Category Archives: Health Policy

Mental Health Monday, either early or late

From Nursing Mental Diseases, by Harriet Bailey, RN

MS. BAILEY WROTE IN 1929:

In the prevention of mental deficiency segregation is recognized as a most important measure, for these individuals have not the mental qualities which make them valuable to society, and economically they are a partial or a total loss. Furthermore, it is an established fact that this type of defective family increases at about double the rate of the general population, that feeblemindedness is inherited, for parents cannot transmit to their children nervous and mental strength which is not theirs to give. From some recent studies made of the feebleminded, it has been shown that not all mental defectives are a social menace, and therefore in need of segregation. Thees studies have also shown that when properly educated and specially trained in the manual and industrial arts, many of them become quiet, law-abiding, useful citizens. Experience also shows that only through education and supervision may they be saved from lived of inefficiency, failure, dependency, and misery.

feebleminded table

 

New Post at Pan American Zoonotic Research and Prevention (PAZ)

boehner1

CONGRESS DECIDES WE KNOW ENOUGH ABOUT MEDICINE ALREADY, CUTS RESEARCH DOLLARS DRASTICALLY

Click here if this isn’t patently idiotic to you→http://pazresearch.org/2013/09/13/stupid-funding-cutbacks/

confederacy

 

TODAY’S ONE IMPORTANT QUESTION

220px-Acyrthosiphon_pisum_(pea_aphid)-PLoS

 

What’s the big deal, then?

A disease alert From ABC 23 KERO Bakersfield:

Link to CDC guide

Link to CDC guide

“Those hospitals discovered carbapenem resistant enterobacteria known
as CRE. It’s a drug-resistant bacterium that could kill someone and he
or she wouldn’t even know it.
Kern Medical Center, San Joaquin
Community Hospital and Mercy Hospital Downtown each discovered a case
of CRE last month.

I have to say that of all the ways to be killed, being killed and not even knowing it would be my favorite. Knives, guns, and malaria look far too painful.

Follow us on twitter @theassassinbug

Chagas’ Disease is NOT the new AIDS: Part I

IN SPITE OF WHAT YOU MAY HAVE READ IN MY FAVORITE NEWSPAPER (the NY Times):

It is a great picture of the bug, though. Why do biting arthropods always have their portraits taken while posing on human flesh?

Chagas’ Disease, while being a medical nightmare, is not the new AIDS.

  • The first, and perhaps biggest problem with this article is calling Chagas’ Disease the “new” anything. Chagas’ disease was discovered in 1909 by a brilliant Brazilian scientist, Carlos Chagas. Chagas’ discovery was justly recognized for this great discovery during his own lifetime.
  • Chagas’ disease is like AIDS, in that it targets certain populations, but that is where the similarity stops. Chagas’ disease is spread by a vector (bugs of the family Reduviidae) that is exquisitely evolved to infect the poor, as it is related to low-quality housing. AIDS does target the poor of the world more than the rich, but there are certain groups that AIDS targeted, or continues to target, that have nothing to do with economic standing. AIDS is not transmitted by arthropod vectors (though there was concern in the early years of the pandemic), but by sexual contact and contaminated transfusions and medical equipment. Chagas’ disease can be spread by transfusion, but this risk is decreasing. As of a few years ago,around two decades after the blood supply began being screened for HIV,  the blood supply in the US began being screened for Chagas’ disease.
  • Chagas’ disease is called a Neglected Tropical Disease. These are diseases that have high prevalence in the hotter regions of the globe, affect a large number of people but yet do not get a lot of attention from the press, their governments, NGOs, and even much of the local population. For example, many residents of Lima (where the power is) don’t even know what Chagas’ disease is, even though it afflicts a large number of Peruvians. Why?  It doesn’t occur in Lima, and public education about the disease does not extend to those who won’t get it, even though they may be the ones most able to help.
  • Stigma: Yes, it sucks to get AIDS or Chagas’ or both together. But tell me from your heart of hearts: Which would you rather tell your co-workers and parents–that you’ve contracted HIV or that you’ve contracted Chagas’. I’m betting on Chagas’. 30 years into the epidemic, and HIV/AIDS still carries a burden unmatched by any other disease.
  • Research funding: No comparison. HIV/AIDS has been a research juggernaut over much of the pandemic. As a result, we’ve made brilliant and amazing progress in treatment and prevention of the disease. Chagas’ disease is still treated by the same two lousy drugs that were used over a decade ago. Some research is being done on new treatments, but I you’d be embarrassed to see the shoestring some of those labs run on. Moreover, most of these studies involve using drugs that were already approved for other indications, such as anti-fungals and anti-malarials.(They ain’t much money to make sellin’ drugs to po’ folk in the developin’ world.)

    No mention of Chagas' disease here.

    No mention of Chagas’ disease here.

Your Mouth Is Not Part of Your Body

THAT’S WHY YOUR HEALTH INSURANCE DOESN’T COVER IT

teeth

ONE would think, to judge by the way health care insurance is provided, that the mouth is some separate entity, rather than the part of your body you probably use the most. Dental insurance, then, becomes like the rider to your homeowner’s insurance that covers your grandmother’s jewelry or your collection of stamps–it  requires some sort of different coverage. I don’t know how the hell you’re supposed to eat, drink, kiss, or bite the fingers off of your predators without a mouth, but health insurance separates this one very important part of your body from everything else. It’s a historical anomaly, and one that should have been corrected when we let surgeons become doctors. If you haven’t noticed already, there’s a fair amount of pathology that can occur within the oral cavity, and much of it is related to illnesses elsewhere in the body.

Why doesn’t basic health care insurance cover problems to the teeth and gums? My primary care doctor’s exam of my mouth is brief and cursory. Would he be able to tell if I were unable to chew my food properly? Would he know where to look for the most common oral tumors?

I went to public health school at Boston University. They have a dental school. Were teeth or oral health even mentioned once during my time there?  (That was a rhetorical question. No, of course, they were not. You would think that with the fluoridation of water being cited as one of the ten greatest public health measures of the 20th century that a light bulb might have gone off over someone’s head, but you would be wrong.)

Why am I thinking about all of this? Well, for one reason, I am now in the situation of shopping for dental insurance. Want to know what I’ve learned? Dental insurance sucks raw eggs. It eats donkey dung. It takes your premiums and then sneers at your pain. Worse than that, it doesn’t do enough for children who are going to need lots of care in order to get the smile that is required for getting a good job in this society.

Dentistry, as sufferers from dental problems know, does not come cheaply. According to thewealthydentist.com, a 2009 survey found the average root canal fee is $740 for a front tooth and $1,000 for a molar. Considering that the average dental insurance only pays around 60-70% for these procedures, the bill will come with an out-of-pocket expense of  around $300. Benefits with most plans generally max out at around $1000-$1300 per year, and you can see that it’s going to take some serious jack if you’ve got more than an occasional problem.

Those of us who were lucky enough to grow up in financial security, along with parents who appreciated the fact that one is neither employable nor datable with a rotten mouth, can most likely survive with this insurance. It sensibly pays for two cleanings a year, helping the insurance company avoid having to pay out for more sever problems. But if you’re the person who grew up in where water wasn’t fluoridated, where you parents had rotten teeth, etc, you’re probably not in position to pay for all the work that needs to be done.

Chew on that for a while, if you can.

rotten-teeth-10

Occupy Boston and Smoking

As I mentioned, I support the Occupy movements for the most part. There does exist anti-Zionist faction that drives me to distraction, but my hopes are that domestic solidarity will suffice for most, and that we will abandon the need to identify with every group that we perceive as downtrodden. If we do have to pick a nation upon which to lavish our sympathy, my vote will be for the Congo.

Politics, however, are the purview of the Meta-Bug, and here we try to stay focused on health matters (and drinks and dishes). And the health matter at Occupy Boston that has me grinding my (unstained nonsmoker’s) teeth is the high rate of smoking that is going on at Dewey Square. Of course, if someone wants to fill his or her lungs with a foul and loathsome gas chock full o’ carcinogens, that is more or less that person’s right. However,  second-hand smoke is so noxious that even outdoors it is capable of causing damage, irritating the airways of asthmatics and exposing others to its risks.

Alas, Occupy Boston has been unable to designate a separate area for smokers, at least by the time of my last visit. “That would be segregation,” complained one  fuzzy young smoker, obviously quite annoyed that someone would suggest segregation at an Occupy campsite. I tried to engage the smoker, explaining that separating people by behaviors which they could control, behaviors that could harm others, was not the same as segregating people by the color of their skin or the gods to whom they prayed.

In the end I think it came down to smokers just not wanting to give up their smokes. Now I can understand that living for days at a time on what is essentially a traffic island, attending General Assemblies for hours at a time, and eating cold donated food for a few weeks could engender an enormous desire to light up. But saying that smokers while smoking shouldn’t be kept at a distance from non-smokers is anti-science, and turns a back on the hard-fought and enormous gains made in public health by working to restrict smoking.

It reflects poorly on the Occupy movement not that they smoke, but that Occupy smokers believe that it is there right to put out second-hand smoke without restriction. The Occupy smokers should just admit that they are addicts and that they need their fix. What’s really at issue is the ability to reflect on one’s own behavior, and be as critical of it as one is of the behavior of others.

We’re baaaackkk. :-)

How’d ya like a fresh dollop of shit in that milk?

Yes, it will help your tomatoes grow, but will it cure lactose intolerance?


The simplified version of the story is this: Doug Stephan is an AM radio talk show host (no, I’ve never heard his show, nor has anyone I’ve ever met heard his show), and in a moment of hubris he bought one of Framingham’s remaining farms. Thinking that he could support it with revenue from his radio show, he decided that a dairy would would make his hobby farm even more wicked cool. When the recession hit, and he could no longer meet the $30,000 mortgage, he began looking for ways to increase the farm’s revenues. Enter the Northeast Organic Farmers Association (NOFA), an organization more political than agricultural, who convinced Mr. Stephan that selling raw milk at $9 a gallon would be the answer to his prayers.

Needless to say, things haven’t been going that well for Mr. Stephan, and he is now looking to have a non-profit (probably with government help) bail him out. In addition, the state agricultural authorities found a high number of coliforms in his product (read: there’s something manure-ish in his milk). Stephan immediately invoked the favorite theory of the whack job, and said that there is a conspiracy to keep him from selling raw milk. Because we love this kind of stuff on the local level, this paranoia made it to the press.

A slightly shorter version of this appeared in the Metrowest Daily News. You can follow the history, should you so desire, by typing ‘raw milk’ in the search box.

Once again, Doug Stephan has decided that the 80 gallons of raw milk he sells to supplement the flagging ad revenues for his AM radio show are of importance to anyone but him and his few dozen customers. I’m not qualified in the mental health professions, so I don’t know if this is a persecution complex or delusions of grandeur. But, having worked in public health, I do know what it isn’t: it is not a conspiracy to keep him from selling his raw milk to the few dozen devotees who are either swayed by the taste (which I am sure is wonderful) or the pseudoscientific health claims (such as “Raw milk cured my _______!”)

As for Mr. Stephan’s website claim that his raw milk sales are being suspended due to “forces beyond” his control, I would take him at his word. What he is saying, in essence, is that it is beyond his control to keep cow manure out of the milk he sells. There were large numbers of coliforms in his milk, the milk he claimed would always test clean according to the rules put forward by the Commonwealth. Now that his milk has failed (as raw milk often does) he cries foul, and puts forth the Glenn Beckish opinion that it must be a conspiracy. Mr. Stephan wants you to think that he is selling his raw milk for some reasons other than profitability (most of his milk still goes to Garelick for pasteurization), and he doesn’t want you to know that there were at least 11 outbreaks of illness due to raw milk this past year, one of them not 30 miles away.

Yes, the rhetoric around raw milk is heated. The reason that those involved in public health get so bent out of shape about raw milk is twofold: 1) It turns the clock back on science, on proven methods for reducing foodborne illness, and 2) due to the vociferous, combative nature of its proponents, those in public health are required to spend time on a food item that is (fortunately) consumed by a minuscule portion of the population.

And yes, I have heard ad nauseam all of the arguments for raw milk, I am not going to respond to each one here. You can find them on the unedited comments section, and form your own responses. Some of them are so flimsy as to be embarrassing to their writers, and it is not my purpose to embarrass the uninformed. What I would like to do, instead, is respond to valid concerns about what public policy should be concerning food safety.

1. Currently, there are no such thing as “food rights.” You have no more right to buy raw milk at the grocery store than you have the right to eat in a restaurant that has been closed by the Department of Public Health.

2. Decisions of science are not determined at an open public forum. The public at large can debate what to do with scientific consensus once it is determined, but the consensus is not equally informed by experts and non-experts. (Somehow, the Framingham Board of Health thinks otherwise, but we now have a board completely staffed by non-experts.)

3. Comparing one food to another in terms of risk is spurious. Foods are prepared and consumed differently, and comparing raw milk to beef, chicken, bean sprouts, or gummy bears is useless.

4. The government has never told anyone that he or she can’t drink raw milk. What the government has said is that it has the right to regulate commerce in raw milk, the same as it has the right to regulate commerce in tobacco, pork, and gummy bears.

If policy is the issue should the average Framingham resident be worried about?

One is the Massachusetts Department of Public Health’s  unwillingness to send their milk safety experts over to the Mass. Department of Agricultural Resources for substantive talks and a unified policy. The head of the Bureau of Environmental Health, Suzanne Condon, feels that it is necessary for all information to be filtered through not only her office, but through Ms. Condon herself. This bottleneck has, in my opinion, been a major obstacle towards creating a coherent raw milk policy, one that can be supported by both Ag and Public Health. This bottleneck not only creates inefficiencies, it favors loss of information, as Ms. Condon’s expertise is in environmental health, not food safety.

The other matter of concern is  that farmers in Massachusetts are reduced to selling an unsafe product to make ends meet. Alas, one of the conundrums of promoting raw milk is that as more farmers sell it, the price drops. (What a surprise, that this miracle product is not also immune to the laws of supply and demand.) An answer? I would consider it a proper use of government to support local agriculture. Of course, the fierce libertarian streak of  Yankee farmers (like Mr. Stephan) might render them unable to accept such largesse.


Is Infertility a Public Health Problem? The Responses

TWO CONFLICTING RESPONSES:

I received two comments on the post on infertility and public health, one pro, one con, both from women with degrees in the health professions.

THE CON: THIS IS A PROBLEM THAT GOES TO THE CORE OF BEING A WOMAN


Richard – Sorry, sweetie, but yours is a much too simplistic way of viewing the biological imperative to bear a child. Approximately 7 million Americans are currently experiencing infertility (1 in 8 couples). The causes of infertility are many (not just ‘advanced maternal age’): structural, Endometriosis, DES, low sperm count, tubal disease, DES exposure, STD’s, stress and who knows what else.
You say that “loving a child is the easiest thing to do – THINKING that you need to create something in your genetic imprint is egotism in the highest degree…” I would say that I love my child beyond all measure, and, at times, it isn’t easy to love her. Read Winnicott, or, how about “The Monster Within: The Hidden Side of Motherhood” by Barbara Almond. Nevertheless, regardless of the ambivalence many parents feel about their children as they raise them, women AND men dream of being parents from the time they themselves are children. It’s one of the “high dreams”, if you will. We are, as a species, inherently both selfish and compassionate, fearful and capable of tremendous love (was just listening to a great program on Wisconsin NPR about this!). Is it sheer egotism to want a child who has your husband’s nose and musical abilities and generosity, or to hope that your child has your hair color and artistic eye or love of mathematics? Why judge this so very harshly? Carrying and bearing a child is also the high dream of most little girls and one of the supreme joys, as far as I’m concerned, that anyone can possibly experience. It carries with it, great risks (although, thankfully, not like it used to a mere 100 years ago), as does parenting ones own biological child.
When my husband and I found out that I was “infertile”, I wasn’t particularly surprised. But I was devastated, as was my husband. I read everything I could, I joined a support group, saw a therapist a couple of times who specialized in infertility. I had to dig as deep as I could about what was important to me. I had actually always been open to the idea of adoption whether or not I had “my own” children, but I was also very aware of the stories of friends of my parents who had adopted children; not one of them had escaped unscathed – meaning, there had been serious and heart-breaking issues with each of these families. I knew if we were to adopt we could be inviting any number of “extra” risks that we might not have encountered had we had biological children. It’s my experience that most couples are very, very thoughtful about the issues and options that arise when they are faced with infertility disease.
Should insurance companies be forced to cover fertility treatment? Should insurance companies be forced to cover impotency? or diabetes? or bipolar disorder? Should they pay for birth control? or substance abuse treatment? Is infertility a public health issue? See http://www.healthandenvironment.org/initiatives/fertility; http://www.healthandenvironment.org/initiatives/fertility; “Carolina Papers International Health: A Global Perspective on Infertility: An Underecognized Public Health Issue.
In closing, let’s ponder the idea of whether unmitigated sarcasm (“sarcolepsy”) should be considered a public health liability. I love you, my friend, but I think you are being a poop-head and rather mean-spirited to boot.

THE PRO: IT IS EGOTISM  THAT FUELS THIS PUBLIC HEALTH PROBLEM

From Lynn Williams, RN-P

My feeling has always been that undergoing fertility treatments instead of adopting a child is like buying a dog or cat from a breeder instead of adopting one from a shelter. Shelling out big bucks for a “purebed” animal or for a mini-me, when there are so many homeless creatures, human and non-human, languishing in shelters and hellish third world orphanages, is, as you put it so well, egotism in the highest degree. The fact that the earth’s resources are already stretched to the limit makes this practice indefensible, and asking taxpayers to foot the bill is outrageous. I would like to see a 5-year global moratorium on human reproduction. Just about every social problem I can think of would be, if not resolved, at least palliated by such a measure.

Is Infertility a Public Health Problem?

No.

LET THE ROCKS AND TOMATOES START FLYING!

At least not in most of the United States.

A Little Background

Yesterday, I was listening to the radio and there was (yet!) another interview by a talk show host, who was (yet again!) sucking up to her interviewee on the subject of infertility and medical intervention to correct what is a normal state on the spectrum of infertility, especially in women who for whatever reason of their own choosing, have decided to delay child-bearing.

I was calling in (yet again!), with the hope of asking whether it can be justified  to require  insurance providers to pay for these treatments( in the 14 states that require health insurance to pay for fertility treatments ). For the umpteenth time, I sat on hold, and my question never managed to make it on air.

Many people close to me have availed themselves of assisted fertility. I love these people, I think that their children are wonderful, and they appear to be marvelous parents. I do not wish to jeopardize my relations with these people, but an inability to confront differences on matters of public policy don’t bode well for countries like ours (cf. Mitch McConnell, Collected Works).

I went home and posted my comments on line, in far blunter words than I would have ever used on air or in conversation with a woman who has struggled with this problem.

In any case, here are the comments as they were posted online.

I think that I am done listening to Radio _____. Listen to ______’s self-entitled mewling about how she somehow deserved to have a baby was more than I could take. I wish for once a radio talk-show host would just once bring up the the fact that MA insurance policy holders are paying for these infertility treatment ego trips. Nor do they ever point out the difference between having a baby and raising a child.
Loving a child is the easiest thing in the world to do–thinking that you need to create something with your genetic imprint is egotism in the highest degree. We can all aspire to things–parenthood, musical genius, a job in the NBA. Sometimes biology doesn’t cooperate, and that, as my parents told me, is life. That adoption is seen as a second best choice for these people makes me doubt their motives in parenting.

I am looking forward to your comments.