KOLAHUN

Dr. Oliver Wendell Holmes, Sr. (1809 - 1894)

Today is the birthday of Oliver Wendell Holmes, Sr. – not to be confused with his son and U.S. Supreme Court Justice, Oliver Wendell Holmes, Jr.

The father was born in Cambridge, went to Phillips then to Harvard. While in medical school, he began to write poetry, first for his own amusement, then to published anonomously and once even to save a warship.

Hearing that the famed USS Constitution was to be scraped by the Navy, Holmes wrote a poem about the ship, “Old Ironsides”. Published first in Boston, the poem then appeared in newspapers throughout the country in 1830, earning Holmes instant fame and preserving the historic ship – which is still seaworthy and located in Boston today.

Despite literary success and contemporary admirers like Edgar Allen Poe, Holmes was more dedicated, it seems, to his medical career.  After studying in Boston and Paris, he earned his M.D. from Harvard and brought to American medicine radical ideas like the use of a stethoscope,idea of patient to patient spread of infection from physician contact long be form germ theory became popular and in 1846, he coined the word “anesthesia”. 

In 1857, Holmes, together with Harriet Beecher Stowe , Ralph Waldo Emerson, Henry Wadsworth Longfellow, James Russell Lowel and John Greenleaf Whittier started a literary magazine.  Holmes named it The Atlantic Monthly. The magazine gained and has since maintained a national reputation for introducing America best writers to the literary world and launching the careers of some of the country’s best known names in letters.

Target's Urgent Care Clinics

With a twisted spin on transparency of cost and ease of service, many Target stores (as well as Walmart, etc.) offer urgent care medical services.  Below is half of the cost schedule listed on the Target website (i couldn't get it to format properly, but follow the link for the full amount):

• Minor Illnesses
• • • Allergies $59
• Bladder Infection $69*
• Cold $59
• Conjunctivitis/Pink Eye $59
• Cough or Bronchitis $59
• Earache $59
• Flu $94
• Mono $69
• Sinus Infection $59
• Sore Throat $69*

• Minor Injuries
• Bruise $59
• Insect Bite or Sting $59
• Minor Burn $59
• Splinter Removal $59
• Stitch Removal $59
• Wound Check $59

• Skin Treatments
• Acne $59
• Athlete's Foot $59
• Cold Sore $59
• Earlobe Piercing $19 per piercing
• Eczema $59
• Impetigo $59
• Poison Ivy or Poison Oak $59
• Rash $59
• Ringworm $59
• Shingles $59
• Skin Infection $59
• Wart Treatment $59††

Most of these services and costs are obscenely insane.  Bypassing some of the more sane pricing (immunizations, free BP checks, etc.) we come to remainder of services which are either grossly overpriced or improper ways to practice medicine.  For example, Target sells self-administered pregnancy tests for about $15, but charge $49 at the clinic.  Unless they are doing blood pregnancy tests, which I highly doubt, you're paying 3x the amount for essentially the same product.  

And now from the UK

A couple of potentially useful new items from the UK, the first from the Liverpool School of Tropical Medicine and the other from the London School of Hygiene and Tropical Medicine (via the Wellcome Trust).  

As an admirer of all this map related, it's nice to see this new interactive map from the London Guys.  Clicking on different countries shows the most common worm (helminth) infections in each country.  Unfortunately, only information on African countries is presently available, though they say they are planning to map the whole world.  Now, if we can increase the availability of the treatment drugs like praziquantal, where the percentage of needs met is less than 2% in countries like Ghana, Tanzania, and Uganda, an even bigger impact will be made.

Not to be outdone, the London rivals for both football and tropical medicine, the guys from Liverpool have been working hard over the past two years to formulate synthetic artemesinin therapy - the most recent and effective treatment for malaria.  If the research advances successfully and the promise of cheap artemesinin therapy arrives, it would be a significant boost to developing countries and international pricing organizations which struggle to overcome the high cost of current artemesinin based therapy.  

Life Expectancy versus Country Income Over the Past 200 years

Over at Gapminder, they've got a great movie-graph plotting income versus life-expectancy for each of the world's countries over the past two centuries.  Their narrator, whose enthusiasm would make him fantastic as a football announcer, has some interesting analyses, especially with regard to China and the Great Leap Forward.  However, he has other analyses that are a little more suspect.  In his defense, to fully narrate the gyrations presented on this moving graph would require encyclopedias devoted to the trends in world wars, engineering advancement, medical breakthroughs, the emergence of pandemics and so forth...i.e. not something that can't expressed in less than 5 minutes.  

Meanwhile, one straightforward meta-analysis of the graph partially refutes Jeffrey Sachs' defense of capitalism.  In The End of Poverty, Sachs argues that capitalism advanced health and income of all countries, without the 'developed' countries cannibalizing the gains of 'developing' countries.  Following the video, this seems clear - all countries over time do show increases in life expectancy and income.  However, Sachs neglects an even more insidious problem directly ascribable to capitalism - both health and income disparities between countries.  Look at the year 1800 - countries are grouped tightly.  Fast forwarding 200 years, one can clearly see that countries now belong to vastly unequal tiers.     

Sachs' answer is to continue the fundamental capitalist system and reduce disparities through rich countries benevolently transferring money and aid to poorer countries (Millennium Development Goals and all that).  But will this really reduce inequality?  And if not what implications does this have for social cohesion in a context of rising population numbers and climate change induced resource depletion?   

Shit, cholera again

Cholera, a disease which can have up to 50% mortality if left untreated, officially arrived in Pakistan this week.  Presciently, authorities had already begun empirically treating anyone who mimicked the disease. Per each individual patient, simply giving IV fluids or oral rehydration salts (ORS) prevents dehydration and likely death.  

But while treating the individual patient is easy, the problem with cholera epidemics is the sheer scale of resources needed.  With hundreds to thousands of patients ill each week, the logistics of the cholera response usually become the rate limiting step.  Immediate constructions of cholera treatment centers which can fluid resuscitate patients, provide for strict isolation of contaminated waste and have adequate clean water need to be constructed.  At the same time, the general population needs to be sensitized about the urgency of seeking treatment when anyone starts watery diarrhea and all contaminated water sources need to be identified and chlorinated.  

In developed countries, the attention to water-sanitation infrastructure already prevents most cases of cholera.  However, in undeveloped countries, the same resource scarcity which leave simple water-sanitation issues a luxury item, also impede effective response once an outbreak occurs.  The cartogram below vividly illustrates this showing the proportional burden of disease.  Those areas which are very poor (africa) and/or very populous (afghanistan and india), contain a high proportion of disease.  

Sadly, Pakistan, which previously had a much lower endemic base burden of disease, may be quickly distort the cartogram further if an epidemic explodes there.  

 

image from worldmapper.org