KOLAHUN

Where have you gone, Willie Horton? (Part 2 of Many)

Right on, New Yorker!!!

Hey,Barack...call me (wink)

Contrasting Anonymous Sources

The Washington Post article referenced in the previous post uses multiple anonymous source.  Here's why according to byline author, Craig Timberg:

"The Washington Post was given access to the written record by a participant of several private meetings attended by Mugabe in the period between the first round of voting and the runoff election. The notes were corroborated by witnesses to the internal debates. Many of the people interviewed, including members of Mugabe's inner circle, spoke on the condition of anonymity for fear of government retribution. Much of the reporting for this article was conducted by a Zimbabwean reporter for The Post whose name is being withheld for security reasons."

Implicit in Mr. Timberg's wording is that these sources feared for their lives.  Mugabe's henchman would likely kill them if they were 'outed' and granting anonymity was the only way to get the story out to the rest of the world.  Now compare that to the recently-departed and celebrated way Tim Russert granted anonymity to his sources (via an excellent tribute to David Halberstam's work right after his death by Glen Greenwald):

"But when I talk to senior government officials on the phone, it's my own policy our conversations are confidential.  If I want to use anything from that conversation, then I will ask permission."

Mr. Timberg granted his sources anonymity so he could get out an important story while maintaining their security.  Mr. Russert, on the other hand, granted his sources anonymity so he can maintain his role as power-broker. 

An Unlikely Source - Zimbabwe and Joe Trippi

In scouring the various sources for the updates on Zimbabwe to understand more the situation on the ground, I stumbled on Joe Trippi's personal blog.  I remember Mr. Trippi for the incredible promise of the 2004 Howard Dean campaign and then some work on John Edwards 2008 campaign.  But in each, I remember him more as a guru of internet, grass-roots building than of international relevance.  Now however, his website seems devoted almost exclusively to covering the disaster and corruption of Mugabe, which the Washington Post details in a lengthy and relevant post here. 

Good for him (and us interested parties). 

First Do No Harm - Urinary Tract Infections

Women, unfortunately, get urinary tract infections (UTIs) all the time.  The usual complaints are pain with peeing, frequent urination and pain below the belly button.  In otherwise healthy women, a simple three day antibiotic course of Bactrim or Ciprofloxin (both $4 for all the pills at most pharmacies these days), easily treats the UTI.

Now, occasionally clinicians find bacteria in women's urine during routine screening while the women may have no symptoms.  In fact, there can be upwards of 100,000 cfu/ml (colony forming units per milliliter of urine) without symptoms.  We, as a field of medicine, used to assume that given the high bacterial load and the risks associated with UTIs, these asymptomatic bacteruria episodes should be treated.

GO TO JAIL-DO NOT PASS GO-COLLECT YOUR RIGHT TO HEALTH CARE

While you and I pay for the privilege of health care, prisoners in the US are the only group in this country with health care as a right protected by the US Constitution.

We replaced the word "inmates" with "Americans" in the ACLU's discription of rights of LA County jail prisoners. Has a better sound to it...

■ Medical/Dental/Pharmacy : Americans have the right to have medical and dental visits available 5 days a week, and pharmacy visits available 7 days a week.

■ Emergencies : Emergency medical and dental are available 24 hours a day. Americans who request emergency attention must have a face to face meeting with medical personnel as soon as possible. Americans who request a dental exam should receive treatment within 3 weeks. Americans may be prescribed dentures if necessary.

■ Cost: When a billing policy prevents Americans from receiving adequate health care because they cannot pay, courts will be more likely to conclude that the policy is unconstitutional.

W.H.O - Guidelines even for here in the US

When an article or discussion focuses on the World Health Organization (WHO), one normally thinks of medicine in underdeveloped countries, responses to Avian Flu, HIV, malnutrition, or some other such 'foreign' thing.  Working here in the US, the WHO really has an 'other-worldy' quality to it.  And, I admit, I fall prey to this characterization myself, noting that much of the US medical care is governed by organizations like the AMA, FDA, CMS and other similar acronyms of various repute.  And so, reading this latest dispatch from the WHO regarding simple pre-operative check-lists to reduce preventable errors, I assumed they meant in resource-poor studies. 

And yet...the major US surgical and anesthetic societies are currently evaluating the WHO proposal and say they are in favor of adopting them - meaning...they don't already have such check-lists in place!  Excellent.  We'll now pre-operatively ensure the identity of the patient, mark the site of surgery, and ask about allergies, amongst other standard check-list questions. 

More Isn't Better - the tale of CT angiography

In a lengthy piece for the New York Times, Alex Berenson and Reed Abelson detail a fundamental flaw of the US health-care system - our misconception that newer is better and more is safer.  A hundred years ago, the health field proved much more adept at preventing than treating.  For example, researchers produced vaccines before finding antibiotics for infectious diseases.  But over the past century, the exponential growth in technology led to profound and marvelous improvements in diagnosing and treating health problems  

Especially, here in the US, the nexus of industry, public research, and the capitalist system produced unbelievable advances in our delivery of health care.  We can see inside the body with high-tech imaging (CTs, MRIs, PET scans, etc.), treat complex diseases with simple pills (HIV, some cancers like CML, etc.), and perform deep surgeries with minimal invasion (laparoscopic and endovascular procedures). 

The Dream Life of Pills (Part 3 of 3)

Considering the billions of dollars spent on medication and the hundreds of millions of dollars lost to unused, expired and discarded medications each year – the life of medications is important to us, for many reasons.  In our final installment, we ask what happens to pills in the afterlife.

Do pills dream of Ambien® sheep?

When medications have outlived their usefulness, they can be safely discarded – though some go on to live a second life, as recycled medication.  Medication not used by one patient is often given to another, to save time, money and lives.

Although current Federal law prohibits the collection of unused and opened medications from the general public for domestic redistribution, there are many exceptions to this rule.

The Way We Live Now...

                                                                                                                                                                                                                                                                                           

                                                                  

                                          

                                       

                                     

                           

                                    

Here's great map of our world today.

Happy Birthday, George Orwell!

From your friends at the Ministry.

The Ministry of Information

“more power to the misinformed”

Doctor, Are You Looking for a Change?

As found in a craigslist.org ad, a cure worse than the disease. The "next wave of medicine"....

Doctor, Are You Looking for a Change?

Our current medical system is in crisis.

While insurance and drug companies secure their profits, your income is plummeting and your patients are drowning in a sea of diseased-based healthcare. We believe you have five years before 25% of Americans who can afford private care will have found relationships with physicians who can truly address their health needs.

You have a choice.

We are offering physicians an unprecedented learning opportunity-training in ---------- Medicine. Graduates of the training program can become part of the next wave of medicine, delivering enormous benefits to patients. As an --------------- medicine physician, patients compensate you directly for your medical excellence and for your focus on patient satisfaction. Help your patients enjoy a better quality, more vigorous life!

Physicians who complete the program receive a maximum of 60 AMA PRA Category 1 Credits.
Training is provided through the ----------------------------------a non-profit corporation, in joint sponsorship with the -----------------------------------, a non-profit corporation.

FOR MORE INFORMATION ON -----------------------  PHYSICIAN TRAINING CALL:
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OR VISIT US AT WWW.-----------------.COM

The Dream Life of Pills (Part 2 of 3)

When A Pill Dies...

Considering the billions of dollars spent on medication and the hundreds of millions of dollars lost to unused, expired and discarded medications each year – the life of medications is important to us, for many reasons.  In our second installment, we ask what happens to pills when they die.

There are several reasons why pills come to the end of their useful life.  Many times, changes in  patient’s medication, nonadherent use, the recovery or death of a patient leaves many pills entombed on the medicine cabinet shelf, in a landfill with the rest of the rubbish, or down the drain.

2007 Environmental Protection Agency findings of traces of prescription drugs in drinking water gave the public a reason to pause before dumping medications down the toilet; but left a lot of people wondering, “What now? What do I do with the medicine?” Well, here’s the official advice on putting your dead meds to rest, from the Food and Drug Administration -

- Take unused, unneeded, or expired prescription drugs out of their original containers and throw them in the trash.  Mixing prescription drugs with an undesirable substance, such as used coffee grounds or kitty litter, and putting them in impermeable, non-descript containers, such as empty cans or sealable bags, will further ensure the drugs are not accidentally taken by others, children or pets.

- Take advantage of community pharmaceutical take-back programs that allow the public to bring unused drugs to a central location for proper disposal.

Some communities have pharmaceutical take-back programs or community solid-waste programs that allow the public to bring unused drugs to a central location for proper disposal.

Strict rules apply about flushing meds down the drain, depending on the State or locality.

Flush prescription drugs down the toilet ONLY if the label or accompanying patient information specifically instructs doing so.

You can also just return the medications to your doctor's office where health care professionals can ensure the proper disposal of medications.

Next Time…The dream life of pills.

The Dream Life of Pills (Part 1 of 3)

At our clinic, we had many questions about what to do with all the returned medications we collect from our patients and that’s when I began to wonder about the lives of pills...(in three parts).

Do pills get old?  Do they die?  Do pills dream of ambiem sheep?

Considering the billions of dollars spent on medications and the hundreds of millions of dollars lost to unused, expired and discarded medications each year – understanding the life of pills is important to us, for many reasons.

Do Pills Get Old? - Expired meds maybe younger than you think.

Expiration dates on medication's full potency are often determined by the manufacturer, usually a 2-3 year period for an unopened container. Once the original container is opened, the expiration date no longer applies. The "beyond use" date, issued by the pharmacy, usually extends the life of the pill's 100% potency to a 12 month period of after a medication is prescribed (presumably when the container is also unsealed). But there is evidence that the efficacy of a drug may be a lot longer than both the expiration date and beyond use date.  An FDA study showed that expired US military drugs, when stored under optimal conditions, retain 90% or more of their potency for about five years past their expiration date. But no rigorous studies have been done to measure the long term potency of the vast majoirty of the thousands of drugs on the market; and 90% potency might be good enough for Tylenol but suboptimal for life saving medications.

Here’s a link to the Medical Letter's report on the use of expired medications…

http://www.medicalletter.com/freedocs/expdrugs.pdf

Next Time…Do Pills Die?

The Lancet

A sharp, small surgical instrument...or, from an American-o-centric mentality, an oft unread, but awesome journal of medicine.  Recently, the Lancet published an early abstract which may likely change the way we prevent serious heart problems during non-heart surgeries.  It has also published an article on the uselessness of a new term in medicine (the blandly named 'multiple metabolic syndrome).  And, to boot...it's even got its own blog. 

Of course, MSF has had some harsh criticism of the Lancet's stance on malnutrition. 

Simplicity and the Essential Drug List

The vast and seemingly redundant number of medicines in the US adds unnecessary complexity.  On a basic level, most people really can't remember a list longer than ten items.  To simplify their lives, they end up creating heuristics and taking reasonable shortcuts.  This leads to clinicians prescribing about 20 drugs for the vast majority of patients they see, regardless of which field they practice.

More insidiously, however, this leads to relatively robust and meaningless arguments on the benefits of medicines in the same class without regard to the larger class differentials.  A couple of residents recently argued that one type of statin (a cholesterol lowering medicine) was better than another one - which happened to be less expensive.  However, in looking up the literature, there weren't any non-industry sponsored studies to back these claims.  More likely, the drug reps of the more expensive drug ingrained in the residents, possibly even with drug-company tainted studies, that one was better than the other. 

All of this contrasts sharply with the limitations of medicines by financial constraints in much of the world.  The WHO has necessarily, then, compiled a list of the Essential Medicines needed for treating the predominant diseases in each country.  Strikingly, there are only about 80 or so drugs on the list.  The obvious attraction is that this list comprises effective and inexpensive medicines.  the secondary benefit, however, is that given its simplicity, the list can be leveraged by public health officials for use by non-physician practitioners - i.e. non-doctors. 

The prevailing question then: are health outcomes improved through this simplicity or do we need the wisdom of highly trained practitioners making nuanced decisions? 

SWINGERS

I was looking at the latest map of 2008 Democratic primary victories when it struck me – that if we were talking about electoral votes and not the number of primaries won, delegates, super delegates – then Hillary Clinton would be way ahead.  If the nominee where chosen based on how the president gets elected (by the number of electoral votes for each state they won), then by now Clinton would have 300 electoral votes to Obama’s 217.  In the General Election, 270 are needed to be elected President.

John Kerry had 257 electoral votes in 2004. In 2000, Gore had 266.  In those close races, most would agree that in the 2000 and 2008 elections the choice came down to one state, Florida and Ohio, respectively and there was no prize for second place.

This year, it might be any one of the “swing states” who’s winner-takes-all electoral votes decide the national contest … Florida (27), Pennsylvania (21), Ohio (20), Michigan (17), New Jersey (15), N. Carolina (15), Virginia (13), Missouri (11), Minnesota (10), Wisconsin (10), Colorado (9), Connecticut (7), Iowa (7), New Mexico (5), Nevada (5) and New Hampshire (4).

Yes, Obama has won more delegates, more super delegates and more primaries and caucuses.  But when facing Hillary Clinton in the 16 swing states above, they both won 8, but her 8 translate into 114 electoral votes to his 82.  What will happen against McCain, in those same states? – Hard to say (but here goes…).

More Natural Disasters - the Chengdu Earthquake

Cyclone Nargis in Myanmar (Burma)

One of the first places to start understanding the Myanmar cyclone is through the map site of the University of Texas library.  From that link, one gets referred to ReliefWeb and to the following simple map of the onset of destruction:

a fesnying of ferrets

Several laguages use collective nouns (a noun that refers to more than one things, animals or persons) in their grammar, but we are sure none more so than the English laguage.  Like "a SHOWER of Bullets", "a BALE of Hay", for example. Some get pretty specific, like "a SHEAF of corn" is the bunble you have after reaping, but a "BUSHELL of corn" is the dry weight of the grain, itself; and pheasants on the ground are called a "nide", those in flight a "nye" and when flushed from the ground into flight a "bouquet".

Test your knowledge of animal collective nouns (some more commonly used than others).

MATCHING
Match the collective noun with the animal group it describes.
Click on the link for the answers.

1. a down                            a. of apes
2. a flamboyance                 b. of beavers
3. a gaggle                          c. of boar
4. a colony                          d. of boy/girl scouts
5. a murder                         e. of cattle (two)
6. a parliament                   f. of crows
7. a pod                              g. of fish
8. a school                          h. of flamingos
9. a shrewdness                  i. of foxes
10. a skulk                          j. of hares
11. a sounder                      k. of geese
12. a troop                          l. of geese (in flight)
13. a wedge                        m. of owls
14. a yoke                           n. of whales

You'll be the smartest hedgehog in your prickle, thanks to another public service message brought to you by...

The Ministry of Information

“more power to the misinformed”

And the Beast Replies

In response to the heparin contamination outbreak, a lot of criticism pointed towards the lax FDA oversight.  Last week's NEJM carried a retort from Dr. Alastair J.J. Wood, where he argues that fault doesn't solely lie with the FDA, but can be pointed back at the accusers: Congress and the media.  He concludes:

"It is easier to attack the FDA than to assume one's own share of responsibility. The press, for its part, frequently reports legislators' criticisms of the agency without providing any analysis of their voting records on FDA appropriations. But the bigger scandal is Congress's grossly inadequate funding of the agency, which demands swift and decisive action. No longer should our legislators be able to publicly excoriate FDA employees while ignoring their own complicity. No longer should any of us berate the FDA while failing to acknowledge that we are asking it to do more and more work with fewer and fewer resources. No longer should manufacturers be able to imply that inadequate FDA inspection is an excuse for adulteration of their product during manufacture. We must stop allowing the game of "kick the FDA" to be risk-free to participants. The public's health is at stake, and the time for adequate federal funding of the FDA is now." (emphasis added.)

That seems reasonable.  I'd agree with massively increasing FDA funding and even removing the Prescription Drug Users fee, which creates a wholly conflicting situation where the drug companies fund, in large part, the salaries of the FDA.  And I even agree with increasing powers given to the FDA, to regulate the safety of medical drugs, biologics, technology, foods, et. al.  And maybe then, we won't have the cause to dump on the FDA. 

But is this really what the good Dr. Wood wants?  At the bottom of his letter is this disclaimer: "Dr. Wood reports receiving lecture fees from the Pharmaceutical Research and Manufacturers of America, serving on the board of directors of Antigenics, and serving on the scientific advisory board of Sapphire Therapeutics, in which he holds stock options."  Gaining personal wealth from drug companies and PhRMA, does he really want further regulation and oversight of those companies and industry?  Or is his letter a simple deflection of the proportional blame that must go to these companies? 

I'd say the latter.

The Cursive Q

The Ministry of Information has learned that school boards across the United States are reducing the amount to time devoted to the teaching of cursive handwriting.  That’s bad news, folks.  Pathognomonic. As cursive goes, so goes the state of the American public education system! 

In 2000, approximately 1/3 of California lawmakers with school-aged children had their kids in private schools, and the same was roughly true for other big states like New York, Texas and Florida…not to mention for members of the US Senate and House of Representatives, according to a 2001 study by The Heritage Foundation.

At time when urban schools are being racially re-segregated under the guise of “school choice”, and teachers focus more on standardize test preparation, enforcing gang affiliation dress codes, conflict resolution, sexual health, English as a second language, etc., who has time to make sure no child's left behind AND teach all that “readin’, ‘ritin’ and ‘rithmatic”  - let alone how to write the cursive G, S or (our favorite)… the cursive Q.

To remedy this situation facing the US education system, the MInistry recommends that all American parents follow the lead of your elected officials - become a attorneys, make millions dollars and pay to get your kids out of public schools - A.S.A.P.  It is the only hope we have to rescue for human society the native values of cursive writing.

The Ministry of Information

“more power to the misinformed”

Missing Targets

Bruce Psaty and Wayne Ray write the following in this weeks JAMA:

Recently, the FDA proposed new guidelines that enable sponsors to distribute publications about unapproved uses of approved drugs and devices.² For drugs, for example, an sNDA [supplemental New Drug Application] is no longer required. The journal that published the article to be distributed must have both an editorial board that uses independent reviewers and a policy of full disclosure of conflict of interest; the article must be peer-reviewed; and the article should not be in a supplement funded by the sponsor.² The information should address adequate and well-controlled clinical investigations and not be false, misleading, or pose a significant threat to health. Distribution is to include the product label, a relevant bibliography, and a representative publication, if it exists, that reaches a different conclusion about the unapproved use. 

Are these proposed changes consistent with the FDA's mission of protecting the public health by ensuring the efficacy and safety of medications? Although peer-reviewed literature serves as the gold standard for evidence-based medicine, there are major limitations in relying on sponsor-distributed literature to regulate off-label use, including the selective publication of studies, the systematic manipulation of the literature, the absence from the literature of critical data necessary for evaluating off-label use, and the potential for undermining the NDA review process.

While I'm sympathetic to their cause of limiting the dispensation of poor or misleading studies the targets of their remedy are incomplete.  If pharmaceuticals are denied the right to distribute these articles, they'll simply find some other way in this, the age of creative information sharing. 

Happy Birthday, Mr. Shakespeare!

In 1584, William Shakespeare left his clerk job at the Ministry of Information (then know as "Merriman's Ale and Buscuit House") to pursue an acting and writing career and in the process went on to contributed more phrases and expressions to the English language than any of those the chaps who wrote the English Bible.

Today is his birthday and our loss was the literary world's gain.

Below is a short list of expressions given to us by the plays of William Shakespeare. Click on the link for more...

Happy Birthday, Willie!

All that glitters is not gold (The Merchant of Venice)

All's well that ends well

As good luck would have it (The Merry Wives of Windsor)

The Ministry of Information

“more power to the misinformed”

Patient, Heal Thyself...CALL NOW!!!!

If it hasn't come to your state yet, direct access testing (DAT) may be on its way.  In several states patients are free to request certain laboratory tests without physician orders.  Direct access testing already exists for over the counter test like pregnancy tests and few states prohibit people from having diabetes screening or cholesterol levels checked at health fairs all over the country, without a medical provider's order or responsibility to treat.

DAT is also big business. Over $10 billion are spent out-of-pocket on health services, with over $1 billion spent on in-home/mall/health fair testing, alone. The market is expected to grow as hospitals, lab testing companies and numerous on-line testing services seeking to directly access patient dollars by cutting out the "middle-man" and allowing patients to manage their own health with less assistance from a licensed provider. 

Some medical boards have lobbied successfully to limit direct access testing in their states, whereas others have offered their services in ordering any test that their patients...er, customers desire.

Similar trends in customer led consulting/purchasing have been seen in other industries. Stock brokers realized, long ago, how much money is to be made in letting their clients manage their own portfolios and Bob Villa was the first of many to convince us to "do it yourself".  You decide the tests and your health care broker will arrange the purchase - $9.99 per trade.

Click below for the test most commonly ordered by direct access clinical laboratory tests....

Willing to Guest Author for Pharmaceutical Companies

I have an offer to all drug companies:  I am willing to sell out.  Honestly.  The latest JAMA has an article describing the role of ghost writing in the lead-up to the Vioxx debacle.  In short, it may have been the case that Merck did some in-house research, then found some experts to put their name on the articles which legitimized them to the medical community. 

But it may have cost them a whole lot to procure, you know, big whig experts.  I, on the other hand, come cheaply.  I don't have a big name yet...so you, Merck (or other big drug company), can get me for pennies on the dollar now.  And when as a result of publishing a whole lot of articles with your work I am recognized as an "expert", I promise to discount you for future services.

Ladies and Gentlemen, the Next President of the United States...

Is this kid going to be our next President?  Most people don't know - but he's already been the Governor of Washington State.

With an African American male and a white woman fiercely contesting for the Democratic presidential nomination, many are asking, “Is American ready for one of them to be President?” 

We probably wouldn’t have to ask that question if more people knew about the many non-white and non-male elected leaders that we currently have serving this country as the chief executive of 11 of our states.  Don’t even get me started on all the ones we’ve had in the past!

See if you can match the names with the state they govern…

Neglected Diseases – Low Socioeconomic Status

Missing from the WHO list of neglected diseases is the root of the problem and a now (another) recent study relating the stressors of living in poverty to mortality in San Francisco Bay Area residents will have us going around the table talking about what the poor already know…being poor makes you sick.  But since this is not the first study that suggests that people at lower socioeconomic levels carry a heavier burden of illness, disease and death, the question remains, “What is to be done?”

Now, we might take that study and fuss around with new clinics, or health promotion ads, or community action groups, or outreach programs and call it "work" – but if the community does not become more affluent, in the process - isn’t that just ignoring the evidence?  Should the poor cut to the chase and follow the advice of the rap star, 50 Cent?  “Get rich or die tryin’.”

The Dangers of Plastic!

After our groundbreaking story about the fluorination of water by terrorist who wish to destroy our way of life, we turned our attention to the numbers in the triangle on plastic water bottles, food containers and other common household items looking for signs of…hidden dangers in our plastics!

Many try to link these codes to cancer risk, as indicators of how much toxic exposure exists for people using those products.  But the Ministry of Information knows better – the codes aren’t meant to inform you of how dangerous plastic is to you, but to convince you of how good plastic is – for the environment.

The plastic industry’s use of these resin identification codes, introduced by its trade association in1988, promotes the idea that plastic is highly recyclable, so you should feel good about throwing it out and buying MORE plastic because, using these codes, it will all be sorted and recycled, right?

WRONG (smack to your face)!!! Unfortunately, recycling plastics is an expensive process, recycled plastics (especially mix-plastics) generally are more expensive than virgin plastic and most recyclable plastic, especially the kinds too toxic to incinerate, makes its way to landfills where they last forever, if not leak toxins into the surrounding environment.

So instead of telling you which codes to look for when buying bottled water, or using grocery bags, the Ministry suggests you REUSE over RECYCLE…refill water bottles with tap water (boiled or filtered, if you must), use reusable cloth bags when shopping and practice saying, “No thank you, I don’t need a bag”, when you buy something that you can carry in your reusable hands.

For those of you lucky enough to have grown up in the ‘60s…this scene from The Graduate.

The Ministry of Information

“more power to the misinformed”

Healthy San Francisco?

Healthy San Francisco’s plan to bring universal health care access to the uninsured of San Francisco gets a lot of media praise, but some of not-so-great truths related to this brand of universal access need be told.

Truth #1 – Status Quo ≠ Innovation.  There’s nothing “new” about an uninsured San Francisco resident walking into the public health clinics to receive care. They’ve been doing it since Chinatown Public Health Center opened its doors in 1971 and at San Francisco General Hospital since the 1870’s.  Healthy San Francisco’s innovative idea is to have businesses contribute to the cost of health care for employees, charging premiums to program participants and charging people to access health services based on income.  Sounds a lot like our current health care system.

Truth #2 – Universal safety nets are actually quite small.  Healthy San Francisco calls for expanding access to the already overburdened Department of Public Health’s (DPH) clinical services. Public plans to expanded primary care services are funded by one-time federal and state grants that don’t cover cut backs being made in public health nursing, mental health services, dental services or any other DPH service that falls to the city’s budget deficit axe.  The safety net will soon have room only for those who can afford to stay on it.

Bangkok...shit!

 

Jubei (guest blogger): [voiceover]….I'm still only in Bangkok... Every time I think I'm gonna wake up back in the public health clinic, seeing patients, writing new blog entries. When I was there, I wanted to be here; when I was here, all I could think of was getting back into the clinic and into the shit. I'm here since “…Dengue Fever” now... waiting for KOLAHUN to post something new... getting softer; every minute I stay in this room, the blog gets weaker, and every minute Kolahun (host blogger) squats in New Orleans, seeing patients….deconstructing Laurie Garrett - he gets stronger. Each time I looked around, the virtual walls moved in a little tighter.  Time for my complimentary, Western-style breakfast...

Neglected Diseases - Dengue Fever

I'd have to say the adjectives used to describe Dengue Fever probably evoke the most Stephen King-esque associations in medicine I can think of.  First, the name itself, Dengue Fever, has quite a sinister twist.  Then there's the description of it as "break-bone fever" disease.  And finally, it's classification as a hemorrhagic fever brings back the horrific memories of the descriptions of hemorrhagic fevers in The Hot Zone. 

The disease itself parallels malaria in many respects.  There are four dengue virus variants (much like the four species of malaria), the virus is spread through a mosquito vector and the incubation period lasts between 3-10 days.  And like malaria, we've got no vaccine (yet) and some of the best preventive measures include mosquito control. 

Of course, while there are quite good prophylaxis and treatment options for malaria, there are none for dengue fever (except supportive therapy).  And there's that whole "hemorrhage" thing which one doesn't see with malaria. 

(pic from WHO)