccine. Hilton, Hunt and Petticrew, writing in 2007, note that
The aetiology of autism remains unclear. The suggestion that MMR vaccination may be a cause received wide-spread publicity, although subsequent scientific research has failed to support a link.(2)On a different note, people who get the vaccine sometimes still get the flu - the vaccine matches what the virus looked like when the vaccine was being made, but the virus looks slightly different now. But the vaccine is still useful, since it primes the immune system, and people who get the flu after getting the vaccine have a milder case of the flu - the illness isn’t as bad. So if you’ve ever gotten the vaccine and later gotten sick with influenza, you would have been even sicker without the vaccine.
Next, we need to look at the positives of getting the vaccine, and then the positives and negatives of not getting the vaccine. Then we’ll be able to make an educated decision on whether or not to get the vaccine.
The benefits of the vaccine are that it provides protection from the flu, as I discuss in this post. Some readers may also be aware of the study that showed that people who received a flu shot are less likely to die - from any cause - over the following year, but I suspect that this is because that those who receive a flu shot are also receiving better all-around medical care - I doubt that the flu shot is a panacea (a cure for all ills). So for our discussion, we’ll focus on the flu, which means we need to talk about what the flu actually can do to us.
Next up: the flu
Also: Why do we need a flu shot every year?
Edited 16 Oct, 4:40 pm Eastern)
SOURCES:
(1) Centers for Disease Control and Prevention, “Seasonal Flu and Guillain-Barré Syndrome (GBS)” at http://www.cdc.gov/flu/about/qa/gbs.htm, on 13 October 2009
(2) Hilton, Hunt and Petticrew, “Autism: a Focus Group study: MMR: marginalised, misrepresented and rejected?” Archives of Disease in Childhood. downloaded 21 March 2008 from adc.bmj.com
(3) World Health Organization, "Influenza vaccines: WHO position paper." downloaded form http://www.who.int/entity/wer/2005/wer8033.pdf on 16 October, 2009
Saturday, August 16, 2008
Give me a saddle, I’ll trade you a car
Earlier this evening I repaired a cassette tape. The repair was simple enough – the leader had broken, but enough of it was left over so that when I opened up the cassette and attached the remaining piece to the reel I’m not already into the brown magnetic portion of the tape every time I press ‘play’, but it led me to thinking about cassette tapes, CDs, mp3s, etc. The benefits of technology, etc. Because although I’ve repaired several tapes, I’ve never yet had to repair a CD. Not that I’d know how, aside from the polishers that I’ve seen for sale. And to repair an mp3? Forget it.
There is a connection here to the difficulty that the medical community presently has with death, though for the moment I forget what it is (I placed the newspaper article down on the computer before I left earlier, since I saw the connection, but now that I’ve returned to the keyboard the thought has flown). And by problem with death, I don’t mean delaying death; I mean deciding when to declare it.
100 years ago, when you were dead, you were dead. No pulse? That’s it; send for the grave-diggers. But then we began to parse death. What do we do with someone who continues to have a pulse, but is irresponsive to all stimuli? Is this person alive? Technology advanced, and things only got messier. Heart-lung machines enable the body, and sometimes the mind to survive periods of death. Heart transplants involved patients living without hearts in their bodies at all, albeit only for the period between when their own heart was removed and the donor heart installed. CPR confused matters as well, as did defibrillation, with their abilities to return a nonbeating heart to proper order.
At the same time, we plunged further into the brain, developing EEGs and debating over the meaning of “brain death”. Some of you will remember the Terri Schiavo case of 2005, which revolved on this issue, among others, but another focus of this discussion is organ donation. Organ viability rapidly declines after perfusion ceases, or even decreases below normal levels. Thus, it is in the best interest of the patient receiving the organs to declare the death of the donor earlier, rather than later. Of course, it is arguably in the best interest of the donor to declare death later, rather than earlier. The same declaration of death must be used for both contexts.
I am here reminded of sub-subatomic particles. The presence of electrons, neutrons, and protons seems obvious to anyone looking at atomic structure, but what about quarks, mesons, etc? Did these only come into being once we shattered our protons and neutrons, much as the shards of a mirror only come into being once the mirror is shattered?
Well, it's late, and I'm tired. I don't know how coherent this is, but I'm off to bed.
Source: Nano, Stephanie. “Doctors Examine When to Declare Organ Donors Dead”. p8B, The Journal News, 14 August 2008 EDIT: in an earlier version of this article it was incorrectly stated that for organ recipients, best practice was to declare the death of the donor later rather than earlier. This is incorrect: organ viability decreases as blood flow decreases, thus donated organs are healthier if harvested earlier. Some spelling errors were also made.
There is a connection here to the difficulty that the medical community presently has with death, though for the moment I forget what it is (I placed the newspaper article down on the computer before I left earlier, since I saw the connection, but now that I’ve returned to the keyboard the thought has flown). And by problem with death, I don’t mean delaying death; I mean deciding when to declare it.
100 years ago, when you were dead, you were dead. No pulse? That’s it; send for the grave-diggers. But then we began to parse death. What do we do with someone who continues to have a pulse, but is irresponsive to all stimuli? Is this person alive? Technology advanced, and things only got messier. Heart-lung machines enable the body, and sometimes the mind to survive periods of death. Heart transplants involved patients living without hearts in their bodies at all, albeit only for the period between when their own heart was removed and the donor heart installed. CPR confused matters as well, as did defibrillation, with their abilities to return a nonbeating heart to proper order.
At the same time, we plunged further into the brain, developing EEGs and debating over the meaning of “brain death”. Some of you will remember the Terri Schiavo case of 2005, which revolved on this issue, among others, but another focus of this discussion is organ donation. Organ viability rapidly declines after perfusion ceases, or even decreases below normal levels. Thus, it is in the best interest of the patient receiving the organs to declare the death of the donor earlier, rather than later. Of course, it is arguably in the best interest of the donor to declare death later, rather than earlier. The same declaration of death must be used for both contexts.
I am here reminded of sub-subatomic particles. The presence of electrons, neutrons, and protons seems obvious to anyone looking at atomic structure, but what about quarks, mesons, etc? Did these only come into being once we shattered our protons and neutrons, much as the shards of a mirror only come into being once the mirror is shattered?
Well, it's late, and I'm tired. I don't know how coherent this is, but I'm off to bed.
Source: Nano, Stephanie. “Doctors Examine When to Declare Organ Donors Dead”. p8B, The Journal News, 14 August 2008 EDIT: in an earlier version of this article it was incorrectly stated that for organ recipients, best practice was to declare the death of the donor later rather than earlier. This is incorrect: organ viability decreases as blood flow decreases, thus donated organs are healthier if harvested earlier. Some spelling errors were also made.
Tuesday, February 5, 2008
The healthcare choices we face
I've already discussed (some of) the reasons why modern Western medicine is so expensive. Now I'd like to discuss some of the choices we're facing.
Simply put, we're up against the law of diminishing returns. We're also facing the reality of several finite resources: money and personnel being two of them.
I'll give several examples:
Keep in mind that care provided to these people cannot be provided to someone else; care for these people is care that is denied to someone else.
These types of decisions appear in medicine every day, several times a day. There is only so much care that can be delivered, and demand outstrips supply. How do we fairly allocate a scarce resource?
Simply put, we're up against the law of diminishing returns. We're also facing the reality of several finite resources: money and personnel being two of them.
I'll give several examples:
- should a 95 year-old, but generally healthy person receive a hip replacement?
- how about a 95 year old in poor health?
- should a chronic smoker be given a lung transplant, given that his smoking (a voluntary act, in theory) is the reason for his lung disease?
- should that smoker be given priority over a patient in need of a lung transplant due to accidental exposure to toxic chemicals?
- or over a 35 year old father of two who was severely injured in a car accident?
- what if the 35 year old had caused the accident because he drove while drunk?
Keep in mind that care provided to these people cannot be provided to someone else; care for these people is care that is denied to someone else.
These types of decisions appear in medicine every day, several times a day. There is only so much care that can be delivered, and demand outstrips supply. How do we fairly allocate a scarce resource?
Saturday, February 2, 2008
Why healthcare is expensive
I just stumbled across this post, about what appears to be a current debate in England regarding what type of medical care should be provided by the state (England has socialized medicine, so in theory, all medical care is provided by the state). Two issues are on the table:
1 - should the state pay for expensive medical care that is unlikely to yield much benefit?
2 - should the state pay for medical care that is needed due to the patient's own folly, e.g. a heart-lung transplant for a chronic smoker?
The writer of the post seems to think that the state should indiscriminately pay for these things. I disagree. But before I go intot he reasons why, I'd like to discuss why medicine is so expensive to begin with.
We have yet to figure out how to pay for all of medical care that people lay claim to. There are a few reasons for this.
* Many people are their own worst enemies when it comes to maintaining their own health. People eat too much of the wrong foods, and not enough of the right ones. People fail to get adequate exercise. People smoke, drink, and fill their bodies with all manner of noxious substances. The result, of course, is poor health.
* Much of modern Western medicine is expensive. CTs and MRIs are useful, but pricey. Lab work can be costly. Pharmaceutical costs can rival mortgage payments. And neither medical education nor malpractice insurance are cheap.
* More medical care is given than is needed. Reasons for this include defensive medicine and patient demand (e.g. demand for antibiotics to treat a common cold).
* Many people without access to a true primary care provider are left using the emergency room for all of their care. ER beds are among the most expensive beds in the hospital, so using one to treat a common cold is extremely wasteful.
* Similarly, the complicated nature of insurance sometimes makes a visit to the ER appear to be the easiest way to go.
* Some people delay seeking medical care (often because they can't afford it, or can do so only with real difficulty) until their problems become severe; severe problems are more costly to treat than minor ones are.
So, our medical costs are high, and in the forseeable future, they are only going to get higher (greying of the population, etc).
Next: the necessary choices we face (link fixed 5 Feb 2008 0207hrs)
1 - should the state pay for expensive medical care that is unlikely to yield much benefit?
2 - should the state pay for medical care that is needed due to the patient's own folly, e.g. a heart-lung transplant for a chronic smoker?
The writer of the post seems to think that the state should indiscriminately pay for these things. I disagree. But before I go intot he reasons why, I'd like to discuss why medicine is so expensive to begin with.
We have yet to figure out how to pay for all of medical care that people lay claim to. There are a few reasons for this.
* Many people are their own worst enemies when it comes to maintaining their own health. People eat too much of the wrong foods, and not enough of the right ones. People fail to get adequate exercise. People smoke, drink, and fill their bodies with all manner of noxious substances. The result, of course, is poor health.
* Much of modern Western medicine is expensive. CTs and MRIs are useful, but pricey. Lab work can be costly. Pharmaceutical costs can rival mortgage payments. And neither medical education nor malpractice insurance are cheap.
* More medical care is given than is needed. Reasons for this include defensive medicine and patient demand (e.g. demand for antibiotics to treat a common cold).
* Many people without access to a true primary care provider are left using the emergency room for all of their care. ER beds are among the most expensive beds in the hospital, so using one to treat a common cold is extremely wasteful.
* Similarly, the complicated nature of insurance sometimes makes a visit to the ER appear to be the easiest way to go.
* Some people delay seeking medical care (often because they can't afford it, or can do so only with real difficulty) until their problems become severe; severe problems are more costly to treat than minor ones are.
So, our medical costs are high, and in the forseeable future, they are only going to get higher (greying of the population, etc).
Next: the necessary choices we face (link fixed 5 Feb 2008 0207hrs)
Tuesday, January 29, 2008
Survival of the most valued
Yesterday on NPR, or perhaps the day before, I heard a spot on the domestication of the cat. Current theory proposes that early, proto-domesticated-cats would have been valued for their abilities to catch and destroy vermin. We can also propose that those cats who were encouraged to stay (or at least, not chased away) would have been those who were the most pleasing to the people in need of vermin control. Part of a cat's appeal would be the nature of its voice, and as cat owners know, there is something appealing in [most] house cats' calls. There is something endearing about the timbre, volume, inflection - something about their calls is socially encouraging.
The speaker compared the socially encouraging nature of house cats' voices to those of wildcats in the zoo, which he found sounded "permanently angry". Truthfully, I might be permanently angry if I was incarcerated in a zoo, and I don't know that I've ever seen a zoo inmate that I'd have called happy, but the point for this discussion is that wildcats, which I gather are genetically similar enough to house cats to successfully mate with them, have voices that are much less pleasant to our ears. The proposal, therefor, is that humans have unnaturally selected house cats for their voices, and for other features we find desirable.
At first glance, this may not seem much different than any form of natural selection - those cats whose traits best enabled them to survive in the world of humans flourished, while those cats who always seemed to be pissed-off failed to survive and procreate. But to look at the issue this way overlooks one key difference. This selection of cats was driven by human intervention. There may not have been a plan behind it, but there was definite intent - "oh, this cat is cute and has a pleasant voice; I think I'll feed it and provide it with shelter."
The phenomenon we describe as natural selection looks only at the relationship between the individual and its environment, and does not consider any guiding intelligence on the part of either. In the case of house cats (and dogs, and domesticated species generally) we find an element of intelligent design, for although we cannot design a species from scratch (yet), we can selectively breed individuals to enhance traits we prefer and reduce traits that we don't. We have hijacked Darwin.
Which leads me to a discussion of healthcare. Individuals who in the natural course of events would die without reproducing are allowed, through the tools and techniques of medicine, to survive, and their genes, including those that made them sickly and inclined to die, are preserved in the gene pool. Thus, instead of naturally shedding undesirable, and even harmful, genes; which would keep the gene pool and the species strong; we keep them and make our species as a whole weaker.
If our medical technology ever gives up or out, then we as a species may be doomed.
The speaker compared the socially encouraging nature of house cats' voices to those of wildcats in the zoo, which he found sounded "permanently angry". Truthfully, I might be permanently angry if I was incarcerated in a zoo, and I don't know that I've ever seen a zoo inmate that I'd have called happy, but the point for this discussion is that wildcats, which I gather are genetically similar enough to house cats to successfully mate with them, have voices that are much less pleasant to our ears. The proposal, therefor, is that humans have unnaturally selected house cats for their voices, and for other features we find desirable.
At first glance, this may not seem much different than any form of natural selection - those cats whose traits best enabled them to survive in the world of humans flourished, while those cats who always seemed to be pissed-off failed to survive and procreate. But to look at the issue this way overlooks one key difference. This selection of cats was driven by human intervention. There may not have been a plan behind it, but there was definite intent - "oh, this cat is cute and has a pleasant voice; I think I'll feed it and provide it with shelter."
The phenomenon we describe as natural selection looks only at the relationship between the individual and its environment, and does not consider any guiding intelligence on the part of either. In the case of house cats (and dogs, and domesticated species generally) we find an element of intelligent design, for although we cannot design a species from scratch (yet), we can selectively breed individuals to enhance traits we prefer and reduce traits that we don't. We have hijacked Darwin.
Which leads me to a discussion of healthcare. Individuals who in the natural course of events would die without reproducing are allowed, through the tools and techniques of medicine, to survive, and their genes, including those that made them sickly and inclined to die, are preserved in the gene pool. Thus, instead of naturally shedding undesirable, and even harmful, genes; which would keep the gene pool and the species strong; we keep them and make our species as a whole weaker.
If our medical technology ever gives up or out, then we as a species may be doomed.
Friday, December 21, 2007
Teen pregnancy, Jamie Lynn Spears
I gather from the news radio that an actor (actress, if you prefer, but would you call a female doctor a doctress?), Britney Spears' sister, Jamie, is pregnant. This would probably escape the attention of the media and the public if she did not also play the title character in Zoey 101, a TV show on Nickelodeon. Like most people, I have a few thoughts on this.
From the point of view of a medical provider: my job is to look after a patient's health interests. Just as I would discuss the value of an immunization against the measles, and the value of simple hand washing to reduce the spread of disease, I'll be discussing the value of safe sex - what it is, how it work, how successful it is, etc.
I know that there are parents who don't want their children to learn about these subjects until they are quite old, or are married. I think that I understand their concerns. Our society has long repressed sexuality, condemning it and its discussion, so there's a taboo to overcome. To intelligently discuss love and sex (two separate things) necessarily involves facing our own beliefs, which the parent may not be comfortable doing. The discussion also acknowledges that their child is getting older, which by extension means that they, the parent is also getting older. It's not just the poets who connect sex and death.
Maybe if we were less uptight about death, we'd be less uptight about sex.
Morality and religion also are involved. If, as parents, we firmly believe that sex outside of marriage is sinful, then instructing our children how to have sex feels like a betrayal to our beliefs and our children's well-being. But it doesn't have to be. A discussion of safe sex can very easily include a discussion of morals. Frankly, it should. Sex is a biological need, but it is often more than a mere mechanical act; it involves and entangles emotions and human relationships. Kids and teens have limited experience (they haven't lived long enough to accumulate it) and can benefit from a parent's guidance.
As a medical provider, I specifically will not discuss the morals of sex and sexuality. First, it's not my position to do so, but more importantly, moral judgment on my part can only interfere with good medical care.
From the point of view of a medical provider: my job is to look after a patient's health interests. Just as I would discuss the value of an immunization against the measles, and the value of simple hand washing to reduce the spread of disease, I'll be discussing the value of safe sex - what it is, how it work, how successful it is, etc.
I know that there are parents who don't want their children to learn about these subjects until they are quite old, or are married. I think that I understand their concerns. Our society has long repressed sexuality, condemning it and its discussion, so there's a taboo to overcome. To intelligently discuss love and sex (two separate things) necessarily involves facing our own beliefs, which the parent may not be comfortable doing. The discussion also acknowledges that their child is getting older, which by extension means that they, the parent is also getting older. It's not just the poets who connect sex and death.
Maybe if we were less uptight about death, we'd be less uptight about sex.
Morality and religion also are involved. If, as parents, we firmly believe that sex outside of marriage is sinful, then instructing our children how to have sex feels like a betrayal to our beliefs and our children's well-being. But it doesn't have to be. A discussion of safe sex can very easily include a discussion of morals. Frankly, it should. Sex is a biological need, but it is often more than a mere mechanical act; it involves and entangles emotions and human relationships. Kids and teens have limited experience (they haven't lived long enough to accumulate it) and can benefit from a parent's guidance.
As a medical provider, I specifically will not discuss the morals of sex and sexuality. First, it's not my position to do so, but more importantly, moral judgment on my part can only interfere with good medical care.
Monday, November 26, 2007
Why the ambulance crew doesn't wear their seatbelts
This is another one on risk:
It used to strike me as strange that EMTs and paramedics typically don't wear their seatbelts. I don't mean in the back of the ambulance during a call. It's hard to be belted in and still treat the patient (though there are some harness systems designed to meet this purpose). But up front, or in the back when there's no patient (say, on the way to a call) - no seatbelt. I have also seen a lot of orthopedic surgeons who ride motorcycles, and almost every respiratory tech that I've ever met smokes.
My theory on this? I think that these people are brought face to face with human misery, and with the frailty of the human body, much more often than is healthy. Eventually, one of two things happens. Either they recognize those human frailties in themselves, and either change careers or go mad with it; or they decide that they're immune. "I won't get COPD or lung cancer from cigarettes, and I'll prove it by smoking them and not getting sick." "My body is not fragile, and I'll prove it by riding a motorcycle, not wearing my seatbelt, etc." "I'm too good a driver to get in an accident," etc, etc. "I am imune."
Which brings me to another point. If I'm putting on my seatbelt when I get into your car, don't be offended. It isn't necessarily your driving that I'm worried about. It's every other driver on the road.
Or be offended, if you want. Because maybe it is your driving that I'm worried about.
[Risk link added 28 Nov 2007]
It used to strike me as strange that EMTs and paramedics typically don't wear their seatbelts. I don't mean in the back of the ambulance during a call. It's hard to be belted in and still treat the patient (though there are some harness systems designed to meet this purpose). But up front, or in the back when there's no patient (say, on the way to a call) - no seatbelt. I have also seen a lot of orthopedic surgeons who ride motorcycles, and almost every respiratory tech that I've ever met smokes.
My theory on this? I think that these people are brought face to face with human misery, and with the frailty of the human body, much more often than is healthy. Eventually, one of two things happens. Either they recognize those human frailties in themselves, and either change careers or go mad with it; or they decide that they're immune. "I won't get COPD or lung cancer from cigarettes, and I'll prove it by smoking them and not getting sick." "My body is not fragile, and I'll prove it by riding a motorcycle, not wearing my seatbelt, etc." "I'm too good a driver to get in an accident," etc, etc. "I am imune."
Which brings me to another point. If I'm putting on my seatbelt when I get into your car, don't be offended. It isn't necessarily your driving that I'm worried about. It's every other driver on the road.
Or be offended, if you want. Because maybe it is your driving that I'm worried about.
[Risk link added 28 Nov 2007]
It's all in my head
The thing about depression - well, one thing about depression - is that it saps the patient of the desire for a cure. It's a sort of psychological cancer that causes a slow inward collapse. And for me the implosion often seems to coincide with the end of the semester, when I really need to be productive, and productive in very specific projects, if I want to pass.
The comparison to cancer is particularly apt as psychologocal illness is now where cancer was perhaps 20 years ago. Some of you may recall that we didn't used to talk about cancer; it just wasn't discussed. We've moved past that, as a society, where cancer is concerned, but we're not there yet on psychologocal illness.
Of course, of course, it's all in my head, though...
Q: What did the doctor tell the patient who had brain cancer?
A: "Don't worry, it's all in your head."
The comparison to cancer is particularly apt as psychologocal illness is now where cancer was perhaps 20 years ago. Some of you may recall that we didn't used to talk about cancer; it just wasn't discussed. We've moved past that, as a society, where cancer is concerned, but we're not there yet on psychologocal illness.
Of course, of course, it's all in my head, though...
Q: What did the doctor tell the patient who had brain cancer?
A: "Don't worry, it's all in your head."
Thursday, October 11, 2007
Log off now and get your 30 minutes of exercise
I'm going to keep this short, for reasons that should become obvious. CBC is reporting that many Americans are spending less time having sex in order to spend more time online. Why do people do this? And will it effect our ability to survive as a species? In 50 years, will the only people left be those without internet access?
Come on, people! Do your part for the human race!
Come on, people! Do your part for the human race!
Friday, September 21, 2007
Be careful with Tabasco sauce
My kittens are teething. You can actually see the new canines growing in alongside the old ones - it's pretty cool. But as part of the process Shadow has developed a taste for chewing at paper and cardboard. You may imagine how I'm not a fan of this, bibliophile that I am, not to mention the papers I need to grade and those I need to hand in to be graded. So I turned to the Tabasco sauce.
I'm not sure where I read this, but apparently cats don't care for the taste of Tabasco, and won't chew on anything that it's smeared on. I spent the first part of this evening smearing Tabasco on the edges of several cardboard boxes, and on several power cords (another favorite chew-toy). Then, for reasons I now forget, I rubbed at my eye.
Never do this. Tabasco sauce burns. Badly. In growing agony, I stumble toward the bathroom, flip on the light and pull off my glasses (no contacts since the cats moved in) and start splashing cold water into my eye. This does several things
- it slowly washes some of the Tabasco sauce out of my eye
- it slowly liberates some of the T. sauce still on my fingers, allowing it to wash into my eye
- it triggers my asthma, and I get short of breath
- it attracts Shadow, who is fascinated by anything that I do in the bathroom. If I'm stumbling into the bathroom, this is going to be a good show.
So it occurs to me that it might be a good idea to wash my hands. I fumble for the soap, peering through a burning eye that I'm starting to wonder if I'll need professional treatment for (viz, an ambulance and the ER, since there's no way I can drive in this state). And in my fumbling I drop the soap into a puddle of kicked-up kitty litter.
By now all of my splashing of cold water has frightened Shadow into retreating into the corner between the bathroom door and the shower stall, but the dropped soap piques her interest. I fumble around my cat and pick up the kitty litter-encrusted bar of soap. Now I have to wash the soap in order to wash my hands in order to wash my eye, which feels like its melting, along with all of the skin around it. I'm having sympathy for the Nazi officers near the end of Raiders of the Lost Ark. I'm also having sympathy for my friend Mike, who was sprayed in the face with pepper spray as part of his training in the police academy.
Eventually, the pain subsides enough for me to turn off the water, sit down, and spend several minutes coughing. For the first time in months, I use my inhaler, but as is often the case, I can't breathe the albuterol in nearly as deep as I'd like to. Nevertheless, my attack subsides at a reasonable rate, probably in part due to my air filter.
I love my pets; really, I do.
I've also decided that I love my air filter.
I'm not sure where I read this, but apparently cats don't care for the taste of Tabasco, and won't chew on anything that it's smeared on. I spent the first part of this evening smearing Tabasco on the edges of several cardboard boxes, and on several power cords (another favorite chew-toy). Then, for reasons I now forget, I rubbed at my eye.
Never do this. Tabasco sauce burns. Badly. In growing agony, I stumble toward the bathroom, flip on the light and pull off my glasses (no contacts since the cats moved in) and start splashing cold water into my eye. This does several things
- it slowly washes some of the Tabasco sauce out of my eye
- it slowly liberates some of the T. sauce still on my fingers, allowing it to wash into my eye
- it triggers my asthma, and I get short of breath
- it attracts Shadow, who is fascinated by anything that I do in the bathroom. If I'm stumbling into the bathroom, this is going to be a good show.
So it occurs to me that it might be a good idea to wash my hands. I fumble for the soap, peering through a burning eye that I'm starting to wonder if I'll need professional treatment for (viz, an ambulance and the ER, since there's no way I can drive in this state). And in my fumbling I drop the soap into a puddle of kicked-up kitty litter.
By now all of my splashing of cold water has frightened Shadow into retreating into the corner between the bathroom door and the shower stall, but the dropped soap piques her interest. I fumble around my cat and pick up the kitty litter-encrusted bar of soap. Now I have to wash the soap in order to wash my hands in order to wash my eye, which feels like its melting, along with all of the skin around it. I'm having sympathy for the Nazi officers near the end of Raiders of the Lost Ark. I'm also having sympathy for my friend Mike, who was sprayed in the face with pepper spray as part of his training in the police academy.
Eventually, the pain subsides enough for me to turn off the water, sit down, and spend several minutes coughing. For the first time in months, I use my inhaler, but as is often the case, I can't breathe the albuterol in nearly as deep as I'd like to. Nevertheless, my attack subsides at a reasonable rate, probably in part due to my air filter.
I love my pets; really, I do.
I've also decided that I love my air filter.
Blueair is clean air
I'm allergic to my cats. I knew this before I got them. But I figured that I could get an air cleaner, or maybe wash the cats from time to time. I bought these car wash wipes and tried them on Shadow, but she immediately started licking her self all over, so I don't think that the wash helped any. So, I went with the air cleaner. I did some research, and chose the Blueair 501, ordered it off eBay and got about 35% off the MSRP (it still cost me a chunk of change), and it actually arrived today - I didn't expect it until the beginning of next week.
My first thought was that this thing is big - it's the size, shape, and color of an overgrown tower computer - over two feet tall and all else in proportion, but I pulled it out of the box and plugged it in (no setup to speak of) though it's only been running a few hours, I feel better than I have, when at home, in several days. I still a bit congested, but the asthmatic symptoms are much less. I am impressed.
Nevertheless, I think I'll be washing the cats again.
My first thought was that this thing is big - it's the size, shape, and color of an overgrown tower computer - over two feet tall and all else in proportion, but I pulled it out of the box and plugged it in (no setup to speak of) though it's only been running a few hours, I feel better than I have, when at home, in several days. I still a bit congested, but the asthmatic symptoms are much less. I am impressed.
Nevertheless, I think I'll be washing the cats again.
Sunday, September 16, 2007
San Francisco takes a new tack on universal healthcare
This past Friday, the New York Times reported on a new universal healthcare effort in the City of San Fransico. (No doubt other papers reported on it also, but the NYTimes article was the one that came up on my Health Econ class's discussion board). Back in the last millennium, the city's residents passed a referendum to provide healthcare for all, but until recently, the city has been unable to put together a successful program. This program, called Healthy San Francisco, came together when they took a slightly different look at the subject: since many of the city's residents already have coverage, couldn't universal coverage be achieved by concentrating only on those without coverage? So far, it appears that it can, but the program is still coming together.
The issues, for those new to the subject, include the fact that our current system for universal healthcare (viz: the emergency rooms of the nation's hospitals (viz (videlicet) is a term I don't get to use enough)) is just about as inefficient a system as Rube Goldberg could ever devise. Ill, uninsured people avoid seeking medical care (because they can't pay for it) until their situation becomes dire, at which time they report to an ER. Medical issues that at their incept might have been treated with simple, inexpensive treatment are often much worse by the time patients seek treatment, meaning that treatment is more costly in terms of time spent ill, time spent in treatment, time spent by the healthcare provider, physical and support services (X-ray, blood work, etc.) and financial cost. A wound on the leg that might initially have required cleaning, stitches, and instructions on wound care might eventually require expensive antibiotics for infection, and amputation of a deeply infected, gangrenous leg. And treatment in the ER costs more than what the same treatment might cost in a primary care setting (in costs to the provider, which are often passed along to the patient)
So SF has launched a program to address these issues. The NYTimes article is unfortunately vague on how the program is funded, since this would be the most interesting part for me, as the need for such a service is not news. Without that information, it is difficult for me to see how easily the SF program might be adapted for other communities. It will be interesting to see how the program fares
The issues, for those new to the subject, include the fact that our current system for universal healthcare (viz: the emergency rooms of the nation's hospitals (viz (videlicet) is a term I don't get to use enough)) is just about as inefficient a system as Rube Goldberg could ever devise. Ill, uninsured people avoid seeking medical care (because they can't pay for it) until their situation becomes dire, at which time they report to an ER. Medical issues that at their incept might have been treated with simple, inexpensive treatment are often much worse by the time patients seek treatment, meaning that treatment is more costly in terms of time spent ill, time spent in treatment, time spent by the healthcare provider, physical and support services (X-ray, blood work, etc.) and financial cost. A wound on the leg that might initially have required cleaning, stitches, and instructions on wound care might eventually require expensive antibiotics for infection, and amputation of a deeply infected, gangrenous leg. And treatment in the ER costs more than what the same treatment might cost in a primary care setting (in costs to the provider, which are often passed along to the patient)
So SF has launched a program to address these issues. The NYTimes article is unfortunately vague on how the program is funded, since this would be the most interesting part for me, as the need for such a service is not news. Without that information, it is difficult for me to see how easily the SF program might be adapted for other communities. It will be interesting to see how the program fares
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