Vol. 174 July 15, 2017 Dumb Government and Smart Guns

July 15, 2017

Gun violence injuries and deaths in the U.S. is a public health crisis.”   – AMA

Gun violence kills roughly 30,000 Americans each year, about as many people as car accidents. The federal government has been restricted in gathering and analyzing gun violence data since 1996 when a CDC study linked the presence of a gun in the house with an increased risk of homicide. The NRA responded with a successful lobbying effort to pass the restriction that the CDC may not use any money allocated to it for “activities that advocate or promote gun control.” It stripped $2.6 million from the CDC budget for firearm injury research. After the Newton School shooting in 2012 Obama issued an Executive Order (one of his relatively few) commanding the CDC to renew their research into gun violence and requested Congress to allocate $10 million for that. Congress never did, and research never resumed.

The NRA has also successfully limited the federal government’s ability to trace guns involved in crimes, “crime gun-tracing”. Some states have developed data bases of crime-gun tracing to identify sources of and reduce illegal gun trafficking. Massachusetts established crime-gun tracing in 2014, but has not published a meaningful analysis of the data which might lead to some action. The 2017 Massachusetts legislature has inserted into their budget proposal a request that the governor produce such an analytical report.

Doctors, particularly pediatricians, are keenly aware of the dangers of having guns in the  house. 90% of accidental gun injuries to children happen in a home with a gun. The American Academy of Pediatrics has explicitly recommended that pediatricians routinely ask gun-safety questions during health and wellness visits. But in 2011, Florida passed a “Privacy of Firearm Owners” law levying $10,000 fines and loss of medical license to any pediatrician that inquired about the presence of firearms in the house. The law was upheld by a Florida state court in 2014 based on “2nd Amendment infringement”. The law was just struck down this year by a Federal Appeals Court that ruled that “there was no evidence that the law infringed on the Second Amendment.” By the way, the Affordable Care Act (aka Obamacare… remember Obamacare?) specifically prohibits physicians from keeping records on gun ownership. an assurance to any paranoid, conspiracy-theory-believing gun owner that docs were now not in league with big government. (see “Docs vs. Glocks”, Scientific American, August 2015. pg. 10)

The solutions to gun violence deaths are mostly focussed on mass shootings including either/or/and:
1. eliminate mental illness,
2. eliminate terrorists,
3. eliminate humane treatment (put water boarding video of terrorists on You Tube),
4. eliminate Muslims,
5. eliminate political correctness  (utter the words “Radical Islam Terrorists” which Obama refused to say (sic.) (1)

The truth is that “mass shootings”, though a big part of media attention, are a small part of the  30,000 annual gun death toll. 62% of  gun deaths are due to suicides committed with guns that DO NOT BELONG to the victim (particularly among the young). Criminals steal about 250,000 guns per year. 1.7 million children live in homes with unlocked, loaded firearms. (2)

The NRA consistently raises the spectrum of the need for the home owner to have a means of self-defense, but a gun is 22 times more likely to be used in a criminal assault, an accidental death or injury, a suicide attempt, or a homicide than it is for self-defense. 61% of gun homicides are by people who know each other.(3)

Making a gun as smart as an iPhone is one way to prevent to a large portion of gun injuries and deaths. Previous attempts to develop such a smart gun have been fraught with problems, have been actively boycotted by gun manufacturers, and have been opposed by gun advocates and the NRA. Kai Kloepfer, a 15-year-old high school student in Colorado, in response to the Aurora theater shooting near his home, started a science project in 2015  to design a pistol that will only fire when a sensor in the grip recognizes the fingerprint of the owner. His project won awards, and Kloepfer delayed his entrance to MIT for a year when he got a grant to develop a working model of such a smart gun. By 2017 he successfully built and demonstrated a smart pistol. The gun takes 1 second to unlock, its battery lasts a year, a light indicates the battery status, and a second light indicates it is unlocked and ready to fire. Neither a child nor a thief can fire the gun. The owner may store up to 10 “authorized user” fingerprints (like for a spouse or domestic partner ). The smart gun is smart enough to NOT  connect with the internet, so it can not be hacked or hijacked.

The NRA response has been predictable: “NRA does not oppose new technological developments in firearms; however, we are opposed to government mandates that require the use of expensive, unreliable features, such as grips that would read your fingerprints before the gun will fire.”(2)

Hey, at least the NRA didn’t evoke the 2nd Amendment argument. That is progress!  Technology can deal with “expensive” and “unreliable”. Technology is far faster to upgrade than the Constitution.

References:
1. “A Nation Captive To The Gun”, Garry Wills, Boston Globe 6/15/2016
2. “The Future of Everything”, Wall Street Journal, 2017, Geoffrey Fowler
3. Journal of Trauma and Acute Care Surgery, 1998

 

 


Vol. 173 July 1, 2017 Bugs and Drugs

July 1, 2017

 

“Eat dirt, and thrive”

 

Since Fleming discovered a mold that produced penicillin which killed Streptococcus bacteria, scientists for decades have been mining soil as a source of new antibiotics. There are so many bacteria competing for nutrients in the dirt that some bacteria will produce toxins to kill their neighbors. The current belief is that soil extraction for new antibiotics has been going on for so long that soil is about tapped out as a source for novel ones.

Antibiotics kill bacteria by attacking their cell walls. Bacteria develop “resistance” to antibiotics with changes in their cell walls that resist the medicinal attack. Individual bacteria cells can’t change their cell walls, but the population of pathogen bacteria as a whole, the “microbiome”, can become “resistant” as the bacteria cells replicate again and again. When only the bacteria which have mutated to ones with a different “resistant” wall remain, the bacteria has become “resistant” to the antibiotic. Your body does not become “resistant”, the bacteria community does..

Viruses have no cell walls, and that is why antibiotics don’t work on viruses, like the ones causing the common cold. Anti-viral medicines against the flu and HIV work by attacking the internal functions of the virus. Some anti-viral medicines attack the virus DNA, others attack the virus RNA, and others attack intracellular proteins or enzymes necessary for virus replication.

Scientists at Rutgers have recently described a whole new class of antibiotics extracted from soil (Italian soil to be exact, if you think that’s important) that don’t work by attacking the cell wall. The new compound inhibits an internal protein, a polymerase, in the bacteria which is necessary for the bacteria to survive. The compound is 10 times less likely to trigger a mutation that leads to drug resistance than current antibiotics. Also it can kill dormant, non-replicating bacteria much better than current antibiotics. Similar compounds that attack polymerases has been successful in treating viruses like Hepatitis C and HIV, but this is the first example of a successful antibacterial effect. It will send many scienticists looking for new antibiotics back to the dirt.

Could this just be another reason to eat dirt? Eating dirt, or geophagia, is a recognized way for animals, and some humans in special situations, to obtain minerals. Pica , eating non-food substances, in a child can indicate that the child is iron deficient or anemic. Pregnant women in Africa are known to eat dirt to enrich their stores of calcium for the fetus. Parrots, bats, and some pregnant women have been observed eating soil with a high clay content to help with gastrointestinal distress. Since dirt can contain lead and other toxins, most people are advised to just take a swig of Kaopectate.

Why not just skip the dirt and go right for the pure mixture of bacteria, a probiotic? In fact, the evidence for the benefits of the use of probiotics is mixed. The use of probiotics has not been dramatically positive in treating diarrhea, eczema, and preventing the side effects of antibiotics. True that probiotics have no significant side effects (the FDA has labeled them as “safe”), but some researchers are concerned that overuse may have deleterious effects on our normal gut bacterial flora.

There are approximately 100 Trillion (that is a “T”) bacteria in our gut. They have been officially awarded recognition as the “gut microbiome”. It is a hot research topic focussing on its roles in digestion, metabolism, immunity, dementia, and even autism. Fecal transplant therapy  (infusion of a solution of healthy donor feces through a nasogastric tube) repopulates the intestine with “good” bacteria as treatment for certain diseases caused by “bad” bacteria (Clostridium difficle) (1) More recently, the dscription of a “breast microbiome” in association with some breast cancers is spurring research into using bacteria as biomarkers in screening for breast cancer.

” The Hidden Half of Nature”, published in 2008, tells a positive story of a couple changing their lives by enriching their garden soil with bacteria-heavy materials while enriching the bacteria of their own intestines by “eating healthy”. One of the authors summed up their approach as: “Mulch your soil, inside and out”.

  1. N Engl J Med 2013; 368:407-415, January 31, 2013

Vol. 172 June 1, 2017 Why Republicans Dislike Obamacare (simplified)

June 2, 2017

“You pays yer money,
and you takes yer choice.”

 

 

The #1 reason is that the Affordable Care Act (ACA) expanded health insurance to at least 23 million voters in the name of Obama, a Democrat.

The #2 reason is that Obamacare is costing the federal government more than the Congressional Budget Office (CBO) predicted.

That is because more of the uninsured enrolled in Medicaid than predicted and less than predicted bought policies through the health insurance exchanges. I am sure that there are all sorts of complex economic reasons for that, but to my mind it seems pretty simple.  If Medicare is the Gold Card of health insurance, Medicaid is at least the Silver Card.  The Medicaid card is accepted by all hospitals and ERs (by law) and many physician specialists. Even some behavioral health services can be paid for with the card. Medicaid insurance is always state-funded, and each state develops their own program.”If you know one Medicaid program, you know just one Medicaid program.”

Obamacare increased federal subsidies to states that expanded people’s eligibility ( i.e.; by raising eligible income levels) for Medicaid insurance. Federal subsidies existed for the first few years, but Medicaid costs would eventually be borne by the individual states’ taxpayers. If you are the Republican governor of a state running for reelection every four years you’re probably not enthusiastic about that. However, one Republican Governor ( Romney of Massachusetts) had already expanded that state’s Medicaid eligibility to achieve nearly 100% insured. The present Republican Governor (Baker of Massachusetts) will be very unhappy if he loses the federal subsidies to Medicaid under Trumpcare.

Health insurance exchanges were supposed to recruit into the health insurance risk pool a lot of healthy young people not covered by employer-based plans. These healthy young people would need less health care than their elders, so their premiums would be a “net plus revenue” to the insurance companies. When that “net revenue” did not appear as large as expected several companies withdrew from the exchanges with much media attention. The “individual mandate” tax which was supposed to “incentivize” the uninsured to buy policies through the exchanges was apparently too low to work.

So, the essential elements of the Republican “replacement” of Obamacare are to:
1) roll back federally subsidized Medicaid expansion and
2) do away with the health insurance exchanges with their federal subsidy of premiums and the associated “individual mandate”.

Of course, Republicans propose to keep the more popular benefits like required coverage for pre-existing conditions and coverage for children up to age 26 living at home. Obamacare also established a new standard definition of “essential benefits” such as pregnancy and other maternal benefits and put a maximum cap on premiums for the elderly. One Republican proposal would define pregnancy as a “preexisting condition” and deny coverage. Watch for further developments in evolving Senate proposals.

The predictions of the CBO in the past (since Nixon created it on the way out the Oval Office door) have been more nearly correct than those of most other agencies and organizations. It’s reputation as bipartisan and objective remains intact. The publication of Republican “replacements” before the CBO’s analysis could be carried out clearly hurt the credibility of their proposals.

Multiple evidence-based studies and the experience of all other developed countries with government-based health insurance (does NOT have to be a “single payer”) have shown that providing universal health insurance in the long run saves money;
-by providing access to medical care for all citizens,
-by enhancing the cost-effective introduction of new technology,
-and by rationalizing the resource allocation of a defined budget.

We have a history of difficulty in taking the long view. For example, the initial enthusiasm for preventative/wellness programs exhibited by the early HMOs eroded considerably when they realized that the policy holder might not be with the same insurance company when the time came years later to reap the benefits of good health (less medical care expenses).  Certainly Governors, congressmen, and other public officials with short 2, 4, or 8-year terms have little incentive to always appreciate the long-term cost benefits down the road. (“No regulations to fight against climate change” comes to mind)

So as “they”say, being either the British magazine Punch in 1846 or Mark Twain in 1884 in “Huckleberry Finn”,
“You pays yer money, and you takes yer choice.” 


Vol. 171 May 15, 2017 Medical Updates (Real News)

May 15, 2017

 

“The Only Thing That Is Constant Is Change -”― Heraclitus

 

 


Those TV ads work … for the drug companies.
A study of the effectiveness of TV ads (Direct-to-Consumer Advertising or DTCA) for prescribed testosterone supplements (no effectiveness in men without endocrine disease) in 75 regional markets from 2009 to 2013 showed that the addition of ONE TV ad per household per month for 4 years was associated with an increase in new blood tests of testosterone level, new prescriptions with blood level testing, and new prescriptions without any blood level testing. About 2% of the middle-aged men in this study of 17 million men received a testosterone prescription. (JAMA,Mar 21, 2017)

In other news, the British Medical Journal published a study of over 900,000 men which showed that those taking testosterone were 63% more likely to develop potentially fatal blood clots in the legs or lungs during the first six months of taking it. (BMJ, Nov. 13, 2016)

Vitamin D gets an “F”.
Vitamin D supplements became very much in vogue when some studies suggested that people with low blood levels had a higher risk of cardiovascular disease. BUT, in New Zealand 2500 adults were given 1000 units of vitamin D once a month and a matched group of 2500 were given placebo. The vitamin D blood level doubled in the supplemented adults, but at the end of 3 years both groups had identical rates of adverse cardiovascular events (12%). (JAMA Cardiol Apr 5, 2017)

PSA testing -“D” or “C”? It depends.
In 2012 the U.S. Preventative Services Task Force (USPSTF) gave the PSA blood test screening for prostate cancer a “D” – (not recommended) because of false positives leading to unnecessary procedures and treatment, and the fact that PSA screening prevented less than 1 prostate cancer-related death per 1000 men screened.

In 2017 the USPSTF is upgrading that “D” to a “C” (maybe a small benefit) but only for men aged 55-69. (Dare we call it a “gentlemen’s C” ?) The “D” remains for those over 70. This upgrade for the younger men is based mostly on the emergence of the “active surveillance” option to immediate surgery or radiation for positive PSA tests and biopsy. The USPSTF strongly recommends that physicians 1) explain all the risks and benefits of PSA testing to men from 55-69, 2) be aware of the patient’s “values and preferences”, and 3) practice effective “joint decision-making” with the patient. (J Watch General Medicine May 15, 2017)

In other news, a Michigan study of 431 men with localized prostate cancer discovered by PSA testing and confirmed by biopsy who opted for “active surveillance” rather than immediate surgery or radiation showed that only 31% actually followed the complete “active surveillance” protocol. (PSA testing every 6 months and annual repeat biopsy.) Another 31% complied with just the PSA test repeats, but not the biopsy. 22% did neither repeat PSA tests nor biopsy. Outcomes were not measured in this study, (J Urol Mar 2017)

Aspirin may get a third “A”
Aspirin is well-known to relieve pain, reduce inflammation, reduce fever, and reduce blood clotting. It does that by inhibiting the production of prostaglandins, a hormone-like substance in play in all those conditions. In 2000 scientists discovered that aspirin also increases our production of resolvins which also reduce our inflammatory response. We make resolvins from Omega-3 fatty acid precursors (hence the contemporary popularity of fish oil).

Investigators are very interested in a newly defined, third effect of aspirin which is unrelated to its role in anti-inflammation – aspirin’s interference in the ability of cancer cells to metastasize. Cancer cells apparently need to be coated with clumps of platelets in order to survive their trip through the blood stream to distal sites. In mice, aspirin’s anti-platelet action (the “reducing blood clots” function) has been found to interfere with platelet clumping around the cancer cell and successful migration of the cancer cells through blood vessels is inhibited. (Scientific American May 2017)

Trying to avoid sugary beverages? Don’t jump to diet soda.
A 10 year study monitoring 4000 people without diabetes for strokes and cognitive decline found that people who drank diet soda every day were three times more likely to develop strokes and dementia. In a separate study people who drank more juices and more sugar-sweetened soda than others were more likely to have poorer memory and smaller brains on MRI imaging than the other people. The researchers state clearly that this is not a cause and effect situation, just an “association”. (Stroke April 24, 2017)
“More research is needed.” Of course.
“Water is best.”

Bilingual brains remember their first language, even when they can’t speak it!
Korean-born adults who were adopted by Dutch families before the age of six and who did not speak nor understand Korean were better at distinguishing between the sound contrasts of the Korean language and could pronounce the Korean sounds much better than those Dutch adults who had no exposure to the Korean language as children. This better discrimination of sounds is not genetically based because numerous studies have shown that all infants are capable of reproducing all the sounds of all languages. “Remarkably, what we learn before we can even speak stays with us for decades.” (Duh!) (Royal Society Open Science, Mar 2017)

No federal money to study pistols or pot.
According to David Hemenway, Professor of Health Policy, Harvard School of Public Health, an average of 300 people get shot in the U.S. each day. One-third of them die. Twenty years ago the CDC funded about $2.6 million a year (“a small amount”) for firearms research. Now that funding is ZERO. Since 2006 Congress has pprohibited the CDC from gathering any gun-related statistics and developing a gun-related data base, but there is apparently no formal, official prohibition for funding gun-issue research,; just the CDC’s desire to “stay out of congressional crosshairs”.

NIH apparently has the same reticence. In the past 40 years over 486 NIH grants have been awarded in the areas of cholera, diphtheria, polio, and rabies which have caused 2000 deaths in the U.S. Over the same 40 years while 4 million people were shot in the U.S. , NIH has awarded 3 gun-issue research awards. (Note: this period of time is during the relatively scientific-friendly Clinton, Bush, and Obama administrations .)

Marijuana is still classified by the FDA and the DEA as a Schedule I substance which prevents any clinical trial or study of its medicinal benefits. Medicinal marijuana must have FDA required “drug development” studies to get off Schedule I, and those studies are virtually impossible while it is on Schedule I. (Note: current Attorney General Jeff Sessions said in April 2016: “Good people don’t smoke marijuana”) (Scientific American May 2017)


Vol. 165 March 15, 2017 Can Pregnancy Make You Stupid?

February 15, 2017

Hub thumbnail 2015

“Most pregnant women will admit to bouts of “pregnancy brain” or “mommy brain” — whether it’s forgetting doctor’s appointments or forgetting their own phone number. This pregnancy-induced mental fog is part of the neurological changes at the start of pregnancy that continue throughout postpartum. ”

 

I am not at all sure that this phenomenon really exists, but scientists at Barcelona University recently published results from their study of 25 first-time pregnant women, the 25 fathers responsible for the pregnancies, and 20 non-pregnant childless women.  By comparing “before conception” and “postpartum” MRIs in the pregnant women the researchers documented a definite reduction in the pregnant women’s gray matter. The volume loss of gray matter occurred in three specific areas of the brain associated with social cognition and emotional feelings.  The differences of volume in the pregnant women was so apparent that the researchers could accurately pick which women were pregnant just by looking at the MRIs. Similar MRI imaging of the fathers and non-pregnant women showed no reduction of gray matter.

Gray matter is the part of the brain cortex that is mostly neuronal cells. White matter consists mostly of connections between the neuronal cells, axons (“wires”) coated with white myelin. The reduction of gray matter in the pregnant women was in brain areas associated with “being able to think about how other people feel and perceive things.” and persisted for 2 years after delivery.

Using fMRI (functional MRI – measures brain activity not just structure) these reduced gray matter areas would “light up”, show higher metabolic activity, when the mother gazed upon a picture of her own baby rather than a picture of someone else’s baby. The researchers speculated that this was a measure of quality “mother-infant attachment”.

The implication of this gray matter reduction is not clear. Many past studies in all kinds of people suggest strongly that people with larger volume of gray matter have better memory and are happier.

A study of ultra-marathoners (ran 2,788 miles in 64 days without a rest day) showed a reduction of gray matter of 6%, but it was reversed in 6 months and was not associated with any brain lesions. In comparison to the less than 0.2% per year gray matter reduction in the elderly this 6% is H-Y-U-G-E. Pre- and post-run Cognitive tests would have been help in this study of ultra-marathoners, but I am not sure you could detect any increase in stupidity in them. Presumably the reversible reduction in brain volume was due to dehydration.

Studies of chronic marijuana users show reduction in gray matter, but increased “connections”, and no loss of cognitive skills (if not high at the time of testing). This and similar findings in adolescent brains have been explained as either a bad thing about marijuana use or as a “maturation” of the brain as it gets “better organized” for specialized tasks. A similar explanation of an “organizing process”, “a pruning toward a more efficient brain” is offered by the researchers of these pregnant women.

So where does this leave us regarding permanent gray matter reduction in pregnant women? We, of course, don’t really know at this point. fMRI studies are still in their infancy, and there is some controversy about what they really mean. But, cognitive tests of both these pregnant and non-pregnant women showed no difference, and no change in cognitive functions after delivery, so we can confidently say that pregnancy does NOT make you “stupid”… or even “stupider”.


Vol. 164 March 1, 2017 The Exercise Paradox

January 31, 2017

Hub thumbnail 2015

“You can’t outrun a bad diet”

It appears that an African native chasing a wounded giraffe through the bush and over the plains for 12 hours in order to get food for himself and his family burns the SAME NUMBER OF CALORIES per day as the modern couch potato. Researchers measuring the urine excretion of two radioactive isotopes of water ingested by the subjects (the “gold standard” of measuring energy expenditure) have confirmed this fact as postulated previously by several studies. These African hunter-gatherers burned about 2,600 calories a day, about the same as average adults in present day U.S. and Europe.

The researchers were looking to measure the size of the “energy shortfall” in Westerners to explain the global rise of obesity. They found none. In fact, another review of almost a hundred (98) world-wide studies of energy expenditure (calories burned per day) revealed that “the persons with all the modern conveniences have similar energy expenditures to those with more physically demanding lives in less developed countries.”  Therefore, “obesity is a disease of gluttony, not sloth.”

Physical activity does NOT cause weight loss, but exercise can help prevent weight gain.  A JAMA 2010 study of 34,000 middle-aged U.S. women showed that 60 minutes a day of moderate exercise (walking) prevented weight gain in those on a normal diet who had previously lost weight through dieting.

As someone who collected articles about  bad things happening to joggers to justify my ignoring Society’s “persistent call to go running”, this is music to my ears. The evidence that exercise, including just walking, is good for you is absolutely true and well accepted. It just doesn’t help you lose weight. Again, as someone who has made a resolution every January to lose weight by going to the gym only to peter out by the end of every March, this made me feel less inadequate, or at least less guilty.

Humans have a fixed rate of energy expenditure which is independent of their physical activity. A subsequent study of 300 people wearing Fit-bits showed that those doing moderate activity  (some exercise and always taking the stairs) burned only 200 more calories than couch potatoes. People doing intense physical activity did NOT burn more calories than the moderately active people. Again, the African bushman burns the SAME number of calories walking a mile as does the Westerner.

Studies of energy expenditure in zoo animals compared to animals in the wild reveal the same constancy. How can this be? No one really knows, but the authors speculate that since human energy expenditure is quite constant (and constrained), we modern adults who are not chasing wounded giraffes over the veld have evolved metabolic adaptations that spend our calories on supporting brain functions (the oxygen you take in with every fourth breath is needed just to feed your brain) , running our inflammatory processes (exercise may prevent inflammation by diverting energy from it), producing more and bigger babies, and living longer. But, I am not sure that I am any smarter than the African bushman who lives to 70 in his world, and many of them do.

Humans have learned to cook which increases the caloric value of many foods and makes them more efficiently digested.
We also have evolved to be fat. Our tendency to store fat is probably an adaptation for surviving lean times.
During lean times our survival is enhanced by us sharing what food there is.
Apes do not share.

“Exercise to stay healthy and vital;
focus on diet to look after your weight.”

References:
1. The Exercise Paradox, Herman Pontzer, Scientific American, Feb. 2017, 28-31


Vol. 161 January 1, 2017 Recap of 2016 Hubslist Blogs

January 1, 2017

Hub thumbnail 2015

“Don’t look back.
Something may be gaining on you.”
-#6 of Satchel Paige’s Guides to Good Living

Click on the date to view the entire blog.

January 1 –   “How bad is the heroin epidemic on a scale from 1 to 10?” Could physician compliance with the patient-reported pain scale have contributed to the over prescription of opioids?

February 1 –  From Z to A – Zika virus to autism with G and F for gluten-free diet in the middle.

February 15 – The “single blood drop” lab test that never panned out (my largest pile of misplaced enthusiasm and the poorest stock tip ever) and “Uber Doctor”.  The founder of Theranos was banned from engaging in any laboratory business for 2 years.

March 1 – “Smith” as the most likely name of your doctor went from #1 in 1930-39 to #4 in 1980-89, replaced by “Patel”, “Shah”, and “Lee”. The largest contingent (20%) of foreign-born U.S. physicians came from India during that period.

March 15 – Health apps (and now Alexa apparently) are not “secure” since they transmit data about your personal use back to company headquarters (at least, not to the NSA … we think)

April Fools Day – TrumpaCare Health Plan Revealed. It doesn’t read quite as tongue-in-cheek now as it did then.

April 15 – The bathroom bill and how diclofenac killed all the vultures in India and why that matters.

May 1 – Multiple private insurance companies pull out of Obamacare (ACA) which somehow continued to be attacked as a “socialistic, single-payor” scheme.

May 15 – Medical fun facts about three presidents and Obama’s prediction in third grade about becoming President and “visiting all the places in Indonesia”.

June 1 – Placebos work better as therapy if they cost more. The Chinese reduced adult myopia by getting the kids to play outside more often while 40% of U.S. toddlers (under 2 yo.) already play with an electronic mobile device.

June 15 – Annual update on sun and bugs … actually anti-sun and anti-bugs.

July 15 – Medication Assisted Treatment (MAT) of opioid/heroin addiction works pretty well without making the patient lie down. So, more beds are NOT needed and are NOT the answer.

August 1 – Five reasons that playing video games improves learning in kids… IF the content is right.

September 1 – Various “redefinitions” of medical “truths” about teen age pregnancies, blood pressure medicines, and lead exposure.

September 15 –  How to be an appropriately skeptical reader of media reports of “medical advances” … aka “Beware of Percentages” in hyped reports of improved outcomes.

October 1 – “Light up or not.” Pros and cons of recreational marijuana referenda on 8 state ballots.

October 15 – Asking your doctor to make you a “DNT ” after “a certain age”. Nine medical tests that can be optional after 65 because their benefits are elusive and results may cause more problems than they are worth. Choose Wisely website.

November 1 – A really scary clown CAN kill you. The same physiological mechanism may have caused Debbie Reynolds’ sudden death while she was planning Carrie Fisher’s funeral.

November 15 – Real health CARE reform is the way to improve on the health care INSURANCE reform of Obamacare.

December 1 – Less old people are leaving their car keys in the refrigerator while Germany and Japan residents gain more weight in a year than we do.

December 15 –  Though the stakes are high (lack of health insurance causes 45,000 unnecessary deaths in the U.S.) it will probably take two years for Trump and the Republican Congress to turn back the accomplishments of Obamacare.
I am hoping that as an unintended consequence of their reframing of the ACA, the law will actually be improved.

HAPPY NEW YEAR from an eternal optimist.


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