The Perfect Disease Surveillance System
Posted on August 23, 2016 4 Comments
How is it that we get to know about diseases like Zika or Ebola? Is it just dumb luck that we encounter patients and then go from there? In a way, yes. These diseases, especially novel ones, have a way of just popping onto the radar without warning. Then we respond vigorously because we weren’t able to do something about the first few cases before the whole thing got out of control.
But what about other diseases? Read More
To Hillary Clinton, I’m Part of the Team
Posted on July 29, 2016 4 Comments
In a vacuum, if both presidential candidates had said/done/tweeted nothing up to this point, I would probably be leaning toward The Orange One. That’s because I am very tired of politicians. Yes, I acknowledge that politicians are necessary in government because not just anyone can do the job. You need someone who knows how to work the system and work within the system.
Then again, the system is broken.
If the system were a television channel.
So I would look to someone who is not a politician and wants to upset the system (or fix the antenna, at least). That person would also have to be a good manager because they would be in charge of a huge bureaucracy (and hopefully cut it down to size). We need a manager in the Executive Branch, not so much a leader. Our leaders can come from just about any other part of the government or the world.
A leader, not a politician.
But we don’t live in a vacuum, and both candidates have said and done things. The Orange one has made it clear that I am not welcomed in this country on account of where I was born. To him, I am a rapist, my friends are terrorists, and my other friends are existential threats to American family values. To him, my wife shouldn’t be listened to because she has 0% silicon in her. To him, he and only he can fix everything that’s wrong.
This is not to say that Hillary doesn’t think that she alone can fix what’s wrong. I believe she does. She just doesn’t say it out loud. Instead, she says that I am part of her team and that my contributions will help her fix things. This is closer to the real world than what Orange is saying. If you really think about it, there is only so much the President of the United States can really do to impact our day-to-day lives. Taxes are set by Congress. The President can only sign or veto tax bills. The safety of my neighborhood is a combination of the efforts of my neighbors and I and the efforts of our local police force. The value of my home is more dependent on my local and state governments than on federal action.
And I like it that way.
Just like I did last week with Trump’s speech, I read Hillary Clinton’s speech instead of listening to her deliver it. I didn’t want to be biased by how she looked, how she sounded, the reaction from the crowd, or what the talking heads said about it. I didn’t even read the comments about her speech on the Gawker.com post.
Don’t ever read the comments.
On the one hand, her speech was very upbeat and optimistic. It was a total contrast to last week’s speech, where the US is in shambles and we’re all going to be killed by radical terrorists. (Radical terrorists are not an existential threat, by the way. Not even close.) She emphasized teamwork and — dare I say it? — collectivism, albeit while giving individual and exemplary examples to prove her points. She explained why it is necessary for us to work together to overcome the problems that our country faces.
Hillary is right, of course. But it’s Congress that really needs to have its members learn to work together. Their collective inactions and partisan actions are tearing us apart and creating too much uncertainty. If Hillary can do as she promises and get bipartisan support for action, then sign me up. But, like a lot of people in the country, I have my doubts.
I have my doubts because of the way that so-called Republicans have been spending millions of dollars on investigating her and holding hearings about her. Were hearings necessary? Yes, but then the hearings got repetitive. They got personal. And it became clear that, like they promised when Barack Obama became president, they are going to vow to themselves and their funders that they’re going to do everything in their power so her presidency fails.
I’m also convinced that Hillary has made some strange allegiances in her time in politics. She may very well owe some favors to people who don’t have our collective best interests in mind. Or she might owe favors to governments who don’t have the United States’ best interests in mind. And that’s worrying.
But I do agree that college shouldn’t be the only way to success. Plenty of people make good livings and contribute mightily to society on only a high school degree, or training in a trade. My house would have fallen apart a couple of winters ago if it wasn’t for a plumber. Dad helped raise me while working fixing cars and machines and placing insulation on oil containers. My cousins drive the sweetest rides while working as welders and technicians. And a lot of men and women help us study public health in comfort while cleaning up after us at the school.
I also agree that going to college should not leave you with a mountain of debt. I agree that we need to get to work on climate change immediately, increasing the use of solar and wind power and decreasing the use of hydrocarbons (i.e. oil). Though I disagree that government alone should fund these endeavors. Instead, the government should make it easy (with less regulations and more incentives, more seed money) for private companies to take these alternative energy technologies to market.
As far as national security, it may seem like I don’t care because I’ve told you that there are other more pressing problems (like heart disease, diabetes, and malaria) killing more people than terrorism. At the same time, I am well aware that terrorism has the uncanny power to disrupt economies. I’m aware that Putin’s Russia wants to be made great again by meddling with the sovereignty of other countries, or even invading them. And I am aware that China has big plans for the Western Pacific.
This is where Trump’s ability to manage kind of doesn’t account for much. Here’s where the Commander in Chief needs to have experience in international affairs. While it may not be the right experience (ISIS ran amok and the “line in the sand” was stepped over and over by Assad), Hillary has the experience of being Secretary of State. It’s not an easy job. It can’t be. Pakistan could have lost its collective mind after Bin Laden was taken out on Pakistani soil by American soldiers. She was there to guide the diplomatic effort to smooth things over.
Finally, from seeing the cast of (non-celebrity) characters who came on stage at the convention and who she is likely to have in her cabinet and brain trust, I’m not worried about her handling of things if she becomes the President. I am, however, very worried about the management of things if Trump becomes the President. With her shortcomings and failures (personal and professional), a second Clinton Administration that doesn’t push nationalism and xenophobia is palatable.
So I guess I’ll hold my nose and vote.
(I’ll review the Green Party and the Libertarian Party candidates’ speeches at a later date.)
Everyone Was Looking For Answers
Posted on July 28, 2016 3 Comments
My wife and I went to a town hall meeting in Carroll County, Maryland, yesterday. The meeting was about the opiate drug abuse epidemic and what different agencies and people were doing about it. The keynote speaker was an agent with the Drug Enforcement Agency (DEA). He gave the usual statistics on number of deaths and overdoses, and what his agency has been doing to counter them. He also talked about how most of the heroin being used in Virginia, Maryland, Pennsylvania and West Virginia flows from Baltimore on what is called “the heroin highway.” (Of course, he clarified that heroin and other opiates are being illegally imported from Mexico.) We then got to hear from people in the community who run different intervention programs. Included in those presentations was one by the local hospital. It went “dilaudid-free” this year, and they’ve seen the number of “seekers” go down along with an increased positive response about pain control from other patients. In essence, not everyone needs dilaudid — a powerful opiate-based analgesic — for things like sprained ankles or strained backs.
People from the local and state health departments also spoke about their agencies’ efforts to curb the epidemic. Locally, they’re raising awareness about the link between abusing prescription painkillers and getting hooked on heroin. They’re also using recovering addicts to talk to peers about prevention. And, of course, they’re distributing Narcan to friends and family of people abusing opiates and heroin in order to prevent deaths from overdoses. Statewide, new rules are coming online to keep track of what opiates and how many are being prescribed. In that vein, a lot of finger-pointing was done at dentists who give prescriptions for 30 days of OxyContin for tooth extractions or installation of braces. A lot of the attendees — many of them parents whose children were prescribed these opioids for “simple” procedures — said that it seemed to them that prescribers (e.g. dentists) didn’t want to deal with a complaint about pain, so they just prescribe the strongest thing in their arsenal.
Most painful of all were the stories of parents whose children died recently from heroin overdose. One parent, a pharmacist, talked about a “pill mill” not far from our location. He wanted something done about that because his child started off addicted to OxyContin. Another parent said that she still has some heroin from her child at the home, and she wanted the local sheriff to take it and analyze it to see if they could trace it back to the source. (Something that is very difficult, if not impossible, to do.) Other parents gave similar stories of otherwise “normal” children who fell into opioid drug abuse and then moved onto heroin, which is easier to acquire and quite cheap.
I say that these stories were painful not only because of the loss of life, the loss of their children. It was painful because it was obvious that they wanted answers, they wanted someone to pay the price for their loss. But there was no one to blame, at least not in the room. For the parents who wanted the drugs analyzed in order to maybe find a dealer, it’s probably not going to happen. And, even if they do track down the dealer, the chance of the dealer being charged with their son’s death are low. And I can see how that must be incredibly frustrating. Someone, somewhere, made the conscious decision to manufacture and sell poison to their kids. Someone profited from their deaths. Even if the chances of people “in the game” are likely that they’ll get killed or seriously hurt for being in it, someone is getting away with hurting those who overdose and/or die.
However, the answers to the epidemic are almost as varied as the drugs that are being used. You can seal up the border to keep heroin from coming in through Mexico, but you’ll have it come in from Asia via Canada. Or you’ll have designer opiates (like all the Fentanyl variants) being made here in the US. And, of course, you’ll have prescription opiates being handed out like candy by people who don’t want to hear your whining about your broken leg. Or could severely restrict prescriptions, piss-off the pharmaceutical industry, and have people move to heroin as they can’t get their pills. Then you could do both, but the underlying social and mental health issues that drive people to addictions are not addressed and they go to other dangerous/illicit drugs (or some licit ones like alcohol and marihuana in several states).
In a perfect world, you would dismantle drug cartels by taking away the demand for drugs. You’d take away the demand by solving social problems that lead people to want to escape their situations by abusing heroin and other drugs. You’d also have mental health readily available to help people who have something happen in their life that leads them to want to escape. Or, if they’re there already, you’d have recovery services ready to help. You’d also have clean needles to prevent infections and people from dying, or Narcan in every public place (like Automated Electronic Defibrilators are now) and in the hands of every addict and their immediate circles in order to keep them alive.
Of course, there are other things that work which I might be forgetting.
While some at the meeting were being optimistic that maybe the epidemic was subsiding, I’m not as optimistic. Looking at the trends, this thing is happening in waves. As Baltimore and other major cities get “dangerous” during the summer, people turn to other drugs to fill their needs. Then they go back to buying heroin once things calm down in the cooler/colder months. Heroin overdoses seem to wax and wean like that, just like almost everything else in epidemiology. I certainly hope that it is calming down. I hope that more parents aren’t looking for more answers. But I don’t know… I just don’t know.
That’s Weird. Radical Islam Is Not an Existential Threat, According to WHO and the World Bank
Posted on July 25, 2016 1 Comment
There’s this thing that you do when you work in public health. You try to look at the top causes of death and disability so you can better understand what you need to do in order to save lives “millions at a time” or some such. To do this, you need to be mindful of all sorts of things, like your sources of data, the quality of the data, and the best way to compare your populations with reference populations. There’s a whole series of courses in public health about this, and they’re very neat to listen to because you get an understanding of why epidemiologists don’t panic.
Seriously, we never panic.
This dog is an epidemiologist during a pandemic.
The reason we don’t panic is because there are always bigger fish to fry, so to speak, when it comes to death and disability. For example, while the deaths of thousands from Ebola is a tragedy — especially because of the delayed response from “The West” — those deaths were a very small number compared to other infectious diseases hitting Africa, hard.
In 2012 alone, there were between 473,000 and 789,000 deaths from malaria in the world, with 90% of those deaths occurring in Africa. (Source: WHO) In 2014, between 690,000 and 990,000 people in Africa from HIV/AIDS. (Source: WHO) Thankfully, advances in antiretroviral therapy for HIV infection and better nets and repellents for mosquitoes are making a dent in all those deaths.
When people started talking about the end of the world because of Ebola, I didn’t panic. (I hope you didn’t, either.) I actually called into a radio show (Michael Smerconish on Sirius-XM satellite radio) and told the dude that the fly was coming. In America, on any given flu season, between 3,000 and 69,000 people die from influenza, a vaccine-preventable disease. (Source: Me. I know a thing or two about influenza.) To panic over one or two cases of Ebola making their way to the US from the returning healthcare workers was not the best thing to do. “We’ll see,” the dude said.
Yeah, we saw.
I told you the other day about the Republican candidate for the presidency making it sound in his rhetoric like the US was in shambles, all immigrants were roaming the streets raping and killing, and Muslims were ready to take out America. And that was just from reading the speech. I’ve listened to it since then, and, Jesus Christ, he made me fear for my life for 2.3 seconds. Then I remembered that the world is at an all-time low in terms of violence, and so is the United States of America. (Sources: The Washington Post and Slate.com)
Have you ever been afraid of flying on a plane? I have. My fear doesn’t come from ever being in a plane accident. Heck, none of the flights I’ve been on have ever even had to diver or go-around on landing. I’ve been afraid at times because my brain races to the worst possible outcome when flying. Any little jump, and the plane is going down.
Or worse.
And it all comes from watching stupid television shows about plane crashes, or YouTube videos, or hearing stories from people who have been in an accident. Because I know these things can happen, the brain tries to tell me that they will happen. It’s that weird ability of the brain to conjure up the worst possible scenarios in order to keep me alert and ready that has made me get a little clammy when flying through turbulence.
I’m still getting my pilot’s license one day, dammit!
So there is this group of evil people out in Syria and Iraq — some in Lybia and Egypt — who are convinced that the only way they’re going to get their way is through fear. They put up some really awful videos of people being beheaded or drowned to death, or worse. They “inspire” people in other parts of the world to just go berserk and kill people for the hell of it. And they do it all, according to them, in the name of Islam.
A quick aside:
Now, I don’t know about you, but if these bozos decided to say that they were doing these horrible things in the name of Christianity, we would probably not call them Christians. And that’s because these horrible things go against every single tenet of Christianity. However, for some weird reason, people in the United States and other “Western” countries are quick to call them “Islamic” or “Muslim” terrorists. They’re terrorists, alright, but they’re not Muslims. Muslims don’t do these things that these terrorists do.
But, whatever, you want to play the name game. Go ahead.
Back to our blog post:
Anyway, these terrorists do all these crazy things, and the number of people they hurt and/or kill — although a tragedy and something that needs to be stopped — is very small in comparison to the big killers out there in the world today. The top 20 killers, according to WHO, are:
- Ischaemic heart disease
- Stroke
- Lower respiratory infections
- Chronic obstructive pulmonary disease
- Diarrhoeal diseases
- HIV/AIDS
- Trachea, bronchus, lung cancers
- Diabetes mellitus
- Road injury
- Hypertensive heart disease
- Preterm birth complications
- Cirrhosis of the liver
- Tuberculosis
- Kidney diseases
- Self-harm
- Liver cancer
- Stomach cancer
- Birth asphyxia and birth trauma
- Colon and rectum cancers
- Falls
Falls! You’re more likely to die from living to be so old that a fall will kill you than from being killed by terrorists. And, according to projections from WHO and The World Bank, the top 20 killers in 2030 will be:
- Ischaemic heart disease
- Stroke
- Chronic obstructive pulmonary disease
- Lower respiratory infections
- Diabetes mellitus
- Trachea, bronchus, lung cancers
- Road injury
- HIV/AIDS
- Diarrhoeal diseases
- Hypertensive heart disease
- Cirrhosis of the liver
- Liver cancer
- Kidney diseases
- Stomach cancer
- Colon and rectum cancers
- Self-harm
- Falls
- Alzheimer’s disease and other dementias
- Preterm birth complications
- Breast cancer
Notice anything interesting? By 2030, your chances of growing to an old age are so good that you’ll be more likely to die from Alzheimer’s disease (and other dementias) than from terrorists. Note that “homicide” is not on the top 20 lists above.
Of course, you could play Devil’s Advocate and say that these projections don’t take into account a major war, a major famine (maybe from climate change?), or a major pandemic. You would be correct, but those things are not taken into account because their probability of happening is still very, very, very small.
Devil’s Advocate is very tiresome, by the way.
Of course, these numbers are for the world over. There can and will be pockets of concentration of things like pestilence and war. We could have some big, elaborate plot carried out by terrorists that would kill another 3,000 people like those who died on September 11, 2001. (Another 3,000 died that same day in the US, by the way. And another 3,000 the next day and pretty much every day.) Vladimir Putin could get a bug (further) up his ass and decide to invade the Baltic States.
These are not reasons to carry out the wet dreams of authoritarian people on any side of the political spectrum. If either Orange or Hillary tell you that anything outside of that top 20 list up there is an existential threat to the American way of life, do not believe them. And if either of them takes away research dollars to fight obesity, heart disease, vaccines, cancer, safer cars, mental health and diseases of ageing… Fight them. Fight them until you can’t fight them any more.
Or until they can’t fight. Whichever.
The things that will kill you
Posted on July 23, 2016
Just listening to the news, you’d think that all of us were going to get killed tomorrow from a massive terrorist attack. Heck, some of my colleagues have been going on so much about Zika that they make it seem like we’re all going to die from Zika… Or that a whole generation of children are going to be born microcephalic.
No, you’re not going to die tomorrow from a terrorist attack. Yes, Zika is a big deal, but it’s not the biggest deal out there.
Take a look at the following table:
If you read it closely, you’ll see that there are a lot of things out there that can kill you, but you should also see that what is likely to kill you varies depending on your age. If you’re under the age of one, you’re very likely to die from a congenital abnormality. (This shouldn’t surprise you if you know about the great advances in delivering and keeping alive — albeit for a short time — children with conditions which would have resulted in stillbirths previously.)
Throughout childhood and into adulthood, unintentional injuries are the most likely to kill you. But take a look at homicides and suicides. Note how suicides appear in the 10-14 age group and how homicide disappears from age 45 onwards. This speaks to behavior and other risk factors, like socioeconomics.
Speaking of socioeconomics… The table up there is only looking at age groups. When you start breaking down the numbers by race/ethnicity, family income, etc. The numbers start looking a little different. Diabetes probably moves up in ranking in the older age groups, as does heart disease. Homicide is probably at the top in the younger age groups. And so on and so forth.
So if you’re worried about Zika killing you, don’t be. But still wear mosquito repellent. If you’re worried about your plane crashing, don’t be. But still put on your seat belt. If you’re worried about ISIS, don’t be. But still say something if you see something.
To Donald Trump, I’m A Criminal
Posted on July 22, 2016 3 Comments
I tried to be objective and read Donal Trump’s nomination acceptance speech instead of listening to him on television. You can sometimes see something on television and misinterpret it for something worse than it seems.
Case in point.
So I went over to Politico.com and read their transcript of the speech. All I got from it is that America is a violent, impoverished, dreadful place where immigrants are running amok killing everyone. I’ll explain.
Pretty early on in the speech, he talks about violence and how he’s “The Law And Order Candidate” who will bring crime and violence to an end.
Then he digs into immigrants:
“Nearly 180,000 illegal immigrants with criminal records, ordered deported from our country, are tonight roaming free to threaten peaceful citizens.
The number of new illegal immigrant families who have crossed the border so far this year already exceeds the entire total from 2015. They are being released by the tens of thousands into our communities with no regard for the impact on public safety or resources.
One such border-crosser was released and made his way to Nebraska. There, he ended the life of an innocent young girl named Sarah Root. She was 21 years-old, and was killed the day after graduating from college with a 4.0 Grade Point Average. Her killer was then released a second time, and he is now a fugitive from the law.
I’ve met Sarah’s beautiful family. But to this Administration, their amazing daughter was just one more American life that wasn’t worth protecting. One more child to sacrifice on the altar of open borders.”
The thing is, we don’t have open borders. There’s a rather large and militarized force on the border, arresting people who cross into the US through points other than official ports of entry. Not only that, but President Obama has been deporting people at record levels. Even those on the Left who advocate for immigration reform are mad at President Obama for doing this.
So much for open borders.
Later in the speech, he went back to that wave of immigrant killings, starting with how badly the economy has been for minorities because of immigrants:
“Decades of record immigration have produced lower wages and higher unemployment for our citizens, especially for African-American and Latino workers. We are going to have an immigration system that works, but one that works for the American people.
On Monday, we heard from three parents whose children were killed by illegal immigrants Mary Ann Mendoza, Sabine Durden, and Jamiel Shaw. They are just three brave representatives of many thousands. Of all my travels in this country, nothing has affected me more deeply than the time I have spent with the mothers and fathers who have lost their children to violence spilling across our border.
These families have no special interests to represent them. There are no demonstrators to protest on their behalf. My opponent will never meet with them, or share in their pain. Instead, my opponent wants Sanctuary Cities. But where was sanctuary for Kate Steinle? Where was Sanctuary for the children of Mary Ann, Sabine and Jamiel? Where was sanctuary for all the other Americans who have been so brutally murdered, and who have suffered so horribly?”
Of course, there were lots of other things on which Trump failed to represent the truth. But I leave that fact-checking to the professionals at NPR, The Washington Post, NBC News, and The New York Times.
There used to be a time when I affiliated with the Republican Party. I wanted people in power who were fiscally conservative, and I was afraid of radical changes because I was very much influenced by the culture on the US-Mexico border, one very much influenced itself by the Catholic Church and Mexican machismo. Then I moved to south-central Pennsylvania, and I got to see over the years how the Republican Party was taken over by xenophobes, homophobes, and religious zealots. I started to see more and more how people with last names like mine or skin tone like mine were not accepted anymore in the Republican Party.
Most of all, I became friends with people outside my socioeconomic status and outside my culture and race/ethnicity. Going to DC and Baltimore on a weekly basis when I was working at the hospital in PA, I befriended more and more Black people. I got to know LGBTQ people — including the coming out of several people who are my relatives — and see them as regular people. And I got to hear from so-called Republicans how all these people were “prone to violence,” “a scourge,” and “the downfall of our society.” None of that is true from a reasonable point of view, and especially not true if you get to know people like I’ve gotten to know people.
If you listen to or read Trump’s speech, you’d think that we were in dire straits. If you think like he and his sycophants do, you’d believe it even more. Even to the extent to voting for him. But I don’t. Call me crazy, but I see the good in people, and I read the evidence before making a decision. More than anything, I don’t fall for the ecological fallacy (or its reverse).
We’ll see next week what Hillary Clinton has to offer, but I’m not holding my breath for her, either. Until then, the nominee has been chosen.
The Classics Are Always the Best Ones
Posted on July 19, 2016
My favorite type of vehicle is the 1979 Jeep CJ7. Other people like other cars, and some people really, really like their cars. For example, these people at the Carlisle (PA) Car Show… The amount of care and dedication they give their cars is admirable. While I love the CJ7, I would probably stick every bit of technology into it that I could. I’m talking an all-glass panel, GPS, a fuel-injected engine, proximity sensors, etc. Heck, I’d stick avionics in it if it had wings.
But not these folks. They keep these cars as close to original as possible.
The full album can be seen in full resolution by clicking here.
Let’s have some fun with fiction
Posted on July 18, 2016 3 Comments
If you’ve been reading this blog for a while, you should know by now that I love to write. More often than not, I’ll write about my life experiences and the opinions that those experiences have formed. Very rarely do I write fiction, so I’d like to write more.
To help me do that, I bought The Amazing Story Generator by Jay Sacher. It’s a little book that has three sections from top to bottom. Each section consists of hundreds of settings, characters, and plots. So you can have thousands of prompts based on how you open the book. For example, here’s what I opened it to last night:
“The night before the wedding, a former child television star refuses to leave the bathtub.”
Talk about getting your creative side going. What kind of story could come of this?
So I’m going to start writing little bits of fiction based on these prompts and feature them on the blog once in a while.
Girasoles
Posted on July 16, 2016
After having no luck in finding a sunflower patch near my house, I drove down to the Virginia-Maryland line (aka the Potomac River) and found one in a park. The owners set it up for people to go to, but they also did it so that birds would be attracted to the area… So the birds could be hunted. While there was plenty of gunshots in the distance, there was no one hunting near the flowers.
Sunflowers are my favorite flowers, by the way. They get their energy from the sun, and they’re good against zombies.
EpidemioLogical 
You’re Gonna Need a Bigger Bait
Posted on August 17, 2016 3 Comments
I’m learning to discern between constructive comments and comments that are engineered to get a reaction out of me. It’s part of the maturation process, from what I’ve been told.
Now, I don’t ignore all comments. Sometimes I’m bored and respond. But I’m getting better at it. For example:
This was a comment left on the blog about three months ago by a known antivaxxer. He’s been banned from commenting here, but his comments still go into moderation. The dude is convinced that there is some sort of linear relationship between vaccinations and neurological disorders, which is par for the course for these nuts. I’ve ignored his comment all this time.
Just look at the comment. It’s so disjointed. It’s so bizarre.
How can you possibly respond to this without getting yourself into a tangled mess of stuff? I mean, there’s no way to reply to this bufoon without you yourself looking foolish. Trust me. So learn to discern what to respond to and what to ignore, even from your friends. Life is better that way.