Archive for Ease and Disease

Keepers of the sacred tablets

Welcome to Rare Disease Month. (Actually, I think that was February, but no matter.) This should make the producers of the few remaining soap operas very, very happy. Look what it did for ABC’s General Hospital:

A recent plot twist … had one character not just getting any cancer, but polycythemia vera (PV), a myeloproliferative neoplasm (MPN). In other words, a rare form of blood cancer for which the standard treatment is blood-letting and anticoagulants.

The TV patient, not satisfied with this prognosis, demands of the doctor, “This protocol sounds like you are treating the symptoms of this cancer; how do we beat it?” “I have to keep going to bloodlettings for the rest of my life?”

Now that’s the beginning of a story arc for the ages. And there’s technical assistance to be had:

Why is GH highlighting this incredibly specific cancer? It’s ostensibly the culmination of a partnership between a company called the Incyte Corporation and the producers of the show to raise awareness for MPNs as part of rare disease month.

Or, you know, not:

But in an opinion piece published this week in medical journal JAMA, Dr. Sham Mailankody of Memorial Sloan Kettering Cancer Center and Dr. Vinay Prasad of Oregon Health & Science University argue that this is really just stealth advertising for Incyte, which just so happens to make only one FDA-approved product, ruxolitinib, which (you can probably see where this is going) is used to treat MPNs, including PV.

Doesn’t sound like an off-label usage. What’s the problem?

But the fictional circumstances could make it seem like ruxolitinib is a first-line therapy for PV, which it is not, the doctors note.

“Instead it has a precise and narrow indication,” they write, explaining that the drug is approved only for patients with an inadequate response or intolerance to chemotherapy, who are dependent on blood-letting, and who have an enlarged spleen.

“Thus, if PV is rare, appropriate use of ruxolitinib in PV should be rarer still,” the doctors say.

On the other hand, you’re not going to see routine stuff like mere strep on General Hospital, fercrissake. And you don’t want to know how much Jakafi (the brand name under which ruxolitinib is sold) is going to cost.

Oh, you do? I checked prices in my neighborhood, and we’re talking $2,800.

For fourteen tablets.

Two hundred bucks, give or take a dollar or three, per tab. If you’re going to be able to afford that, it probably helps to have a steady gig on an ABC soap.

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Let ’em die

“First, do no harm.” This is not technically part of the Hippocratic Oath, but it’s consistent with its values. So naturally, it’s got to go:

Remember that once you change the idea that docs never kill to the idea that killing is mandatory if “asked,” then you get docs (and nurses) who decide to be god and doing the killing spontaneously, or causing a person to die indirectly, not because the treatment won’t really help the patient, but merely because the patient is looked down on as useless, so why not?

An unfortunate incident to illustrate:

Once I worked a few weeks filling in at the ER at one of the IHS hospitals in the Sioux area. While I was giving report to my replacement, a moonlighting resident who worked in Baltimore but flew in to help on the weekend, one of the staff members came in to ask if we would check an x ray that the feeding tube was placed correctly so they could tube feed a lady with a recent stroke until her swallowing ability improved.

The resident, however, said: “Why don’t you just give her morphine, haha”… (implying we shouldn’t feed her but just sedate her into a coma and let her die of dehydration etc). The staff doctor said “WHAT?” and the resident repeated the same thing.

The staff doctor said quietly: “well, we don’t do things that way here,” and left, telling the nurse he would be back later in the evening to check the x ray.

I kept silent, since I had no authority here but knew my next door neighbor was a member of the American Indian movement and would have her group intervene if this was done.

But you know, I wonder how many poor black patients he cared for in Baltimore also got “morphine, haha.”

The black community already distrusts the medical community but since elder suicide is seen as a problem for rich white people, they aren’t worried about this. Yet.

“First, do nothing”?

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Twenty-eight left

A couple of years ago, the Family Physician set me up with a 30-day trial ($10 out of pocket) of something called Invokana (canagliflozin). After a couple of doses, I felt terribly queasy, and abandoned the drug; after 15 years or so, the doctor knows when I’m giving up on something, and that was the end of that.

It theoretically could have been much, much worse:

People with diabetes are already at risk of having lower limbs amputated because of circulatory and nerve damage that the disease does over time. However, in two clinical trials of the drug canagliflozin, marketed as Invokana, Invokamet, and Invokamet XR, patients taking the drug were twice as likely to need amputations.

Most of the amputations were of toes or the middle of the foot, but some patients needed their entire foot or leg removed, sometimes even above the knee.

The FDA is now calling for the dreaded Black Box Warning.

I know only one other person who takes this stuff; I’m debating whether I should shove this link under his nose, or wait for the Black Box Warning to show up on the next package.

Addendum: I told him directly.

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Without costing zillions

I wonder if I might someday get a chance to try this out:

A new cartilage-like hydrogel material could make the job of repairing knees much easier, say scientists, as it’s 3D printable and can be made as an exact fit for each individual knee.

The new research focuses on the two crucial shock absorbers inside the knee, known as the menisci, and replacing these parts of our bodies needs both the right material properties and the right shape.

That’s a challenge the scientists from Duke University have taken up, showing that a suitable hydrogel meniscus can be produced by a 3D printer costing US$300 in just a day.

If that feat can be replicated on a larger scale, we’re looking at simple and inexpensive knee repairs for what are usually complex and problematic injuries.

I wish. For the curious:

The research has been printed in ACS Biomaterials Science and Engineering.

DOI: 10.1021/acsbiomaterials.7b00094

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A disappointment I had expected

Still, it flattened me more than I thought it would: today was the annual Architecture Tour, and it was the first one I’ve missed since 2006. It wasn’t that the price had gone up or anything; it’s just that I can’t manage more than about a dozen steps before going woozy, and besides that, getting in and out of the car seven times is a horror in its own right.

I suspect that I’m also going to have to shelve any lingering ideas I might have had for World Tour ’17, presumably some time in the fall when I would have earned some vacation time, having burned up all my 2017 summer days last summer in so-called Recovery Mode. As slowly as this recovery is going, I may never leave town again.

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Beyond mere spam

I think this would bother me:

It’s not like the manufacturer is going broke, apparently:

Like all of the TNF inhibitors, infliximab is an expensive medication, costing about US$900 for a 100 mg dose, and within the United States is covered by almost every medical insurance plan (though caps on many plans make it possible to be covered for only a subset of treatments in the course of a year). Infliximab is supplied as a sterile, white, lyophilized (freeze-dried) powder, so must be reconstituted and administered by a health care professional, usually in a hospital or office setting. For this reason, it is usually covered under major medical insurance rather than prescription drug coverage. The loading regimen for all approved indications occurs at weeks 0, 2, and 6 at the above dosages.

A check of the formulary at CFI Care (not its real initials) got the Nelson Muntz treatment.

Respondents to the original thread estimate the price of this mailer as $25-55 per unit, which I presume you can afford to spend if you’re getting $900 per dose.

(Via SwiftOnSecurity.)

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Save the chocolate for later

You need the vanilla for more important purposes:

Keep a sealed bottle of real vanilla in your first aid kit as a dental pain reliever. If not sealed it will evaporate over time and if you have ever had tooth pain you’ll appreciate the suggestion. Uncap the bottle, remove the seal, hold a tightly wadded paper towel over the opening and turn it upside down for a moment saturating it. Then quickly hold that wad tight against the painful tooth for a full minute. Within 10 seconds the pain will completely disappear.

The real stuff these days costs as much as a trip to the dentist, but the dentist is open maybe 30 hours a week, and maybe she can see you two weeks from now.

(As seen in The Foxfire Book.)

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A miserable spring

And a mostly horizontal one, at that.

So when’s dry season?

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Painless, my eye

Okay, not my eye, exactly:

I suppose everyone’s forgotten Edward Scissorhands by now.

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No matter whose name is on it

“Reforming health care has become an impossibility,” says the Z Man:

As soon as anyone makes any noises about fixing the system, the army of lobbyists, hired by every vested interest, shows up to bury the reformers. If they are not able to kill the idea of reform entirely, they set about corrupting it into another grift that their clients can use to get a free shot at your wallet. The only people not represented in these efforts are the voters. They get no say.

This is the main reason Trump’s efforts to address the problems of ObamaCare failed last week. What Ryan and the other crooks in the GOP were hoping to do is pass a bill that made it easier for their paymasters to skim money from the rate payers, while providing fewer services. Ryan’s bill was just an attempt to help the people feeding at the trough get a little fatter off the middle-class. Its failure suggests we have reached the end phase.

Talk to anyone responsible for paying health insurance premiums and they will tell you that the rates are reaching the point where they cannot be paid. When premiums are going up by multiples of inflation, there can be only one result. Once rates pass a certain level, people stop paying those premiums. You get black markets, non-compliance and a system that can only persist through brute coercion. Soon after you get collapse.

Even Bernie Sanders has figured this out. You’d think someone in the Republican ranks would have caught on by now.

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Permanent adaptation

Despite my ongoing despair, it may be that at some level, I have actually refused to accept the possibility that I will never walk again unassisted. How do I know this? It came to me in a dream.

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Hum a tune, save a life

It’s the way CPR works:

Music can be a lifesaver — literally.

When first responders are being taught to perform hands-only cardiopulmonary resuscitation, known as CPR, on an adult whose heart has stopped beating, they’re told to administer 2-inch sternum compressions (between the nipples) at a rate of around 100 beats per minute (bpm). That’s a little less than twice a second, and can be hard to approximate. So thank goodness for pop music.

“Staying Alive” by the Bee Gees is a classic example of a song that hits that 100 bpm benchmark (and has obvious connotations to the task at hand). Ditto Gloria Gaynor’s breakup anthem, “I Will Survive.” Looking for something a little less on the nose? Try Hanson’s mega-hit “MMMBop.” All of those tracks appear on a 100-bpm playlist released this week by New York Presbyterian Hospital.

And if you dig reverse psychology, there’s Norman Greenbaum’s evergreen “Spirit in the Sky” — and Queen’s “Another One Bites the Dust.”

(Via Fark.)

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Tore him a new one

Either that, or greatly expanded the old one. Nevertheless, it had to hurt like hell.

Moral: Never, ever tell a ton and a half of angry hamburger to stick it.

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No matter how many payers

By now no one should be surprised by this:

[A]ll systems of paying for and providing healthcare suck; all of them suck worse if you’re poor and none of them are especially bad if you’re rich. There is no happy, Disney-movie solution and on many levels, the more lawmakers mess with it, the worse it gets.

Before all this started, if you were poor and didn’t have insurance, you were perfectly free to die in a ditch; if you chose not to, showing up at a hospital emergency room would get you treatment (hospitals are generally not allowed to turn away anyone who is genuinely ill or injured) and a whopping huge bill. Under ACA, you could also die in a ditch or walk into a hospital uninsured, but you were going to be fined in addition to the big bill*; under ACHA, the uninsured get the same two choices and skip the fine, but if they choose the hospital and survive to buy insurance they will pay a 30% surcharge on their premiums — and so will you, if you go more than two months without insurance. This is all very interesting, but if the initial aim was to reduce the number of uninsured citizens who die in ditches, exactly how does either plan accomplish that goal? They don’t, no more than a low-flow showerhead in Seattle or Indianapolis helps droughts in California or a shrinking fossil aquifer in Arizona.

The line I keep hearing is that “everyone has to be insured so the risk pool is large enough,” which will come as a surprise to the statisticians and actuaries who work for insurance companies. It does not take a huge pool to make the risk usefully predictable and there’s a lower limit to the rule that adding more people makes the risk more predictable and therefore allows reducing the amount of “just in case” money the insurer needs to keep for off-the-prediction surprises: you do have to pay all those mathematicians, adjusters, attorneys, salesmen, managers, top brass and support staff — and the investors are hoping for a little profit on the money they have put up to get the whole thing rolling, too. The thing people seem to think they are saying boils down to “if everyone pitched in a dollar, we’d all be able to afford healthcare when we needed it,” a charming sentiment that skips blissfully over what right the rest of us have to demand a dollar from every random stranger.

As always, there’s a footnote:

* The fine is (if I remember correctly) under $2500, which is just about big enough to be insulting and for the the person without two dimes to rub together, might as well be $25,000 or $250,000.

I’m awaiting the first proposal that calls for filling in all the ditches, so no one can die therein.

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Shrinkage may occur

If you’ve been thinking that what I need more than anything is to see a psychiatrist, well, you got your wish.

And during that first visit, she decided that I probably ought to be taking twice as much antidepressant, and wrote me the appropriate script. Anything else I might conclude is almost surely premature.

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Down to get the friction on, or off

One thing about those handy little skis for the back of one’s walker: they don’t last all that long. Of course, six months ago I would never have believed that I’d still have to use this cursed thing half a year later.

Anyway, after going through half a dozen of them, I switched brands. The newer ones come from Yunga Tart, and I’ve only worn through one pair in two months. The bag says they’re “Super glidey,” and I don’t know about that, but putting on the spares last night made the hated device several percentage points easier to push.

These attach differently from all the others: instead of friction-fit around the base of the walker leg, it has an expandable (so it fits sizes other than 1″) center section, placed with a setscrew.

According to the bag, the bag is made in China, and printed there, but the actual equipment is made in the USA.

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Sugar in the morning, sugar in the evening

But God forbid you have sugar at suppertime:

I know I need to be less credulous about such things but the “prediabetes” PSAs get under my skin because they seem to imply EVERYONE is (apparently 1/3 of people over 18 qualify by the standards, and half over 65). BUT: I have read a couple of articles recently that are by doctors/endocrinologists who are skeptical of the designation and who argue it’s not that helpful, and just leads to worry for some people (like me), other people who might actually benefit from lifestyle changes ignoring medical advice, and perhaps leads to unneeded interventions with medication. (And also, there is a strong streak in the US of “you brought this on yourself” — and if I turn up prediabetic or diabetic I will be FURIOUS because then why am I doing 150+ minutes of exercise a week, and trying to avoid added sugars, and not eating potatoes, and limiting how much bread I eat, and I gave up orange juice and sodas a long time ago … but of course, if you have that unlucky genetics, there you are.) I have enough of a perfectionist streak in me to make me miserable and ascetic about things, and I could see how hearing “your blood sugar is a little high” leading me to do something like give up ALL carbohydrates and try to exist on eggs, meat, and vegetables.

I am neither a doctor nor an endocrinologist, and it’s been a few years since I stayed at a Holiday Inn Express, but I am becoming persuaded that this “prediabetes” business is a chimera. In the diagnosis of Type 2 diabetes, symptoms are largely irrelevant. What matters are the numbers: score badly enough, and down comes the giant foot to crush you into submission. And those numbers are purely arbitrary: 126 mg/dl (says WHO), A1C 6.5 (American Diabetic Association). What’s more, some medications you might take for other reasons tend to push those numbers up. I’m starting to believe that eventually everyone gets it, if something else doesn’t get them first. My own approach to the disease is simply to keep the numbers low enough to keep the medical profession from complaining loudly.

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Good as dead

I suppose that I’ve already beaten the odds, or at least flattened them a bit:

Vivek Murthy, the surgeon general of the United States, has said many times in recent years that the most prevalent health issue in the country is not cancer or heart disease or obesity. It is isolation.

Do you think maybe we’re sick of other people?

Beginning in the 1980s … study after study started showing that those who were more socially isolated were much more likely to die during a given period than their socially connected neighbors, even after you corrected for age, gender, and lifestyle choices like exercising and eating right. Loneliness has been linked to an increased risk of cardiovascular disease and stroke and the progression of Alzheimer’s. One study found that it can be as much of a long-term risk factor as smoking.

The research doesn’t get any rosier from there. In 2015, a huge study out of Brigham Young University, using data from 3.5 million people collected over 35 years, found that those who fall into the categories of loneliness, isolation, or even simply living on their own see their risk of premature death rise 26 to 32 percent.

Let the record show that “eating right” is something that requires a correction factor.

The studies under discussion deal with the longevity, or lack thereof, of men, which suggests the Real Reason why women live longer: less research.

(Via Jason Kottke, a mere 43 years old.)

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GOPcare

I am having no difficulty curbing my enthusiasm for whatever spaniel’s brunch the Republicans come up with to replace the ACA. Mostly, it seems hurried, as though someone went through an outline, printed up a set of bullet points, and then tried to come up with something for each of them.

That said, Megan McArdle thinks even less of it than I do:

There is no sensible thing that you can do to our health-care system that will not offend huge numbers of voters. Thus we got Obamacare, a program which, to a first approximation, 0 percent of Democratic policy analysts would have put forward if asked to design a rational program to extend coverage and improve health-care delivery. It was a gigantic Rube Goldberg contraption, deliberately complicated and opaque to avoid openly angering any important constituency, and arguably, fatally flawed for that same reason.

Now that Republicans have their turn in the spotlight, they’re resorting to all the same tricks: the secrecy, the opacity, the long implementation delays (the better to get a good score from the Congressional Budget Office, and oh, yes, also, get them past the next election before voters meet their program). The inability of either party to make a principled stand for sensible policy is a problem, a very big one. And Republicans sure haven’t fixed it.

The only people who are going to be happy about this situation, I suspect, are those crying in the wilderness for single-payer — because the worse it gets, the more likely they are to have their dream eventually fulfilled.

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Apple Bloom says get with it

Life is too short to spend wallowing in depression, says a 17-year-old singer/actress:

While we’re at it, let’s get a second opinion:

I suspect The Truth Is Somewhere In Between.

(Slightly salty language in the second video.)

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Going before the voters

California has a ballot initiative for statewide single-payer health care, and in terms of ballot language, it is admirably clear. Senate Bill 562, if you please:

The people of the State of California do enact as follows:

SECTION 1. This act shall be known, and may be cited, as the Californians for a Healthy California Act.

SEC. 2. (a) The Legislature finds and declares all of the following:

    (1) All residents of this state have the right to health care. While the federal Patient Protection and Affordable Care Act brought many improvements in health care and health care coverage, it still leaves many Californians without coverage or with inadequate coverage.

    (2) Californians, as individuals, employers, and taxpayers have experienced a rise in the cost of health care and health care coverage in recent years, including rising premiums, deductibles, and copays, as well as restricted provider networks and high out-of-network charges.

    (3) Businesses have also experienced increases in the costs of health care benefits for their employees, and many employers are shifting a larger share of the cost of coverage to their employees or dropping coverage entirely.

    (4) Individuals often find that they are deprived of affordable care and choice because of decisions by health benefit plans guided by the plan’s economic needs rather than consumers’ health care needs.

    (5) To address the fiscal crisis facing the health care system and the state, and to ensure Californians can exercise their right to health care, comprehensive health care coverage needs to be provided.

(b) It is the intent of the Legislature to enact legislation that would establish a comprehensive universal single-payer health care coverage program and a health care cost control system for the benefit of all residents of the state.

Okay, that name is terrible. And “rights,” at least the way I learned about them in school, simply exist; they can’t be created out of whole cloth by mere humans.

Still, the Trump administration’s executive order calling for killing off Obamacare also calls for the Feds to “provide greater flexibility to states and cooperate with them in implementing health care programs,” and I figure that if Californians really, truly want this, whatever it might cost them in the long run, I can’t think of any good reason why they shouldn’t have it.

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No carbs for you

There are folks who never get near carbohydrates, and they’re perfectly happy about that. And then there are the rest of us:

My take has long been that if you like low carb — if you find it a pleasant way of eating, feel good on it, and lose the weight you want — then by all means, great. I’ve written several posts explaining that my experience on such diets has consistently been the opposite. I find them tremendously unpleasant, feel physically bad while adhering to them, and to top it all off I don’t even lose weight.

My own rule on such matters is simply this: any dietary advice intended to be all-inclusive will eventually prove to be utterly worthless. For all I know, by 2030 they’ll be pushing Cool Whip as the One Perfect Food, and Cheez Whiz as the Indispensable Supplement. Or they won’t. I don’t plan to give a damn one way or the other.

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News for the pre-deceased

This advice is worth considerably less than what you paid for it, even if you got it for free:

I just get frustrated at all the unwanted health advice we seem to get pushed at us. There’s also a series of PSAs now about pre-diabetes, and there’s apparently a website you can go to if you are wondering “Am I pre-diabetic?” (I suspect it’s just a page with a big red YES written on it, and GO TO YOUR DOCTOR and DON’T EAT ANYTHING BUT VEGETABLES on there)

Well, this is what Wikipedia says on the topic:

The page “Pre-diabetic” does not exist. You can ask for it to be created, but consider checking the search results below to see whether the topic is already covered.

I did eventually turn this up:

Fasting blood glucose levels are in a continuum within a given population, with higher fasting glucose levels corresponding to a higher risk for complications caused by the high glucose levels. Impaired fasting glucose is defined as a fasting glucose that is higher than the upper limit of normal, but not high enough to be classified as diabetes mellitus. Some patients with impaired fasting glucose can also be diagnosed with impaired glucose tolerance, but many have normal responses to a glucose tolerance test.

Allow me to point out that the only people with no risk factors are already dead, and they could not possibly care less about glucose levels.

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The Death Panels approve

The Food and Drug Administration, by law, takes no position on pricing. The advantages of their neutrality are occasionally offset, though, by stories like this:

Here’s yet another facet of the U.S. drug pricing conundrum: older treatments which have been around for years can win label expansions that significantly increase their value, and consequently, their list prices. That appears to be the case with Marathon Pharmaceuticals’ deflazacort, a steroid that has now achieved FDA approval for treating the devastating muscle-wasting disorder Duchenne muscular dystrophy (DMD). There’s a dearth of available DMD treatments (and the most recently approved one in the U.S. was cleared under a cloud of controversy), so it’s not hard to see why the FDA wants to speed treatments to the finish line. But Marathon also decided to price the drug, which is available for less than $1 per pill in Canada as a steroid, at $89,000 per year. And since the treatment isn’t already approved in the U.S. for other, cheaper indications, there’s no risk of doctors prescribing it for off-label purposes to Duchenne patients.

Then again, this sort of news is by now old news:

In recent years, companies that have gotten old or existing drugs approved to treat rare diseases have reaped big financial rewards. For example, tetrabenazine, a drug that was available from abroad and used for years to treat the uncontrollable tremors of Huntington’s disease, was approved as an orphan drug in 2008. In 1998, it cost $42.28 for a bottle of tetrabenazine pills from a European pharmacy, according to Joseph Jankovic, a neurologist at Baylor College of Medicine. After receiving approval as an orphan drug, that bottle of pills — now known by the brand name Xenazine — carried a list price of more than $6,000 in the U.S. in 2008. The price was repeatedly ratcheted up to more than $21,243 a bottle, according to Truven Health Analytics data. Xenazine accounted for $325 million in U.S. sales in 2015, the year it went generic, according to data from Evaluate, a market intelligence firm.

I suppose I should be grateful that none of the stuff I take costs as much as $10,000 a year. (Yet.)

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No way out

When the options are no options at all:

I knew what CGM was, but I’d never seen it in action. Here’s the pitch:

A continuous glucose monitor (CGM) determines glucose levels on a continuous basis (every few minutes). A typical system consists of:

  • a disposable glucose sensor placed just under the skin, which is worn for a few days until replacement
  • a link from the sensor to a non-implanted transmitter which communicates to a radio receiver
  • an electronic receiver worn like a pager (or insulin pump) that displays glucose levels with nearly continuous updates, as well as monitors rising and falling trends.

Some days you can’t win for losing.

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The cost of crowdfunding

Last summer while I was laid low by a wrecked nervous system, a friend who is a legitimate social-media maven suggested turning to GoFundMe; the campaign didn’t quite make its $4000 goal, but the last installment on the hospital bill was only $3800 or so, so I figured I had no reason to complain.

There are, however, some ethical-ish questions raised by this practice:

Medical crowdfunding could have negative effects on equitable access to health care. The likelihood of a crowdfunding campaign reaching its funding goal may depend in part on factors such as the kind of treatment needed and the reason for the campaign. Differentiation by the popularity of the medical cause or sympathy for the recipient goes against principles of treating patients according to the severity of their medical needs or aiming for the greatest good in treatment. In other words, funding according to popularity runs against evidence-based attempts to use our health care funding as fairly and efficiently as possible.

I have always felt that I had more recognition than I could possibly deserve, so I can see this, maybe.

Other factors, such as the recipient’s physical appearance, social connections, ability to get media attention for the story, and online communication skills are also likely to affect a campaign’s success. If those characteristics are correlated with the recipient’s position in society, then medical crowdfunding will have a tendency to benefit mostly those who are already in a relatively advantaged position.

At this one, I shrug; life has always favored rich young pretty people, the sort who get mentioned in Vanity Fair sidebars while still in their twenties, and it would be silly to expect otherwise from their crowdfunding campaigns.

If we had a truly egalitarian healthcare system, perhaps some of these concerns would evaporate. But I think it’s a safe bet that other criticisms would arise, particularly among those who fancy themselves the Official Measurers of legally defined equality.

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Like, cosmic, man

This came in the mail yesterday:

You are invited to participate in the COcoa Supplement and Multivitamin Outcomes Study (COSMOS), an exciting new randomized clinical trial being conducted by Brigham and Women’s Hospital in Boston, MA and the Fred Hutchinson Cancer Research Center in Seattle, WA.

COSMOS is studying the role of cocoa extract and multivitamin supplements in improving health. The trial is conducted entirely by mail, with no required clinic visits. Studies have found that cocoa extract may reduce the risk of heart disease and age-related cognitive decline.

If you’re interested — they’re looking, they say, for men 60 and over, and women 65 and over, who have not had cancer, a heart attack or a stroke — the details are here. I’m still weighing the possibilities.

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And the food just makes you sicker

This cancer patient has enough to worry about, don’t you think?

It took a long time, but thanks to a couple of occupational therapist ladies and a food therapist, the nurses and other staff here eventually noticed that I was was physically wasting away due to a mixture of the poor diet being offered on the menu here and me suffering an almost complete loss of appetite due to said menu. For instance, a side salad consists of two tomato quarters, three slices of cucumber and a few slivers of lettuce. For the past couple of weeks, my daily food intake has been a couple of slices of toast with butter and a small bowl of Rice Krispies for breakfast, a couple of satsumas for lunch and maybe some more satsumas or nothing for dinner.

For “satsuma,” feel free to read “tangerine.”

Anyway, the staff dietician perhaps has cleaned up her act:

Now I’m being given special fruit energy drinks and fortified soups that they say I’ll still be able to receive for free when I return home. Also the occupational therapists and food therapist have said that I should turn the conventional healthy-eating rulebook on it head and eat the complete opposite. Fried meat and eggs. Double strength milk with lashings of cream and butter. Lots and lots of chocolate bars and bags of crisps. They’ve given me a four page leaflet filled with the most unhealthy foods you can imagine and told me that I should now follow this diet. Mind you, I’ll probably then end up dying of a heart attack.

As the late Warren Zevon once pointed out, “Life’ll Kill Ya.” And this is how it’ll do it.

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Advantage: cheapness

Out of yesterday’s tweetstream:

Which ends up here, and to these two paragraphs deemed relevant to my interests:

The blood pressure medication Dean had taken for 20 years was hydrochlorothiazide. It is the most commonly prescribed medication for blood pressure, not because it is safe or effective, but because it is the one insurance companies choose to pay for! Below is an eye-opening quote from an article sent to me by a reader. (Thanks, Joan.)

‘In an article published in Postgraduate Medicine, Saint Luke’s Mid America Heart Institute, leading cardiovascular research scientist, James J. DiNicolantonio, Pharm.D., and cardiologist James H. O’Keefe, M.D., examined some of the most commonly prescribed blood pressure medications and their effectiveness in reducing heart attacks and mortality versus a placebo. In many instances, the research revealed that often the most popular medications are not only not the best, in many instances they are not any more effective than a placebo or may actually cause harm… The most commonly prescribed thiazide diuretic in the United States is hydrochlorothiazide, with more than 1 million people receiving a prescription in 2008. However, this medication increased cardiovascular death and coronary heart disease compared to both the placebo and control in two clinical trials. Alternatively, only 25,000 people received a prescription for chlorthalidone in 2008, even though this medication consistently demonstrated significant reductions in heart attacks and strokes compared to placebo… Currently there is no universal rating system in the United States where medications can be selected by clinicians based upon their effectiveness. Rather, insurance companies ‘pay for performance’ or ‘pay for service,’ but this does not guarantee the selection of effective medications.”

Read the full article here: http://www.prweb.com/releases/2014/11/prweb12291899.htm.

I have always suspected that a drug manufacturer would rather sell you a hundred thousand pills over 25 years for $4500 than sell you a single treatment for $20,000. They evidently make it up in volume.

That said, I have been taking some form of HCTZ — generally in combination with, yes, potassium — for more than a decade. My heart’s fine, if a tad irregular; it’s everything else that’s messed up.

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Why there will be no TrumpCare

David Brooks came up with this howler:

The Republicans are going to try to introduce more normal market incentives into the process. They are probably going to rely on refundable tax credits and health savings accounts so everybody can afford to shop for their own insurance and care.

Nobody actually believes this, of course, least of all the Z Man:

As soon as the phrase “market incentives” comes up, you know that there is no existing market. This is a phrase cooked up by managerial class types so they can engage in central planning, but pretend they have respect for free markets. Incentives are synthetic creations to get people to do things they otherwise would not do. If you want a market, you don’t want central planners dreaming up incentives to warp the market. What would be the point? You want the buyers and sellers to sort things out among themselves.

Pseudo-intellectual posers like Brooks don’t understand this because he does not have the slightest idea how any of it works, but he is willing to expound on just about everything as if he is an expert. That’s a problem we have in the mass media age. The alleged experts that citizens rely on for opinions spend all their time filling the air with laughable nonsense. In health care, for example, most Americans not only think it is a right, they think it is a product that should never be rationed. This is complete lunacy, but you can’t blame people for thinking it. All the “smart” people say it on television.

All goods and services are rationed. The question with health care is how is it to be rationed. Will it be by price or by a monopoly of supply? Progressives want the latter so that their coreligionists on the health care boards can murder enemies of the faith by denying them health care. The alternative should be arguments in favor of free markets, but instead we get magical thinking from guys passed off to us as conservatives by the mass media. The result is an increasingly misinformed public.

Then again, this is a case where the public prefers to be misinformed, because they think it’s in their best interest, be it financial or philosophical. I suspect the one and only way to get rid of government distortion of the health-care marketplace is to entirely remove the government as a player, and this isn’t going to happen so long as someone’s Aunt Tessie needs to go on dialysis. Square One exists only in theory, and practice says that theory will never be tested. I suspect Donald Trump, who has endorsed single-payer in the past, will do so again — just so long as we don’t call it that.

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