Category Archives: healthcare

A Vaccine? Not so fast

Currently, Covid-19 has killed slightly over a million people worldwide, close to a quarter of that here in the United States. This is about equal to the annual death rate from Tuberculosis which is the most lethal infectious disease worldwide. Interestingly both are airborne respiratory diseases. The recent announcement of a ninety percent effective vaccine has buoyed hope world wide. The vaccine is being developed by a collaboration between Pfizer, an American drug manufacturer and BioNtech, a German Biotech company.

Whereas the initial data is encouraging, it is only initial data. What is yet to be determined is will the vaccine be durable, that is will its effectiveness to prevent the disease last more than a few months? Will it be effective in groups not tested? Pfizer has done a good job of including a mix of ethnic, racial, and age groups in the Phase III trial but will it work with neonates, or pregnant women, or as yet unknown variables?

Its distribution is also problematic as it requires that the vaccine be maintained at nearly minus 100 degrees Fahrenheit. That requires special equipment, way beyond a home or commercial freezer, which isn’t commonly available.

A real unknown is its adoptability. If and when an effective vaccine is available, will the public actually get the shot, actually two separated by two weeks? In terms of global human health, vaccinations are second only to good sanitation in improving the life and health of humanity. That said, we are living in a time of distrust in authority in general and in this case distrust in vaccinations.

Although anti-VAX (opposing vaccination) movements have waxed and waned since the time of Edward Jenner and the inception of vaccinations, the current movement began after outright fraud by Andrew Wakefield. He published a since retracted paper claiming that the Measles, Mumps, and Rubella (MMR) vaccine caused autism. It turns out that he was paid by an attorney to fabricate data that would be to his advantage in suits by parents with autistic children against drug manufacturers.

Several entertainment personalities promoting the anti-VAX position have apparently had an inordinate influence on the public. Actress/model Jennifer Biel testified against a California bill meant to limit medical exemptions for vaccination of school children. Jim Carrey and his one-time girlfriend Jenny McCarthy, Robert Kennedy Jr, Mayim Bialik of “Big Bang Theory” fame, and others with no relevant medical experience drive the anti-Vax train.

Our current environment of anti-intellectualism and anti-authoritarianism acts to combine with the anti-Vax movement to provide a big impediment to defeating Covid-19. The announcement of preliminary positive results with a vaccine is encouraging but we have a long physical and psychological way to go before life can return to normal. At the earliest, this is estimated to be the third quarter of 2021 or later. Until then we will need to continue to – you guessed it – wash your hands, wear a mask, and maintain a proper social distance.

Dr. Bob Allen is Emeritus Professor of Chemistry, Arkansas Tech University.

Healthcare Must Include Everybody

A sure-fire way to lower the cost of health insurance for those willing and able to buy it is to let people die on the curb in front of the hospital. Yep, give up your humanity and you too can save on health insurance. When the motive for healthcare is profit and there is no profit in free riders, what else?

If you opt for humanity and take that person into the hospital, it can cost you, and likely cost you a lot. That person without health insurance will incur costs that the hospital must absorb. The only way for a hospital to stay in business if they accept indigent care is to charge paying customers, usually insurers, more to offset the unreimbursed care.

If we are to be humane and provide care for the free riders, is there a better way? If we wait for high blood pressure to cause a heart attack, treatment of that one event can cost hundreds of thousands of dollars. Alternatively, drugs to manage high blood pressure can be had for pennies a day. To not provide for the blood pressure medication is just the sort of thing that Ben Franklin spoke of when he said “an ounce of prevention is worth a pound of cure.”

The reason President Trump and the Republicans struggle to produce a health plan to replace the ACA, even though they have had several years now, is there is no plan that actually works if it doesn’t include everybody, at least humanly. There are two ways to do that – make sure everybody has access to affordable care through private insurers or go to a less costly single-payer, not for profit, universal healthcare system like just about every other country in the world.

Government managed systems work and work well. We currently spend much more per capita on healthcare with poorer outcomes. There are over 40 countries with lower infant mortality rates, greater life expectancies, and lower costs.

President Trump said his replacement healthcare plan would cover everybody and cost less. So where is it? I can predict immediately that any plan from the Republican party will not mandate coverage with a complete, effective policy. This guarantees free riders and uncompensated costs. Another promise is to lower spending by the elimination of subsidies for the poor. It will lower or eliminate healthcare for the poor.

For those middle-income folks there are now cheaper insurance policies available, but only because of substandard policies. Lower costs mean less coverage. The ACA policies required a minimum standard of coverage which included preventive care. Cheap policies are available which allow you to pick your coverage limit – lower coverages mean lower policy costs. This however, can leave the taxpayer on the hook for catastrophic costs.

The real winners with a conservative healthcare plan are the rich, no surprise there. Taxes will go down while at the same time subsides not previously available to the rich will go up.

Conservatives continue to try to view healthcare as subject to the same market forces as buying unessential commodities, but it just doesn’t work that way. We are alone in the world with our failure to make that recognition. In these times of a debilitating even lethal pandemic, it is unconscionable to not provide quality healthcare to everyone in the country.

Dr. Bob Allen is Emeritus Professor of Chemistry, Arkansas Tech University.

Dealing with an Epidemic

Unless you live under a rock, you are at least aware that we have a viral infection rearing its head in the United States. Whether you call it an epidemic or a pandemic is immaterial. It began most likely in a market in Wuhan, China where any number of wild animal meats were on sale. Bats have been suggested but it isn’t yet clear.

The infection due to this virus is called COVID-19, as it is a member of a group of viruses known as corona viruses and it appeared in 2019. The virus itself has been given the name SARS-CoV-2 – short for Severe Acute Respiratory Syndrome second corona virus.

The first response by the government has been to close our borders to countries where an infection is already established. This response was too little too late. It appears the virus has been circulating in the United States for weeks now. There are reported cases in 15 states and 6 known fatalities. As a respiratory virus, its symptoms are similar to the annual flu but more lethal. It also seems to be more transmissible.

Meanwhile, on the economic front, the Federal Reserve has taken a step to stimulate business by lowering the rate it charges to loan money. The idea is to stimulate economic activity and get folks out to spend money. Weird huh? On the one hand, we are told to stay home to avoid the possibility of person to person transmission and at the same time get out in the public and spend to get the stock market value back up.

The Whitehouse proposed a couple of billion dollars to fight the epidemic and the Democrats have proposed much more. Even if approved it is not clear how this money will be allocated. Obviously a vaccine must be at or near the top of the list. Testing equipment and medical supplies from face masks to respirators are needed. Most important is to disrupt person to person contact. Officials have recommended the usual hand washing and if you exhibit symptoms, stay home – don’t go to work or school.

But here our for-profit healthcare system begins to fail us. Health and Human Services Secretary Alex Azar, a former drug company executive and pharmaceutical lobbyist, said that although he would want to make it affordable, he won’t promise that it will be. You hear all the time that related vaccines are “free” but the fine print says “with most insurance.” When the working poor get sick, they don’t stay home. If their children get sick, they go to school. There are a lot of folks whose jobs have no sick leave option – you don’t go to work you don’t get paid.

We need a healthcare system that recognizes it only works if it works for all. Free vaccinations. Full stop, payments to those who shouldn’t be going to work and payments for care of their sick children. And importantly a system that guarantees that they will still have a job if they stay home for an illness.

Dr. Bob Allen, Ph.D., is Emeritus Professor of Chemistry at Arkansas Tech University.

Medicare for All

It shouldn’t be this hard, really. Just about every country in the developed world has some form of universal healthcare, managed by a central authority. Management varies, the degree of supplemental private insurance varies, and the degree of coverage varies, but one factor is common to all the others: it works. Everybody gets coverage, outcomes are better, and the total cost is lower.

The arguments against universal healthcare here in the United States are numerous and generally are all wrong. One of the sillier arguments is that you can’t compare the success in smaller countries with our more populous country. Nonsense, anyone that knows about healthcare coverage knows that the larger the insured pool, the more predictable the costs, and hence the lower the costs.

The most common argument is we just can’t afford it. Michael Bloomberg, billionaire and occasional wannabe presidential candidate proclaimed that “Medicare for all would bankrupt us for a very long time.” Nonsense, it’s not bankrupting European or Asian countries, why should it bankrupt us?

As a percentage of our Gross Domestic Product (GDP,) We have, hands down, the most expensive system in the world. For example most European Countries, Canada, Japan, and Australia all have costs in the 10 to 12 percent range, where we spend over 17 %. And they cover everybody, we don’t.

Another argument is that the coverage “there” is not as good as here. It depends on what metric but if you compare the broadest of categories we lose every time. In life expectancy, we don’t even break the top 25. We are far behind the likes of Greece and Canada. How about infant mortality, surely we take care of our neonates. Not nearly as well as most of the others. Our infant mortality rate is twice or more than the rate of Europe. Our rate is even higher than Cuba’s! Maternal mortality rates are even worse. We have on the order of 7 times as many women dying compared to Finland, and about 3 times as many as the average of the rest of the developed world.

Some claim they don’t want some faceless bureaucrat determining their healthcare, but what is the alternative? As a comparison, where do you think the interests lie for an investor in a for-profit insurance company? Why did it take government intervention to ensure coverage for people with preexisting conditions?

We can pay for it through our income taxes. Any increase in taxes will be offset by decreases in the need for private insurance. To ease the transition we can introduce it starting with the most important, childbirth. Prenatal/maternal care should be THE pro-life issue, then the children are kept in the system as they age.

At the other end of the system, we should lower the age for the introduction of Medicare. Currently, most healthcare insurance is provided through the workplace. In the gig economy, lose your job – lose your insurance. It is more difficult and takes more time for quinqua- or sexa- genarians to find a job.

A final argument to debunk is that our government just can’t do the job. Nonsense, our government is as good as or better than that of France, or Great Britain or Germany, right? As the most prosperous democracy, we can do this.

Dr. Bob Allen, Ph.D., is Emeritus Professor of Chemistry at Arkansas Tech University.

Republican Healthcare – or Lack Thereof

About the only way I know to lower the cost of health insurance for those willing and able to buy it is to let people die on the curb in front of the hospital. Yep, give up your humanity and you too can save on health insurance.

If you opt for humanity and take that person into the hospital, it will cost you, and likely cost you a lot. That person without health insurance will incur costs which the hospital must absorb. The only way a hospital to stay in business if they accept indigent care is to charge paying customers, usually insurers, more to offset the unreimbursed care.

If we are to be humane and provide care for the free riders, is there a better way? If we wait for high blood pressure to cause a heart attack, treatment of that one condition can cost hundreds of thousands to millions of dollars. Alternately, drugs to manage the high blood pressure can cost pennies a day – Penny wise, pound foolish.

The reason the republicans struggle to produce a health plan to replace the ACA, even though they have had several years, is there is no plan that actually works if it doesn’t include everybody. There are two ways to do that – make sure everybody has access to affordable care through private insurers or go to a less costly single payer universal healthcare system like just about every other country in the world.

Government managed systems work well. We currently spend much more per capita for healthcare and with poorer outcomes. There are over 40 countries with lower infant mortality rates, greater life expectancies and lower costs.

The new president said while campaigning that his replacement healthcare plan would cover everybody and cost less. As to the costs we won’t know until after the Congressional Budget Office (CBO) scores the new bill. I can predict immediately however that it won’t cover everybody because the first line of conservative talking points is repealing the mandate to purchase insurance, guaranteeing free riders. Another promise is to lower ACA spending, which means that subsidies for the poor will be lowered or eliminated, further reducing the pool of insured.

For those middle income folks there may be cheaper insurance policies available, but only because substandard policies will again become available. Lower costs mean lower coverage. The ACA policies required a minimum standard of coverage which included preventive care. Cheap policies will be available which only cover catastrophic costs. Ironically, avoiding the costs of preventive care leads to greater catastrophic costs.

The real winners with the proposed healthcare law are the rich, no surprise there. Taxes will go down while at the same time subsides not previously available to the rich will go up.

Conservatives continue to try to view healthcare as subject to the same market forces as buying unessential commodities, but it just doesn’t work that way. We are alone in the world with our failure to make that recognition.

Zika in Arkansas

Currently there are several confirmed cases of the Zika virus in Arkansas. The cases all involve individuals who contracted the disease while traveling in areas where the disease is prevalent, usually Latin American or Caribbean locales.

The virus can be carried by two related mosquitoes, Aedes aegypti and A. albopictus. Transmission of the disease occurs when a mosquito bites an infected individual and picks up the virus in the process. Then when that mosquito bites another uninfected person and inoculates them with the virus. Of the two mosquitoes, A. ablopictus is the lesser threat as it feeds on animals in addition to humans. On the other hand A. aegypti prefers humans and is therefore more likely to transmit the virus among humans.

Once contracted, an infected individual is capable of spreading the disease for several months, both via mosquito bites and also sexual contact. The virus has been isolated in the semen of infected men up to two months after acquiring the disease.

The range of A aegypti includes almost all of Arkansas, only the northeast corner near the boot heel of Missouri being outside the range. A aegypti is particularly problematic because it breeds rapidly and in amazingly small amounts of water. Eggs laid in a bottle cap’s worth of water mature to adults in as short as a weeks time. Also troublesome is that A aegypti is a daytime feeder when humans are more likely to be out and about.

The Zika virus causes a range of symptoms. A minor set of symptoms include rash, mild fever, joint pain and headache which may persist from a couple of days to a week or so. What has gotten the most attention of course is the teratogenic effect. If a pregnant woman gets infected, the virus can pass to the fetus and cause a condition know as microcephaly, an abnormally small head. The condition is severe and can result in seriously impaired brain function and premature death and.

Avoiding travel to the Caribbean or Latin America is no longer enough to be safe here in Arkansas. Because we have infected people and the transmitting mosquitoes, we are all at risk. So what is to be done? Obviously don’t get bitten by an infected mosquito, but that is easier said than done. The first line of defense would be to use an effective repellent. The gold standard, the agent which all others are compared to is DEET. Nothing is as effective nor lasts as long per application. The science is clear that all others have a weaker effect and don’t last as long.

Broad scale spraying of insecticides has been shown to reduce transmission rates, but in so doing kills off not only the target mosquitoes, but also any and all other insects. Many of these are not only desirable but a necessary part of human life. The FDA has recently approved an interesting strategy involving the use of gene modification to create a mosquito whose offspring can’t reproduce.

Most promising is an effective vaccine to prevent infection. This will have the least impact on the biosphere. No deaths on non-target insect species, nor any disruption of other organisms that rely to some degree on mosquitoes as part of their diet.

Zika

As if we didn’t have enough insect and tick born diseases to worry about, an emerging risk is the relatively new (to the western hemisphere) Mosquito born Zika virus. Add it to other scourges around Arkansas such as Rocky Mountain Spotted Fever, Erhlichiosis, and Tularemia from ticks (also deer flies for Tularemia), and mosquito born West Nile Virus and St. Louis encephalitis (SLE). Any and all of these diseases can have serious consequences especially if left untreated.

Zika is a new viral disease which is projected to be an issue in the future in much of the United States including Arkansas because of the ability of the host to breed and spread in a number of climatic niches. The mosquito vector, genus Aedes, is a day-time feeder and is said to be able to reproduce is a bottle cap’s worth of water. So far no known disease transmission from mosquito bites has occurred in the United States, but transmission from bites has occurred in two territories in western hemisphere, Puerto Rico and and the US Virgin Islands. There are reported cases in most states from travelers who were exposed overseas.

Zika was discovered in 1947 in Uganda. From the 1960s to 1980s, human infections were found across Africa and Asia, typically accompanied by mild illness. The symptoms are common to a number of other mosquito born viral infections. From there the virus moved to south-east Asia and across the Pacific. During a 2013-14 outbreak in French Polynesia, the neurological disorder Guillain-Barré syndrome was linked to Zika infection. In South America, the first reports of locally transmitted infection came from Brazil in May 2015. In July 2015 Brazil reported an association between Zika virus infection and GBS.

It is only a matter of time until the local mosquito population becomes infected with the Zika virus, and begins to spread the disease among humans. The most frightening aspect of the disease which has recently been confirmed by the US Centers for Disease Control (CDC) is a unique birth defect that occurs in the offspring of infected women. Microcephaly is a condition where the infant is born with an abnormally small head and underdeveloped brain. Brazil has reported a rate of about 2,500 cases of microcephaly.

The disease has also been shown to be transmitted by blood and semen. Men with the virus have been know to transmit the disease to sex partners. It is currently not know if women can infect partners.

The condition results in a poor prognosis for normal brain function and individuals have a greatly reduced life expectancy. Although there can be other causes of microcephaly, the CDC has affirmed the connection between the Zika virus and the Brazilian outbreak.

Two months ago President Obama asked congress to appropriate 1.8 billion dollars to fight the spread of the disease. The republican controlled Congress has so far refused to act on the request. Without congressional support to fight the disease the president has no choice but to switch funding within the CDC, taking it away from monies committed to surveillance and treatment of Ebola.

Congress, name your poison.

Interstate Health Insurance?

If the Republicans win the general election in the fall and Obamacare is repealed, what happens? Several common threads run through the various strategies from Republican front runners.

The most odious feature of the the Patient Protection and Affordable Care Act (PPACA) among conservatives seems to be the mandate, so it will go. If you don’t want to buy insurance, you don’t have to. If for example you get pneumonia from an untreated infection, you can go to the hospital and get free care. For the hospital to remain in business however, they have to cover the cost of the “free” care with higher costs to the paying customers – the insurance companies. And remember that emergency care is the most expensive way to deliver care, bar none. The cost to those who buy insurance will go up to subsidize the uninsured. This doesn’t do anything to lower costs, it’s what we had before and it is a silly way to keep everybody healthy.

So everyone, republicans included, realizes that steps need to be taken to bring down the cost of healthcare and one thing you hear constantly is that allowing the purchase of insurance across states lines will increase competition and thereby lower costs. Will it work? It works with widgets. If someone in another state sells widgets at a lower price than that can be bought here, then go there to buy where the price is lower.

The story with health insurance is quite a bit more complex. The PPACA includes provisions that already allow the purchase of health insurance across state lines. The difference between the PPACA compact provisions and earlier interstate sales provisions are that the PPACA requires all states to comply with a minimum level of insurance coverage. But interstate sales is not happening, so why?

Insurance companies make money by negotiating prices for “healthcare commodities” – doctors fees, hospital costs, laboratory costs, drug costs etc. All these costs are negotiated to control costs to the policy holders. The nature of the policies sold in a state are regulated in the state.

Georgia, Maine, and Wyoming are states that have taken the step to promote interstate sales. The problem is not that regulations prevent it, but rather no insurers are interested. In none of the aforementioned states, has an out of state insurer expressed interest in selling in those states. This is partly due to the fact that out of state insurers will still have to abide by the rules in the states where they sell.

Eventually it may happen. There is a case to be made that costs are lower the bigger the pool of insured, and crossing state lines could expand the pool for a given insurer. In some markets such as large metropolitan areas that cross state lines, this could happen sooner rather than later, but the development will take time. How how much will this lower the cost to a consumer?

Experts cite the fact that insurance costs depends on how healthy a given group of policy holders are. Arkansans currently have the highest obesity rate in the country, Colorado the lowest. If an insurer from Colorado wanted to sell in Arkansas, the policy costs would be base on the obese Arkansas pool, not the fit Colorado pool. Consequently what cost savings may occur would be small.

In a final irony, a catch-22 of sorts, interstate sales of insurance means federal regulation, anathema to generally states rights conservatives.

Homeopaths Without Borders

Homeopaths without borders

There are a number of international organizations with the title “ … without borders,” most notably Doctors without Borders (Médecins Sans Frontières.) It is a humanitarian organization, founded in Paris France in 1971. This Nobel laureate organization has been sending doctors and their staffs around the world to provide health care where none is available. They go to treat extremely dangerous diseases such a Ebola and in extremely dangerous places such as active war zones.

Contrast that with Homeopaths Without Borders, who describe themselves as a humanitarian organization who travel to treat a relatively innocuous disease with sham treatments. Understanding just how preposterous Homeopathy is requires a little background. Before the time of modern medicine, treatments and drugs frequently were more dangerous than the illness itself. As just one example of many, George Washington died from bleeding to death – on purpose. He wasn’t supposed to die but he was being bled as a cure for what ailed him. You take out the bad blood and you get better, right?

Homeopathy was created by Samuel Hahnemann in 1796 (Washington died in 1799.) This medical modality was based on his idea of the law of similars. Substances that cause symptoms in “normal doses” can cure those same symptoms when given in infinitesimally small doses. One “drug” in the homeopathic pharmacopoeia is Nux vomica. A normal dose will make your stomach hurt (and then kill you) as this stuff is strychnine. A tiny dose however is supposed to be a cure for stomach aches.

A classic example of a homeopathic treatment is Oscillococcinum. This flu remedy is made from the liver of a duck. It is ground, dissolved in water, and then that water is diluted with ten times as much water. Take this water and dilute it ten fold. Do this 400 times.
1/10000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000.

For all practical purposes there is nothing left of the original preparation, only water. The water can be used directly or is added to chalk and evaporated. There is absolutely no chemical or biological reason that these treatments would have any effect at all.

Because there is nothing in these remedies, they can do no direct harm. Before modern medicine this alone could be beneficial to replace the use of dangerous things like blood letting. In this day and age however the substitution of magical thinking for real, efficacious treatments is not only unethical, but also dangerous.

http://www.hwbna.org/

http://www.hwbna.org/


Homeopaths Without Borders is currently working in Haiti to “treat” a disease known as Chikungunya, a viral infection spread by mosquitoes. The symptoms of infection are mild and flu-like with a moderate fever. Many of those infected have no symptoms at all. The condition usually resolves itself in a matter of days. Homeopaths treat this disease with another extremely diluted nostrum. The homeopathic treatment does nothing good, bad, or otherwise and the disease resolves itself.

One may ask what’s the harm? The harm is that unsuspecting individuals see that a disease exists, a treatment is employed and the disease goes away. The conclusion is homeopathy works. It doesn’t. One may in the future be led to the idea that substitution of cheap homeopathic treatments can replace more expensive drugs that actually do have an effect. They can’t.

Homeopathy falls in the realm of what some call alternative medicine. Why alternative medicine? Because it it worked it would be called medicine.

Guinea Worm

Jimmy Carter and the Guinea Worm

The Guinea Worm, Dracunculus medinensis, is a nematode which has infected humanity for millennia. It is a subject of interest because of the large size, up to three feet long, and the fact that infection with the worm is extremely painful as the worm makes its way within the body. Secondary infections can be lethal.

Knowledge of the infection dates back to antiquity. Some authors suggest that the closing verses of three stanzas of a poem in the Sanskrit book Rig-Veda, allude to the Guinea worm. The worm was well known to ancient Egyptians and has been found in mummies dating back to 2000 BCE.

The life history of the Guinea worm begins when contaminated water is consumed. The Guinea worm spends part of its life cycle as a larva in an intermediate host, a tiny copepod. When consumed by humans, the copepod dies and releases larvae. They bore through the stomach wall into the peritoneum where they mature. The smaller males mate with the females. Adult females then migrate to the skin, ultimately boring through the skin. When an the infected person then bathes the inflamed tissue in a body of water the female releases larvae, only to be consumed by copepods, renewing the cycle.

Traditional treatment is to extract the worm by slowly winding it onto a stick after it has broken through the skin, a process that can take hours to months long. This may be the source of the biblical allegory of Moses and the serpent. So the story goes, at one point while wandering in the wilderness, the Israelites were again being sinful so God sent serpents to the camp and the people started dying. God told Moses “ Make a snake and put it up on a pole; anyone who is bitten can look at it and live.”

This is also likely to be the origin of an ancient symbol – the Rod of Asclepius, the Greek god of healing. It is the major symbol for professional healthcare associations in the United States, the staff and snake being a proxy for a worm on a stick. It’s a single image instructional manual so to speak.

The disease due to infection is called Dracunculiasis. It has affected millions into the twentieth century, mainly in parts of Asia and sub-Saharan Africa. In 1986 the Carter Center, founded by President Jimmy Carter, estimated that there were 3.5 million people infected. With a small amount of funding and a big educational outreach, that number has dropped to 186, and is likely to be completely eliminated within a year or two. This will be the second disease eliminated from mankind, after Smallpox.

And the solution is so simple. The intermediate host, the copepod, is not a microscopic organism, but rather a little crustacean about the size of a small grain of salt. All that is necessary is to filter drinking water through a gauze-like membrane, even a bandana will do! Because there is no alternate host, once the organism is eliminated from the human population, the worm will be extinct.guinea
The Carter Center set in motion a program to train locals to teach this simple hygiene measure which will soon eliminate a grotesque disease which has afflicted humans for thousands of years. Thank you Jimmy Carter.