Tag Archives: health care


Generally the citizens of red states take in more from the feds than they pay out in taxes. Conversely blue states pay out more than they take in. There are exceptions, red Kansas pays out more than it takes in and blue New Mexico takes in more than it pays out.

Both Trump and the Republicans in congress have repeatedly stressed their plan to repeal the Patient Protection and Affordable Care Act (Obamacare.) Will it be replaced? If So what will replace it? House majority leader Kevin McCarthy said “”Nothing’s been decided yet but I would move through and repeal and then go to work on replacing.” There are several competing ideas floating around, all of which will mean less support for healthcare.

The medicaid expansion is certain to go, eliminating healthcare support for about 14 million people nation wide. Most republican plans drive people with pre-existing conditions into very expensive high risk pools, essentially eliminating insurance for those with lower incomes. Most republican plans will return to annual and/or lifetime limits – exceed your limit and you no longer have insurance at any cost.

People will continue to get sick, insurance or not. In fact without the preventive care measures built into Obamacare, they likely will get more sick. Without reasonable healthcare protections, they won’t be able to afford to go to a clinic for treatment of a cold. They will wait until on death’s bed with pneumonia before they go to the hospital for treatment but can’t pay with dollars they don’t have.

So our population will suffer more serious health care emergencies, increased medical bankruptcies will lower payments to hospitals and staff, and smaller rural hospitals which operate on narrower margins will close their doors, further decreasing access to health care for much of the state’s working poor.

And it won’t stop with just healthcare. Expect cuts to any number of federal programs including food stamps, housing subsidies, subsidies for transportation, etc.

Here in Arkansas we are one of the net takers receiving more in federal dollars than we pay in taxes. Over 684,000 votes were cast for Trump. Around a half a million voters and their children will lose some or all of their healthcare support. Another half a million more could lose some or all of their nutritional support (foodstamps, WIC) including children. What do you think a Venn diagram of Trump voters and beneficiaries of federal largess would look like? Considerable overlap?

The real irony in all this is that the republicans’ lust for smaller government will negatively impact their voter base in the red states. The more prosperous blue states will have their treasuries buoyed by the reduction in federal tax payments. They can use that money to provide for the health and welfare of their citizens. The less prosperous red states will be allowed to continue on a downward spiral with lower wages, poorer health and an every person for themselves paradise. Be careful what you wish (vote) for.

The Human Microbiome

The human body is composed of something like 30 trillion cells. Those are are own, made by ourselves from our DNA. Living on and in us however is another 40 trillion or so cells made up of a slew of bacteria, mainly in the gut. The microbiota include viruses, fungi and protozoa. In aggregate, they occupy nearly all other body cavities such as the mouth or vagina in addition to every square inch of our skin. The average forearm alone is home to over forty different species of bacteria.

Since Louis Pasteur expounded on the germ theory of infectious disease, the common idea has been that the only good bug is a dead bug. Yes there are bacteria that can cause toxic effects and some people go to great lengths to try to sterilize their bodies using alcohol or antibacterial detergents and lotions. Ironically, irregular use of these agents may be breeding resistant organisms and hence doing more harm than good.

The vast majority of our micobiota do not cause acute diseases. And in fact recent research suggests that we may well be able to improve our health by fine tuning just which of these trillions of bacterial cells there are. In 2007 the National Institutes of Health began a effort to study all aspects of the human microbiome as it relates to health and well being. The effort involves studying the genes of the microbiota, but in so doing scientists are learning of just what the bacteria are doing. Some very interesting results are turning up.

It has become apparent that the microbiota in the gut of a neonate are very important in training the immune system. Essentially our immune system needs early examples of non-self cells to “learn” how to properly react. There are many autoimmune diseases such as juvenile diabetes and rheumatoid arthritis where our immune system fails to properly distinguish between self and non-self, resulting in inappropriate attacks on our own cells.

Interestingly, there may be connections between the gut and our mental health. There is a correlation between conditions such as irritable bowel syndrome or Crohn’s disease and psychiatric conditions like anxiety and depression. A 2009 publication from the NIH noted, “While evidence is still limited in psychiatric illnesses, there are rapidly coalescing clusters of evidence which point to the possibility that variations in the composition of gut microbes may be associated with changes in the normal functioning of the nervous system.” In mouse models, they found both behavioral and brain chemistry differences between normal mice and those raised in a environment free of bacteria.

The real promise in this research follows from the fact that our microbiome is or can be quite variable between birth and death. Both the variety and number bacteria can change over time periods from days to years. A recent application involves “fecal transplants.” Some patients who have been treated with strong antibiotics have had their colons overgrown with C. difficile, a harmful bacteria. Transfers of normal microbiota from a healthy donor allows for the repopulation of the recipient’s colon and the elimination of the harmful bacteria.

Cell Phones and Cancer, Again

Like the Phoenix rising from ashes, so is the “cell phones cause cancer” meme. The current claim is based on a study done with rats exposed full body for nine hours a day for several months. The result was a statistically significant increase in two types of tumors, gliomas and schwannomas. Gliomas are tumors in glial cells of the brain and are rare, the incidence in 2008 was less than 7 per 100,000. In this study the schwannomas were found in heart cells and are even rarer. Important also was the fact that there was a dose-response relationship. Higher intensity cell phone radiation produced a greater incidence of tumors.

So is it time to keep that phone on speaker and never, never carry it around in your bra? Maybe not, at least the bra part. Where as there were increased tumors observed in male rats, there was no increase in tumors in females regardless of the dose (intensity of radiation.) That in itself is a problem as both male and female rats have glial and schwann cells so why were only the males affected?

The bigger problem with a link between cell phones and cancer is the fact that it is biologically implausible. Cell phones utilize radio waves as do WiFi, TV, microwaves and others. This is the lower energy form of electromagnetic radiation that does not cause ionization and therefore doesn’t cause chemical reactions. A chemical reaction is required to cause a mutation in DNA and hence initiate cancer. Higher energy radiation known as ionizing is a well know cause cancer. Too much ultraviolet (UV) radiation from the sun is the most common cause of cancer. X-rays are also a known cause of cancer.

The history of cell phones and cancer is somewhat odd. In 1989 Susan Reynard , 31, was diagnosed with an astrocytoma, a tumor of the astrocytes which is another type of brain cell. The tumor, in the eyes of her husband resembled the outline of a cell phone – just like she held it to her head. She died in 1992 and her husband sued the phone manufacturer and service provider claiming a causal link between her cell phone use and the tumor which killed her. He lost the suit.

A number of studies with laboratory animals and epidemiological studies with humans have been been conducted over the years with variable outcomes. Studies with animals always suffer from the fact that there may be physiological differences between us and other animals, hence risk factors will be different.

Even without a controlled study the connection between brain cancer and cell phone use seems sketchy. Whereas the incidence of brain cancer has remained relatively steady over the past few decades, use of cell phones has increased several hundred fold. It is estimated that 91% of adults in the US use cell phones.

Epidemiological studies look at the relationship between disease and human population factors. The most accurate are prospective studies where a group a people are followed over a long time span to see if there is a correlation with a disease and their exposure. A prospective study concluded in 2011 confirmed this lack of a relationship. Thousands of participants across 13 countries were followed for close to a decade. The was no discernible relationship whatsoever between cell phone use and cancer.

EPA Rules and Regulations

The 1960s saw much turmoil, but one positive feature was the growing awareness of the need to protect the environment. Rachel Carson’s seminal book, Silent Spring, was published in 1962 and brought an awareness of the damaging effects of the use of persistent pesticides. Other dramatic events during previous decades such as fogs comprised of sulfuric acid killed people. This occurred when an inversion layer trapped the stagnant air.

In 1969 the Cuyahoga River in Cleveland OH caught on fire, causing hundreds of thousands of dollars of damage to a couple of bridges. The fire was a result of pollution from oil and other flammable factory wastes – and this wasn’t the first time.

The growing concern of the public, youth activism, and the first Earth Day forced the hand of President Nixon. Previously protection of the environment was spread over several agencies, but mainly the Health, Education, and Welfare Department’s National Air Pollution Control Administration and the Interior Department’s Federal Water Quality Administration. The programs were combined with the creation of a new cabinet department, the Environmental Protection Agency.

Existing laws concerning water were amended and strengthened and became the Clean Water Act of 1972. The act established the basic structure for regulating pollutant discharges into the waters of the United States. And it is not static but rather dynamic, being amended as sound science influenced policy. Changes have met with controversy.

Supreme Court decisions in 2001 and 2006 had left unclear just what the “waters of the United States” mean, so the EPA and Corps of Engineers collaborated on the Clean Water Rule which more clearly defines just what waters will be subject to regulation. The ultimate goal is to protect drinking water. Agricultural, and industrial concerns have called the rule overreach and in fact Attorney General Leslie Rutledge has sued to block the implementation here in Arkansas.

Similarly the Clean Air Act has existed since 1963 but has been amended several times as needed to protect the air we all depend on. Toxic emissions that resulted in acid rain, and levels of heavy metals that can cause nerve damage and especially brain damage (Mercury, Cadmium, Lead) have been lowered in the environment.

The EPA has been studying haze (smog) in National Parks and Wilderness Areas since 1988. In 1999 they began an ambitious program to work with states to clear the air. The haze is due mainly to power plant emissions of fine particulates. The Regional Haze Rule however has been delayed to the point that recently The Sierra Club has sued the EPA for failing to implement a plan in conjunction with the state of Arkansas. [disclosure: I am an officer in the Arkansas Chapter of the Sierra Club]

Another contentious feature of clean air results from Bush’s EPA declaring Carbon Dioxide a pollutant in 2006. Much litigation later, President Obama has sought the Clean Power Plan, meant to reduce CO2 emissions by 32% by 2030. Both the Regional Haze Rule and the Clean Power Plan are being vigorously opposed by our Attorney General as being too costly.

As the population continues to grow, our regulatory structure must meet the demand of more pressure on clean air and clean water. We are the problem, and we have to be the solution.

Mean Coal

To say that every time you flip a light switch, you kill another coal miner would be an outrageous and unsupportable allegation, but we need to think about the costs, in addition to the electric bill, of keeping the lights on.

Close to half of the electricity produced in the U.S. comes from burning coal, and a lot of it. Current use is about a billion tons of coal a year. The costs we pay directly include the actual costs of extraction of the coal, and additional costs tangentially related to coal extraction. The tragic deaths of 29 miners in West Virginia forces us to see these additional costs.

In addition to the deaths from accidents are the more significant but less dramatic deaths from diseases associated with coal mining. Black lung disease is estimated to take 1,000- 3,000 thousand lives per year. Chronic, non-lethal conditions such as related cardiopulmonary diseases affect many, many more miners. If the coal companies pay the health care costs associated with mining, then the cost is added to the price we pay for electricity, but the emotional costs are immeasurable and born by the miners and their families.

We literally have to decide what a life is worth. How much are we willing to spend on our electricity to prevent another death through greater but much more costly safety regulations? Put more bluntly, how many deaths and how much debilitating illness will we tolerate to save money on our electric bill?

Costs which we bear collectively but outside the cost of electricity are more insidious. Severe environmental degradation occurs when mountain top removal strategies are employed to get at coal seams. The tops of mountains are blasted and pushed into surrounding valleys. Acid drainage from various mining techniques can destroy virtually all life in affected watersheds. Emissions from the burning of coal include numerous toxic metals such as mercury, cadmium, lead and arsenic. More radionuclides are released to the environment from burning coal than the total fuel cycle of nuclear reactors. Coal combustion is the major contributor to global warming and and changes in ocean chemistry through acidification.

So the question becomes what do you want to pay for your electricity, in dollars, lives and the environment you leave to our children. The most important thing you can do is examine how much energy you use. You really don’t need kilowatt-hours of electricity. What you want is a warm in the winter, cool in the summer, well-lit house. Or a successful business that meets the customer’s needs.

To a surprising degree, this can be achieved through the utilization of what Amory Lovins calls “negawatts.” That’s the energy you don’t use through efficiency. It’s better than a free lunch, it is a lunch that pays you to eat it! Examples abound: LED light bulbs, attic insulation, shade trees, and clotheslines just to name a few.
Even if we don’t act responsibly, ultimately we will power the world without burning carbon because we will have used up it all up. But we can act responsibly, we can decide that the adoption of a world powered by truly sustainable energy is our best and only future.


Lethal Laetrile

In 2013 the parents of a 2 year old girl abandoned traditional medicine in Maine and sought a alternative healer in Arizona for treatment of a form of eye cancer. This was against the recommendations of the physicians in Maine who had determined that the cancer had spread to the surrounding tissue and needed additional conventional treatment.

The alternative healer, Martha Grout MD, didn’t use traditional treatment for the condition, a known protocol but rather substituted the use of Laetrile, which has never been shown to be a treatment for any condition, much less cancer, and is not approved for use by the Food and Drug Administration.

The drug was administered by the doctor at about 3 PM and the child was dead by 8. Cause of death? Cyanide poisoning. The doctor was reprimanded but not prosecuted and continues to practice her particular voodoo.



Laetrile, aka Amygdalin, is made from the seeds of the Rosaceae family and contains a substance which when consumed releases cyanide, in this case a lethal dose. So much for safety of this “natural medicine.”

Laetrile has been around since the 1950s but has never been shown to be effective in treating any condition. The original proponents suggested that normal cells can’t cause the release of cyanide, only cancer cells could. Cyanide would only be released within a cancer cell, killing it, but sparing normal cells. Not true.

Steve McQueen, the actor known for motorcycle chases in a World War II movie or a car chase movie in San Francisco, died while receiving Laetrile treatments in a clinic in Mexico in 1968. Laetrile can still be obtained from Mexico.

When the FDA began seeking fraud prosecutions for those selling Laetrile, the story changed. It was then described as a vitamin (Vitamin B-17), a deficiency of which could lead to cancer. This tack was taken because vitamins are regulated differently than drugs. Again the problem is that it is just not true. Laetrile is not a vitamin. There is know known condition that results from not having Laetrile as part of any diet.

Yet again the story changed. Once it could no longer be legally marketed as a vitamin, it became a necessary ingredient in a holistic approach to complete health, what ever that means.

Today the field of quackery is wide open due in large part to the internet and a significant change in the law with respect to how drugs are regulated. Previously anything sold as a drug had to be proven both safe and efficacious. In 1994 Senator Hatch of Utah sought and had enacted the Dietary Supplement and Health Education Act.

Basically it defined a new class of “drugs” known as dietary supplements that no longer required proof of effectiveness or even safety. The only protection a consumer has is that the substance is what it claims to be, and doesn’t claim to be a drug. Advertizing is rife with claims such “supports a healthy” or “contributes to” or “promotes.” These terms can be interpreted by consumers as a supplement may really do something, but are sufficiently vague that they escape any regulation as a real drug.

Now more than ever – caveat emptor – let the buyer beware.


Ozone – Stratospheric or Tropospheric

What is the next word you think of if you hear the word ozone? About twenty years ago the answer would invariably have been hole, as in the “ozone hole” over the Antarctic is expanding. Currently if you hear of ozone at all, it is more likely in the form of ozone alerts which occur most commonly on hot summer afternoons in urban environments.

Ozone is another of those Dr. Jekyll, Mr. Hyde molecules. It is at the same time both beneficial and dangerously toxic. It all depends on where it is. Way up in the stratosphere, about 25 kilometers up, it protects us from deadly Ultraviolet rays from the sun, but down near the ground where we breath it is a reactive substance which damages lungs and exacerbates asthma and cardiovascular disease.

There is fairly good evidence for life arising on this planet over 3.5 billion years ago. One hypothesis is that life formed in the seas, as life on the surface of the planet was impossible due to the intense deadly Ultraviolet (UV) rays striking earth. A few billion years later and following the evolution of the chloroplast, oxygen (O2) began to accumulate in the atmosphere. In a cyclic process in the upper atmosphere the more abundant O2 is turned into Ozone (O3). This tiny bit of Ozone absorbs the dangerous UV rays and makes life possible on the surface.

Life then climbed out of the primordial soup and started building air conditioners, refrigerators, and the like which require a refrigerant to work. Compounds know as Chlorofluorocarbons (CFCs) were chosen because they were effective, non toxic and relatively stable. Bear with me here, I’ll get back to Ozone quickly.

Ozone hole over Antarctica

Ozone hole over Antarctica

It’s the stable part got that gets us in trouble. When CFCs escape the refrigerator or air conditioner, they get in the atmosphere. They are stable enough to get all the way up to the Ozone layer without falling apart. There a combination of reactions destroys the Ozone. Enough could literally wipe out life on the planet. Even small amounts of Ozone destruction lead to an increase in retinal damage and skin cancer.

And that is the story of the Ozone hole, a climatically related figure of speech referring to a lessening of the total amount of Ozone in the stratosphere. Luckily we figured this out and by an international agreement known as the Montreal Accords agreed to ban the production and use of these substances. The Ozone hole is slowly shrinking and is by about 2050 expected to be completely healed.

Now back to ground level Ozone, the Ozone we don’t want. Ozone formation at ground level where we breath is not natural. The the fault here is internal combustion engines – Cars and trucks and buses that run of gasoline or diesel.



Because engines aren’t 100 per cent efficient, some uncombusted gases escape the tail pipe. Known as volatile organic carbon (VOCs), they react with Oxygen and sunlight to produce Ozone. Luckily Ozone is unstable and degrades rapidly so if it forms in the afternoon, it is gone by the evening. Toxic ground level Ozone can be controlled by reducing the production of the VOCs. Reducing the number of cars in urban environments through mass transportation is a very effective measure. Alternately reformulating fuels to produce less VOCs works to some degree, but raises the cost. Natural gas fueled vehicles produce less VOCs and electric vehicles none.

Affordable Care Act

Disincentivizing Work

The Republicans have a bright and shiny new word they’re using to bash the Democratic Party in general and Obamacare in particular — Disincentivize. As in Obamacare disincentivizes Americans to work.

This characteristically disingenuous attack on The Affordable Care Act (ACA) comes from a purposeful misinterpretation of a recent Congressional Budget Office report titled “The budget and Economic Outlook: 2014 and 2024.” About 30 pages out of 175 addressed the ACA.

The point the Republicans tried to exploit was a couple of lines that said “The ACA will reduce the total number of hours worked, on net, by about 1.5 percent to 2.0 percent during the period from 2017 to 2024, almost entirely because workers will choose to supply less labor — given the new taxes and other incentives they will face and the financial benefits some will receive.”

See, ensuring access to healthcare takes away jobs! No, not really. What the report said is some people who previously had to keep a full-time job just to be insured may not need to. The ACA ensures that affordable insurance is available to individuals regardless of pre-existing conditions or income.

People who can now get insurance on the open market can decide to work less, or retire a little earlier than they would have. If a person retires early, this opens up a job for another worker — a far cry from taking away jobs.

Once it was clear that jobs weren’t being taken away, the Republicans switched to the disincentivise mantra. This is their argument: If a person doesn’t have to work to maintain access to expensive health insurance, then they won’t work. Access to affordable healthcare makes us lazy. Really, that’s what they think.

Republicans have traditionally resisted just about everything which contributes to the quality of life. People are lazy because they would like to be able to spend more time with their family? People are lazy because after working long and hard, and saving their money, would then like to retire a little earlier? People are lazy because they would rather not work two jobs if they didn’t have to? Really?

Americans already work the longest hours among workers in the industrialized world. That means we have less time to be with our families, less time to enjoy time with friends, less time to volunteer for our church or club. What is wrong with this picture?

You know what else disincentivizes people to work? Those things that contribute to the enjoyment of the American dream — the 40-hour work week, overtime pay, Social Security, Medicare, Medicaid, and now the Patient Protection and Affordable Care Act.

Should we get rid of the mortgage deduction for home ownership and the dependent allowances on our income tax? Saving money disincentivizes work? Meanwhile, the Republican controlled House of Representatives will be taking the next two weeks off, on our dime. What’s that about disincentives to work?


Worried Sick- the Nocebo Effect

A synthetic form of thyroxine called Eltroxin, chemically and biologically identical to natural thyroxine, has been in use for over forty years. It is used effectively to treat hypothyroidism which if left untreated can result in a range of symptoms up to and including heart disease. In 2007 GlaxoSmithKline moved its manufacture from Canada to Germany. At the same time they updated the actual tablet, changing its physical form but leaving the active ingredient the same.

Shortly thereafter in New Zealand a trickle of reports of adverse side effects not seen before were received by a health monitoring organization. After the new side effects began to show up in the press, reports of the new symptoms skyrocketed over a thousand fold even though the only difference was the appearance of the pills, not the chemistry.

A study by a team of Italian gastroenterologists involved patients who were lactose intolerant and a control group who weren’t. The subjects were told that the study involved examining the effects of lactose on the gut. Even though the subjects were given only a glucose tablet which can not cause symptoms, forty four percent of those intolerant and and 26 percent of those tolerant, reported gastrointestinal problems.

Many here in the US and overseas suffer from a so called WiFi syndrome. A range of symptoms including nausea, head aches, joint pain etc. occur when they know they are exposed to electromagnetic fields, but only if they know they are exposed. There is absolutely no evidence that the EMF can cause these symptoms.

These examples are only three of hundreds of examples of what is know as the nocebo effect, from latin for “I shall harm”. In years past this may have been referred to as a form of mass hysteria, now more benignly called a psychogenic illness. In some cases it has been shown that the mere suggestion of a possible symptom or side effect can cause a biochemical change in the body which results in the symptom, but only from the suggestion.

This was shown elegantly in an animal model using rats. They were trained by classical Pavlovian training to become asthmatic. First the experimenters gave the rats a natural substance, histamine, which causes an asthma reaction and paired that with the ringing of a bell. In subsequent trials just the bell ringing would cause the rats to release excess histamine into their blood, thus triggering an asthma attack. If rats can be trained to become asthmatic, shouldn’t it be true that people who have asthma reactions could be trained to not react?

The nocebo effect is the evil twin of the better known placebo effect, latin for “I shall please”.

nocebo and placebo

nocebo and placebo

Any benefits of homeopathic medicine, and much folk medicine are a result of the placebo effect, including modern day agents associated with Traditional Chinese Medicine, acupuncture, much of chiropractic, and over the counter medications called nutritional supplements.

The question as to whether society should allow profit from the sale of placebos is a moral one. Should some one make money by suggesting that a nostrum will do something, even if it only works for believers? It sure works for Madison Avenue. Ca-ching.

Get the Shot!

Being a geek, I’m a big fan of the TV sitcom, “The Big Bang Theory”. It is well written and does a good job of reflecting real science. Several of the characters are scientists. Amy Farah Fowler is Sheldon’s sort of girlfriend. The character is portrayed by actress Mayim Bailik, a neuroscientist who holds a PhD from UCLA .

Here’s the problem; Amy the character, appears to be more scientifically literate than Mayim the real life scientist. Mayim is the spokesperson for a group with views that go far beyond main stream medicine, such as recommending homeopathic treatments and not following scientifically accepted vaccination schedules for infants. The former would substitute ineffective sham medicine (homeopathy) with scientifically proven, efficacious drugs. In the case of the latter, rejecting vaccinations or even delaying an appropriate vaccination schedule puts not only the person or their children at risk of unnecessary illness, but also society at large.

The effectiveness of vaccinations depends on so-called herd immunity. To stop communicable disease does not require absolutely everybody be vaccinated, just a high enough percentage to disrupt transmission. Some individuals can’t be vaccinated for certain diseases for example neonates and pertussis- whooping cough.

Fall and rise of Whooping cough

Fall and rise of Whooping cough

They are protected from this once common disease by virtue of the fact that those around them have been vaccinated and therefore don’t carry the disease. If an older unvaccinated child gets pertussis s/he can transmit the bacterium to an infant with fatal results.

A real problem with getting a vaccination is a misperception of risk. A person may known of someone who got a flu shot, and had a bad reaction or had the shot and still got the flu. This knowledge introduces a bias. It doesn’t however change the fact the the overwhelming odds are in favor of getting the shot. Depending on the vaccine, the strain of influenza, and several host factors,

“ …How well a flu vaccine works is challenging, in general, recent studies have supported the conclusion that flu vaccination benefits public health, especially when the flu vaccine is well matched to circulating flu viruses” – Centers for Disease Control statement. The odds of a severe negative outcome, usually to an allergic reaction to the vaccine are in the one to millions range.

Back to the bias of knowing someone for which a flu shot didn’t work, or had a reaction. Does knowing someone who won the lottery make you more likely to win the lottery? Most folks would say of course not. But this is the same kind of bias. You think of just one outcome among many, many. But that doesn’t change your odds.

We all know someone who doesn’t wear a seat belt. S/he frequently justifies the self-endangerment by claiming that they know of a case where someone died due to the seat belt. The same bias. Evidence from literally billions of passenger miles shows seat belts save lives.

Vaccinations are generally safe and are generally efficacious. Vaccinations protect not only those vaccinated but also others through the herd immunity. Participate in society, get the shot.