Archive for Ease and Disease

Down at 34th and Vine

Jerry Leiber and Mike Stoller drew the map; the Clovers sang the song; and I’m out here with nothing even slightly resembling a love potion.

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A true boner

And not in a good way, either:

The human body is marvellously complicated, so it’s no wonder that sometimes things can go spectacularly wrong — and we only find out by accident.

That’s what happened to a 63-year-old man who went to a New York emergency department for left knee pain after falling on his behind, and ended up with an alarming and rare diagnosis — penile ossification.

The doctors found the shockingly rare case when they took an X-ray of the man’s pelvis to check for signs of bone fracture due to his fall. Instead, they spotted a bone-like calcification in a truly unexpected place.

Calcium salts had built up in his soft tissue and hardened into “an extensive plaque” along his entire penile shaft.

That poor soul definitely got the shaft.

(Via Glenn Reynolds.)

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Ignore that expiration date

You don’t want to do that with milk, obviously, but what if you happen to need a painkiller and the nearest one is positively ancient?

I recently had a bout with severe, immobilizing back pain, which is slowly easing off (the inevitable result of a partially disabling injury back in 2004, which resulted in a spinal fusion and permanent nerve damage). The doctor (not my usual one) initially prescribed a couple of days’ worth of Tylenol 3, and advised me to get it extended by my primary care practitioner when I got home.

Unfortunately, I couldn’t get in to see her in the short term; so I looked in my “stash” of previous prescription medications to see what I had that might suit. I found a prescription for Vicodin issued to me in May 1999. I wasn’t sure whether the remaining pills would still be any good after 20 years, but I had nothing to lose, so I tried one. Its potency was probably less than when it was made, two decades before, but it was still more than strong enough to be effective. It’s providing as much pain relief as Tylenol 3, from a lower daily dose (1 tablet every 4 hours, versus 2 Tylenol 3 pills every 6 hours). I’ve got enough to last several days.

My last Lortab dates to 2012. I’m not about to toss it out.

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From the “If only” files

Is your family physician showing signs of being weary of the whole healtb-care industry? Show the doctor this:

The US Food and Drug Administration today approved Peaceaudi (Idongivafumab) injection for intravenous use for the treatment of medical burnout.

“Medical burnout is a serious condition, which affects thousands of doctors across the country. The effects of burnout have untold consequences, and could significantly shorten the careers of physicians if untreated,” said Arnold J. Palmer, MD, assistant to the regional manager for drug development of the FDA.

“This announcement marks the first time a drug has been specifically approved to treat medical burnout. Idongivafumab’s unique ability to target and inhibit C-suite peptides, as well the entire electronic health record (EHR) cascade, represents a quantum leap in burnout science. Clinical test subjects also noted a marked decrease in symptoms of Entitled Patient Pruritis (EPP) during the course of treatment. 87% percent of those treated stated they felt ready to type at a keyboard with their back to the patient, and feelings of the need to apply to law school, write a novel, or sell crafts on Etsy, fell by a whopping 98%. This drug may truly revolutionize health care.”

Although there’s one characteristic it shares with lots of non-revolutionary drugs:

With a typical cost of treatment estimated to cost $212,000, the makers of Idongivafumab are working to ensure that this new treatment will be covered by all major insurance carriers.

Assuming there are any left by the time this becomes a reality. And for what it’s worth, the “-mab” suffix indicates a monoclonal antibody, and drugs of this type ain’t cheap.

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It was nineteen years ago today

And this is how it happened, more or less:

It has begun.

At precisely 5 pm, I drew off my first tumbler full of this diet-antifreeze stuff I’m supposed to be drinking. It took nearly an hour to finish. At approximately 28 ounces per tumbler, that means I have to do this four times more. “Slow down,” say the instructions, “if you start to feel nauseated.” I have the sinking feeling that I’m in for an all-nighter. Time to put a fresh roll on the spindle.

Later that night:

Four quarts later, I’m done with this stuff. In terms of salutary digestive effect, it’s up there (or down there) with four bowls of Texas-style double-toilet chili. (And no beans, dammit.)

And the next day:

And after all that, the procedure itself was pretty much anticlimactic. I really don’t remember a whole lot about it, or even how long it lasted; today’s high-quality anesthetics apparently work faster than a half-hour of MSNBC, and with fewer mind-numbing aftereffects. Did they find a dollop of polyps? No, just two of the little buggers, which were duly sheared off and sent to the lab for examination. Recovery time was about as long as it took for me to get home and pop a TV dinner into the microwave.

Beyond that, I have no idea what’s going on. Perhaps it’s just as well.

Evidence that I had no idea: They wheeled me back to the recovery room and said something to the effect of “Leave your gown on the bed and go ahead and get dressed.” This was about the limit of my comprehension at the time. I got through the first part of the instruction easily enough, and suddenly: “Ahem.”

A short woman with a wicked grin was standing in the far corner. I turned around to greet her, having had enough presence of mind to remember my manners, but apparently not quite enough to fully comprehend that having removed my gown, I was wearing, um, nothing. It took me another couple of minutes to catch on. Still, it wasn’t like she’d never seen me in that state before.

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It frigging hurts

You know, I’d probably do this even if it had no therapeutic effect at all:

Can’t help but shout an expletive every time you stub your toe? Don’t feel too bad, you may actually be doing yourself a favor. A new study finds that swearing when injured has a measurable effect on pain tolerance. In fact, dropping the F-bomb specifically when in pain increases tolerance by up to 33%.

The study, led by a group of language and psychology experts in the United Kingdom, explored how effective established, new, and invented swear words can be in increasing pain tolerance and pain threshold.

The research is based on a 2009 study by Dr Richard Stephens, a senior lecturer in psychology at Keele University, who found that swearing can increase pain tolerance for a short time. The new study investigated whether people could use more appropriate language when injured and get the same effect.

Stephens, along with language expert and author, Dr Emma Byrne, and acclaimed lexicographer Jonathon Green, created two invented swear words, “twizpipe” and “fouch,” for the study.

“Twizpipe”? “Fouch”? Who are these jackholes, anyway?

Says Dr Byrne:

“Twizpipe mirrors the humorous element of swearing and is fun to say, whereas fouch is harsh-sounding and concise, similar to the existing four-letter swear word.”

Narrator: ‘There exist other four-letter swear words.

The real swear words were also consistently rated higher in emotional impact than the invented ones, the researchers say.

Well, quelle farking surprise.

Oh, and this is probably worth mentioning:

The study was funded by the pain reliever Nurofen.

Which is available in many countries around the world, but not this one. If you want one, take an Advil.

(Via Stephen Green.)

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It bugs them no end

Maybe you should have gone a little easier with the swatter:

Over 15 years ago, researchers found that insects, and fruit flies in particular, feel something akin to acute pain called “nociception.” When they encounter extreme heat, cold or physically harmful stimuli, they react, much in the same way humans react to pain. Now, scientists have found that the nervous systems of insects can also experience chronic pain. A new study in the journal Science Advances shows pain lingers throughout the insects’ short lives well after an injury has healed.

Acute pain is generally short lived — like the pain from cutting your finger, which may last for days but eventually recedes. Chronic pain, however, lingers long after an injury has healed and may even last the rest of an injured person’s life. According to a press release, it generally comes in two forms, inflammatory pain and neuropathic pain, the type of electric shooting pain caused by overactive nerves.

Ed Cara at Gizmodo reports that to understand whether insects also experience this long-lasting version of pain, researchers damaged one leg in a group of fruit flies, an injury which can cause chronic nerve pain. After the insects were allowed to heal, the researchers then placed them in a hot room to see if the flies were more responsive to stimuli. After the leg injuries, the flies would try to leave the room at lower temperatures, unable to withstand the heat as much.

I know the feeling.

Cite: DOI: 10.1126/sciadv.aaw4099.

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The Reaper sends his regards

Unsurprisingly, he sends them C.O.D.

There comes a point in life, apparently, when anything worse than a runny nose suddenly seems like the end of the world as you know it. And I am there, Jack.

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Just the two of us

This qualifies as a heartbreaker for us Secret Garden fans:

A few months ago Fionnuala was diagnosed with breast cancer. After surgery, she has now started radiation treatment as well as infusion therapy. Her medical team has advised her to concentrate on her health situation, so subsequently, we have decided to cancel all concert plans for the rest of this year. This involves concerts in China, Korea and Norway.

We hope to be rescheduling all touring plans in 2020. We’ve been looking forward to performing the music from our new album Storyteller which was released in April. The response to the album has been great. We’re thankful for all the support we’ve received and we regret that we have to postpone the upcoming touring plans. Fionnuala’s health is the most important issue now. Meanwhile, we hope you will enjoy the new album Storyteller.

Secret Garden — Fionnuala Sherry and Rolf Løvland — won the Eurovision Song Contest in 1995 with the perennially lovely “Nocturne”:

Storyteller is their tenth album, from which comes “The Pilot”:

And of course, we wish them well.

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It’s a medical device

Which doesn’t make its operation any less risible:

[T]he thing with the BBs-taped-to-your-nipples-as-an-orienting-device will never not be weird and funny to me. Not every place does it but the place I go does. It’s also weird and awkward trying to make small talk with a woman you either have never seen before, or don’t know well AT ALL (I think it was the same tech as last year) while she’s moving your breasts around and getting them in the right orientation for the machine).

One of the few examples of unalloyed Male Privilege in this universe is not having to deal with this. (There’s that whole prostate thing, but it’s over with in a hurry, though I can tell you that it doesn’t feel like a hurry.)

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I haven’t the vagus idea

I suspect this will be greeted by a chorus of Nopes:

Looking for a powerful thrill? Want to get over your fear of snakes? Although not exactly recommended, you can get a snake massage to try to accomplish both those goals.

When you enter the New York shop Dreaming Goddess, a woman named Serpentessa can help you with this unusual $300 service. The massage lasts a minimum of 1 hour, 15 minutes and involves letting multiple boa constrictors slither across your body, reports CBS New York.

According to Serpentessa, the snakes “tone and stimulate the vagus nerve in our body and that releases endorphins and oxytocin,” she told the network.

Assuming, of course, that they stay where they’re supposed to tone and stimulate. What are the chances of that?

The snake therapist herself admits she cannot control where the snakes go on a person’s body. Serpentessa does say that her snakes have never hurt anyone.

However, several “trained,” captive snakes have been known to hurt people — even if just by accident.

“Oh, shut up, silly woman,” said that reptile with a grin;
“Now you knew darn well I was a snake before you brought me in.”

(Via Fark.)

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Looking up into the abyss

Roberta X writes on a topic I wish I had a reason to know nothing about:

Here’s the deal: most of the drugs developed to “treat” depression are about as subtle as a hammer. I used Wellbutrin to quit smoking, back before there was a specific stop-smoking version of the drug, and it made me twitchy and strange (yes, more than usual). But it got me past the critical few weeks of really strong cravings, so it was worth it in the short term. Long-term? No thanks; I’d rather be moody.

But it’s not really an either-or choice; for me, mild depression can be faked away. Tricked. Cheated: get busy at something, get into the physicality of it or the mental effort of mowing a lawn, building a bookshelf, even, something, putting words on paper, and you can forget how everything is bleak and gloomily awful.

Maybe it still is, when the thing is finished; maybe it comes back. You’ve nevertheless bought your brain an hour or more of different chemicals, different electrical patterns, different thoughts.

Which may be why I’m popping my current antidepressant somewhere between 45 minutes and an hour before turning in for the night: if I’m lucky, I’ll have faked the brain out of whatever foolish thing it was worrying about most of the evening.

Depression’s a real thing but it doesn’t help to let it loom too large. If you pick at it, it just grows. If you possibly can, go do something else instead. The only way to get off that track is to stop going around on it and there are scads of other things to do. If they’re not fun, at least they can be useful. It’s like picking away at a brick wall with a lovely, sunlit meadow on the other side: there’s a lot of gritty mortar to dig out before that first brick falls and lets a sunbeam through.

When in doubt, change the subject. It works for me better than it has any right to.

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Crystal Pepsi it ain’t

The first Quil product from Vicks, NyQuil, dates back to 1966; it was successful enough for the company to introduce a non-drowsy formula, which they had the temerity to call DayQuil. They followed up with a version of NyQuil without any of the cold-symptom ingredients, sold strictly as a sleep aid, which was dubbed Zzzquil.

Now your basic Zzzquil comes in a 12-ounce bottle that sells for around $9. It contains a fairly common Active Ingredient, diphenhydramine HCl; the 30-ml cup contains 50 mg of the stuff, the equivalent of a couple of Sominex tabs, plus various flavorings, none inspiring, something to make it look nice and murky, and 10 percent alcohol. And that was just fine for a while; subsequent variants came in gelcap form, and there’s even a version with melatonin. What we didn’t have was a version lacking both the murky colors and the little swig of ethanol.

And then yesterday the young lady bringing out the grocery order from Walmart showed me the NewQuil, still with the triple Z, but mostly translucent and utterly lacking in booze content. Still a 12-ounce bottle, still around $9, though Voldemart marks it down to $7.99 or so. I have no idea how well it works; the same first-cousin-to-Benadryl main ingredient remains at the same level. But it’s now on my shelf, so I will have to try it eventually.

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High fall risk

Fall Risk bracelet

Three years ago, I was given a bracelet that said that, and no choice of whether I wanted to wear it or not. The damnable thing seems to have taken hold of me, and not in a good way either.

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What reason do you need to be sure?

The FBI’s definition of a “mass murder” specifies a minimum of four deaths, not including the murderer himself, in a short period of time. A lot of these get into the news, particularly if (1) firearms are involved and (2) the killer belongs to a group disfavored by politicians and news media. Blaming the weapons is fatuous — when I was in the Army, we had literally hundreds of guns on hand, and not one of them ever broke loose — which means there might be something else involved:

SSRIs have a risk of increasing violence in patients, even in patients who have no previous history of violence or aggression before taking the medication.

This risk of violent behavior, both to the individual taking the medication and those around them, is so significant, it has led to the FDA mandating a black box warning on all SSRI medications. These black box warnings are designed to provide information and draw attention to the fact that the medication has serious and life-threatening risks.

As of 2004, all antidepressants in the U.S. are labeled:

“Anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia, hypomania, and mania have been reported in adult and pediatric patients being treated with antidepressants for major depressive disorder as well as for indications, both psychiatric and nonpsychiatric.”

This of course does not mean that every mass shooter was driven to it by Prozac — Elavil, which I take, is older than God and has no black-box warnings at all — but given the American tendency to treat antisocial activity first with drugs, this is an area that probably needs more attention before the next person tries to shoot the whole day down.

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Ask your doctor if it’s right for you

Pretty much all the prescription-drug commercials on TV follow this same uninteresting pattern:

Sufferers of Sweaty Elbow Syndrome can relax. Clinical trials have shown that Placebon causes up to a 7.5% drop in elbow sweat production in almost half of users. If you or someone you love are living with SES, ask your health care provider about Placebon.

In rare cases, patients reported depression and suicidal thoughts. Stop taking Placebon and see your health care provider if these occur. Side effects are rare, and include herniated discs, coronary artery blockages, and sudden incontinence. Patients who use alcohol or have visited regions with ebola outbreaks should not take Placebon. Do not take Placebon if you are allergic to Placebon.

Emphasis in the original. One question, of course, remains unanswered:

How in the Ninety-Nine Names of Spongebob am I supposed to know if I’m allergic to a drug I’ve never taken?

This is so they can say “We warned you” when the stuff makes you deathly ill. CYA all the way.

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Fair to meddling

Used to be, you had to have had six hours of chemistry to be able to comprehend the term “opioid.” Now it’s on page A-2 of the paper almost every damn day:

The news media makes a lot of noise about addiction, but I wonder how much of a problem it really is. If you look at the estimates of how much heroin and cocaine are being imported, it looks like either everyone is getting stoned every day —or— some people are using a heck of a lot, like a gram a day. I don’t think everyone is getting stoned, so there must be large population of heavy drug users.

As for busts (arrests), I wouldn’t be surprised if it was just the newcomers who are getting busted. The old established outfits don’t want any competition, so they are happy to tip off the cops whenever they get wind of an upstart trying to horn in on their racket.

Ultimately, of course, the government becomes the dealer of choice:

So the best people were quite determined not to see Linda. And Linda, for her part, had no desire to see them. The return to civilization was for her the return to soma, was the possibility of lying in bed and taking holiday after holiday, without ever having to come back to a headache or a fit of vomiting, without ever being made to feel as you always felt after peyotl, as though you’d done something so shamefully anti-social that you could never hold up your head again. Soma played none of these unpleasant tricks. The holiday it gave was perfect and, if the morning after was disagreeable, it was so, not intrinsically, but only by comparison with the joys of the holiday. The remedy was to make the holiday continuous. Greedily she clamoured for ever larger, ever more frequent doses. Dr. Shaw at first demurred; then let her have what she wanted. She took as much as twenty grammes a day.

“Which will finish her off in a month or two,” the doctor confided to Bernard. “One day the respiratory centre will be paralyzed. No more breathing. Finished. And a good thing too. If we could rejuvenate, of course it would be different. But we can’t.”

“You are a true believer, blessings of the State, blessings of the masses. Work hard, increase production, prevent accidents and be happy.’

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Aw, go fund yourself

If you’re asking “How do we get to single-payer health coverage?” here’s part of the answer:

After rejecting a 60-year-old woman’s request for a heart transplant for lack of “a more secure financial plan,” Grand Rapids, Mich.-based Spectrum Health recommended that she start a $10,000 fundraiser to come up with the money, according to a Detroit Free Press report.

The recommendation came via a Nov. 20 letter from a nurse with Spectrum Health’s Heart & Lung Specialized Care Clinics. In the letter, the nurse told Hedda Martin of Grand Rapids that the multidisciplinary heart transplant committee determined she is “not a candidate at this time for a heart transplant due to needing more secure financial plan for immunosuppresive medication coverage.”

Immunosuppresive drugs help prevent a person’s body from rejecting a new heart or other transplanted organ. The nurse also told Ms. Martin the transplant committee “is recommending a fundraising effort of $10,000.”

The letter was reportedly posted on social media by the patient, sparking backlash from some commentators over the committee’s decision. According to the report, some commentators on Twitter compared the committee to a “death panel.”

Warning: Malwarebytes barked at that link, citing the presence of dubious code.

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Don’t take any crap

Instead, give it:

According to the Centers for Disease Control and Prevention, about one in every 59 children in the U.S. is diagnosed with autism, up from one in every 150 in 2000. They report that “about half a million people on the autism spectrum will become adults over the next decade, a swelling tide for which the country is unprepared.”

The apparent rise in autism spectrum disorder (ASD) and its stubborn resistance to treatment has spurred a legion of researchers to enter the field and explore the disability in innovative ways.

Currently, effective treatments for ASD include behavioral therapy, speech and social therapy, psychiatric medications, and dietary and nutritional approaches. However, no medical treatments have been approved to treat core symptoms of ASD such as social communication difficulties and repetitive behaviors.

One promising avenue of autism research involves the gut microbiome, which is the collection of microbes that lives in our intestines and helps us in many ways including digestion of our food, training our immune system and preventing overgrowth of harmful bacteria. Recent research suggests our gut microbiomes also affect brain communication and neurological health. Worldwide, interest is growing in the idea that changes in normal gut microbiota may be responsible for triggering a vast range of diseases.

In a new study, “Long-term benefit of Microbiota Transfer Therapy in Autism Symptoms and Gut Microbiota,” published in Scientific Reports, Arizona State University researchers Rosa Krajmalnik-Brown, Ph.D., James Adams, Ph.D, and lead author Dae-Wook Kang, Ph.D, demonstrate long-term beneficial effects for children diagnosed with ASD through a revolutionary technique known as Microbiota Transfer Therapy (MTT), a special type of fecal transplant originally pioneered by Dr. Thomas Borody, an Australian gastroenterologist. Remarkably, improvements in gut health and autism symptoms appear to persist long after treatment.

The researchers speak:

Cite: Dae-Wook Kang et al, Long-term benefit of Microbiota Transfer Therapy on autism symptoms and gut microbiota, Scientific Reports (2019). DOI: 10.1038/s41598-019-42183-0

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Hungry hungry HIPAA

No medical procedure is complete without paperwork:

Went to the lab this morning to get my blood drawn. The lab is part of the medical industrial complex, so you have to pay a visit to the registration desk first. “Papers, please” or the equivalent, but not too many questions, no filling out of forms, and only two signatures required. Don’t understand why they need my wife’s birth date, nor why they need a signature acknowledging their privacy policy. I mean, it’s their policy, not mine. They need proof that they have shown it to me? This is double no-good no-think. Whatever.

I think they’re required to shove that form under your nose at least once a year, or the sacred stores of Lortab will be placed off limits.

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Next: Tommy John surgery

Sometimes events overtake us even in the world of fiction:

“Lou Gehrig,” a comedian once joked, “actually died of Lou Gehrig’s disease. Now what are the chances of that?”

I suppose you had to be there. But it occurred to me the next morning, while I was thinking up excuses not to get out of bed, that some fairly unlikely things had been happening to me of late, things I wouldn’t have dared to predict a couple of months ago. That space/time discontinuity, or whatever it was, could have opened up a path to just about any place in the universe. Or it may have been there all along, waiting for someone — make that somepony — to pass through. I’d never have known. It never would have occurred to me that the fabled land of Equestria was something more than just a clever idea by some talented people, a premise on which stories could be based, a pretext to sell toys to youngsters — and, yes, I admit it, occasionally to me. And the idea that Twilight Sparkle, of all ponies, should find that portal, step through it, and find me at the other end? What are the chances of that? With apologies to the late Mr. Gehrig, I consider myself the second-luckiest man on the face of the earth.

The Sparkle Chronicles (2012), chapter three

I definitely didn’t see this coming:

There’s an interesting article at Skeptical Inquirer by Harriet Hall suggesting that Lou Gehrig was misdiagnosed. He didn’t have amyotrophic lateral sclerosis but chronic traumatic encephalopathy (repeated head trauma):

“In 2010, McKee et al. published a study suggesting that repetitive head trauma in collision sports might be associated with the development of a motor neuron disease. It was based on autopsy findings of abnormal proteins in the brains of three athletes. McKee herself stressed that the findings were preliminary, but the study prompted many to question whether Lou Gehrig was correctly diagnosed with ALS or actually had CTE as a result of his many concussions.”

An acquaintance of mine died from ALS a few months back. Given the sort of fellow he was, I’m sure he would have found this at least slightly amusing.

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Gouge potatoes

What we’re looking at here:

Insulin aspart was approved for medical use in the United States in 2000. In the United Kingdom it costs the NHS about £ 1.89 per 100 units as of 2019. In the United States the wholesale cost of this amount is about 30 USD. In 2016 it was the 87th most prescribed medication in the United States with more than 8 million prescriptions. Manufacturing involves yeast, which have had the gene for insulin aspart put into their genome. These yeast than make the insulin, which is harvested from the bioreactor.

The most recent NADAC says $35 or so, if they can get it for you wholesale. Which, of course, they can’t:

Senate Bill 1019 would permit a pharmacist to dispense this stuff without a prescription in case of emergency; I’m not quite sure how this is going to affect routine refills, but the bill has arrived at the House after passing the Senate 46-0.

(With thanks to Dan Lovejoy.)

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Gratuitous gratuity

More than just a mere tip:

The family got together for lunch on Saturday at The Imperial restaurant in downtown Portland. With a name like that, and the fact that they take reservations, I was a afraid it might be expensive, but it wasn’t too awful. $150 for six, with coffee, no alcohol. Because there were six of us, the bill included the tip. It also contained a 3% wellness charge. I have no idea where that came from.

I was curious enough to try to track that down, and:

From the DOC restaurant menu: A 3% health and wellness charge will be added to each check to provide health insurance and living wages for all our staff. Thank you!

Which, I suppose, might be preferable to just jacking up the price and not explaining why. Judging by the comments on that second link, though, a lot of people would prefer the jackage.

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This spud’s for you

I hadn’t heard this before:

Truth be told, I’m not entirely sure I’m hearing it now.

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Tons of money, stat

So why is it that we spend more on health care than pretty much everyone else on the planet? One theory:

Perhaps because we think we like to think we are sick and we like spending money on doctors and lab work and drugs. Perhaps because we are willing to spend the money and the medical establishment is willing to take it. In any case, I suspect it’s just our mindset: charge on until we are stopped, and then bust down the barricade and charge on some more… Crazy people run up bigger medical bills, and we Americans might be the craziest of all.

I dunno, but I suspect most of our health care dollars are spent on old people, and a lot of that is spent on people who are not even mentally with us anymore. It is easy to foist unnecessary treatments on people who are barely aware of what’s going on. But hey, Medicare will pay for it, so it gets done.

Certainly the medical establishment doesn’t go out of its way to keep from taking our money.

And then I look at the doctor’s office, which includes three actual medical personnel and four people who push paper, and I am no longer surprised.

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What is Stage Four?

“The thing to note about Stage Four,” said Christopher Hitchens, “is that there is no Stage Five.”

Alex Trebek, host of Jeopardy! v2.0 since its debut in 1984 (Art Fleming did the 1.0 version through the 1960s and 1970s), isn’t going to let Stage Four get him down:

“Now, just like 50,000 other people in the United States each year, this week I was diagnosed with Stage 4 pancreatic cancer,” he said. “Now normally, the prognosis for this is not very encouraging, but I’m going to fight this, and I’m going to keep working.

“And with the love and support of my family and friends and with the help of your prayers, also, I plan to beat the low survival rate statistics for this disease,” he said.

He then joked that he has to keep working due to contractual obligations.

“Truth told, I have to! Because under the terms of my contract, I have to host Jeopardy! for three more years! So help me. Keep the faith and we’ll win. We’ll get it done.”

It’s hard to imagine Trebek not working. For that matter, it’s hard for Trebek to imagine Trebek not working:

In 2018, while being interviewed by Harvey Levin on Fox News, Trebek floated the idea of retirement, saying the odds of him leaving Jeopardy! in 2020 were 50/50 “and a little less”. He added that he might continue if he is “not making too many mistakes” but would make an “intelligent decision” as to when he should give up the emcee role. However, in October that year, he signed a new contract to continue as host through 2022.

He’d had a few health issues before, but heck, the man is 78 years old. In the meantime, I’m guessing he’ll take Thoughts and Prayers for $1000.

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Harshing your melanoma

A drug that seems to work against skin cancer? As Glenn Reynolds would say, “Faster, please”:

For people with the deadly skin cancer melanoma, one dose of the drug Keytruda before surgery might stop the cancer in its tracks, according to a groundbreaking new study.

Keytruda (pembrolizumab) is a PD-1 inhibitor, an immunotherapy drug that triggers the body’s immune response to attack cancer cells. According to results of this study, the drug’s effects peak as early as seven days after treatment — much earlier than previously seen in other studies.

It even works on politicians:

Keytruda is the drug responsible for the remission of former President Jimmy Carter’s cancer in 2015. Carter, then 90, had melanoma that spread to his brain and liver. Treatment with Keytruda appears to have cured him.

And don’t ask the price:

The drug isn’t cheap, costing about $150,000 a year. Keytruda is covered by most insurance, including Medicare, but copays can be high, according to the Kaiser Family Foundation.

The surgical option, though, isn’t likely to be any less expensive.

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You got a lot of nerves

To me, the amazing thing about hand transplants is not that they work fairly well, but that they work at all: all those nerves have to be positioned just so. Anyone whose nerves have gone to hell will recognize this pattern:

When I read about these things, it takes me back to the decade in which I had nerve injuries in both my arms and suffered constant and often substantial neuropathic pain (I’ve described it here and elsewhere). I’m not comparing myself to these patients (thank goodness). Nevertheless, I have had a fairly lengthy experience of nerve injury, and then a lengthy convalescence (a couple of years, actually) and rehab from nerve surgery, and am well aware of the dangers and difficulties inherent in rehabbing any nerve problem. Hand transplants involve a great deal more, of course. But they also involve the reconnection and growth of many nerves, and that takes a long long time.

In particular, the article recalled a dream I had a night or two after surgery on my right arm. I dreamed that my arm had been amputated and I’d been given another arm that was attached at the shoulder with clumsy, Frankensteinish stitches. At the time, my right arm was essentially unusable, and in tremendous pain. The rehab ended up being fraught with problems — I changed physical therapists about four times before I found one who knew how to help me — and my recovery took two to three years. It’s been about twenty years and I’m now about 85% to 90% better than I was before the surgery, which is practically miraculous and for which I’m very grateful. But a person doesn’t forget an experience like that.

Two and a half years following all that spinal stuff, I have to wonder if “recovery” means anything in my case. Pain has been mostly quieted, and I am grateful for that, but I still can’t walk more than a couple of steps. Since I tend to be a bit wobbly when standing still, I’m thinking that somewhere along the way I misplaced my equilibrium. At least I don’t dream about it.

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Adjusted for inflation?

Bernie is Not Pleased:

U.S. Senator Bernie Sanders sent a letter to Catalyst Pharmaceuticals on Monday asking it to justify its decision to charge $375,000 annually for a medication that for years has been available to patients for free.

The drug, Firdapse, is used to treat Lambert-Eaton Myasthenic Syndrome (LEMS), a rare neuromuscular disorder, according to the letter, made available to Reuters by the senator’s office. The disorder affects about one in 100,000 people in the United States.

The government is intensifying its scrutiny of the pharmaceutical industry and rising prescription drug prices, a top voter concern and a priority of President Donald Trump’s administration.

That word “free” actually means something in this case:

In the 1990s, doctors in the US, on behalf of Muscular Dystrophy Association, approached a small family-owned manufacturer of active pharmaceutical ingredients in New Jersey, Jacobus Pharmaceuticals, about manufacturing amifampridine [the generic name] so they could test it in clinical trials. Jacobus did so, and when the treatment turned out to be effective, Jacobus and the doctors were faced with a choice — invest in clinical trials to get FDA approval or give the drug away for free under a compassionate use program. Jacobus elected to give the drug away, and did so for about twenty years.

But that compassion stuff buys no yachts:

Catalyst anticipated that it could earn $300 to $900 million per year in sales for treatment of people with LEMS and other indications, and analysts anticipated the drug would be priced at around $100,000 in the US.

Fooled you, analysts.

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Fark blurb of the week

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