Population medicine

Obamacare treats not for the patient in particular, but for the patient on average, globally, or in the abstract

This isn’t a problem specific to the ACA; it’s endemic in national health systems all over the world, all of which are more or less in the thrall of pharmaceutical companies who control and produce most of the research that determines population medicine.

The problem with the pharmaceutical companies sponsoring research however is twofold:  1, they control who gets into the study and define the outliers; and 2, most of these studies are not appropriate for population generalizations because they are small in size or short in length.  Oh, and I guess this makes it threefold:  any results that are not favorable to their drug will never see the light of day.

Now controlling who gets into the study is related to the outliers in that, if in the pretrial part of the study, people who have adverse reactions right away will be eliminated from the study.  So people who might give a truer picture of the drug’s ill effects will have been eliminated right off the bat.  And outliers are defined as people who have reactions that are supposedly really rare and do not give a true picture of the overall study results.  For instance, take Celebrex.  It’s a nonsteroidal anti-inflammatory drug, in the same class as aspirin, ibuprofen, naproxen, etc.  Pfizer, the manufacturer, said its drug was better than those others because it didn’t hurt the stomach.  Well, as it turns out, that was not the case at all.  The reason they were able to claim that is because, if you read the link above, you will find that they only released the first six months of a year’s worth of data.  Most of the stomach problems developed in the second half of the study; because of this they were able to deceive regulators, medical providers, and the public at large into believing this drug was safer.  They altered the study’s parameters to hide crucial data related to side effects, and they explained “poor results as the result of ‘statistical glitches.'”  ***statistical glitches is researcher speak for outlier***

Perhaps the worst offender in this is Merck.  Their drug, Vioxx was taken off the market because of the substantially increased risk of a heart attack while taking it.  This was defined as an outlier in their results – which means they knew there was an increased risk before this drug ever went on the market.  Yet they chose to define a statistically increased risk as an outlier, dump all the data related to the people who had had a heart attack during the course of the study, and publish results that were very positive toward their drug.  Of course, they also paid for a study to be published that was favorable to their product without disclosing their financial relationship and were subsequently sued.  Multiple times, in multiple countries.

Regarding study length:  In the case of Celebrex, they released results related to only six months of what ended up being a six year long study.  How can one make a decision about a medication’s safety or efficacy when the study hasn’t even been completed?  Where are the critical thinking skills for those who are in charge of approving a drug?  Where are the critical thinking skills for those prescribing the drug?  The public doesn’t have the general ability to decide if a study is good or not, they rely on the government to determine a drug’s safety and effectiveness, and they rely on their providers to prescribe drugs that have benefits that outweigh the risks.  They are being seriously failed on both accounts.

Unfavorable results are related to both of the above drugs.  Data that showed there was substantial risk for certain groups of people in both cases was simply hidden.  In many cases, studies are never published at all – their data is simply buried and never sees the light of day.

So why is any of this relevant?  Well, guidelines are created based on the cumulative results of published studies.  And guidelines are what are forced on providers in order to make sure they are adhering to the standard of care.  Standards of care are based on population medicine, not on individual people.  They don’t allow for individual preferences, variability in response to a drug, differences in financial circumstances or lifestyles, religious prohibitions, or any other individual determinants of a person’s ability (or desire) to adhere to a given regimen.

If we can’t rely on the results of studies, we can’t rely on guidelines that are created from them.  And this is a big problem when reimbursement, and even licensing is predicated on adhering to guidelines.  In a local to me case, an Arizona cardiologist is under investigation because he advocates non-guideline based recommendations for his patients.  This is a huge problem.  If a physician can’t read research and make decisions for his practice, but is expected to blindly follow guidelines or face having his license revoked, how can one trust one’s medical provider that they are doing the right thing for you, the patient?

In an even more insidious fashion, the powers that be (government in collusion with the pharmaceutical and insurance companies) are requiring (here in the States anyway) that a provider have an NPI.  That’s a national provider number.  And it has to be printed on all prescriptions or the pharmacist will not be required to fill them.  So what?  Well, if you don’t follow the guidelines, and you don’t accept the insurances the government wants you to — because you prefer to offer your patients advice that you feel is healthier and safer for them as an individual — you can have your provider number yanked even if your license is not revoked.  Either way you can’t fully care for patients and are out of business.  I wish I had links for you for this one, but I don’t.  I don’t even remember where I read this, but trust me when I say this is indeed going on.

Population medicine.  Peak medicine.  Grasping for financial straws.  And you, and I, the little people suffer.


Measles Schmeasles.

I am SO DAMNED SICK of all the hype about the ‘outbreak’ of measles at Disneyland.  So far, nationwide, there are something like 171 ETA 87 cases connected to Disneyland.  171, 87, people.   And how many have died?  NONE. 

When my children were small, my mother, a former nurse and special education teacher, asked me not to continue with the current vaccination schedule because she had concerns about a possible MMR/autism connection.  Now, keep in mind, this was in the early 80’s, LONG BEFORE DR. WAKEFIELD.  My oldest son did have a change in behavior after receiving his first MMR.  It concerned her enough that she made the request.

She also had concerns based on Japanese research, if I remember correctly, about other problems like ADD/ADHD and vaccine induced encephalopathy.  So I did as she asked.  My children *were* fully vaccinated.  Just not according to the CDC schedule.   And not until they were ready to start school.  The key, I believe is that in the 80’s, and early 90’s, the vaccine schedule was approximately HALF the number it is today, and doctors were much more proactive about NOT giving vaccines to children who were sick.  Today?  Not so much.

Let’s talk about measles for a minute, shall we?  My oldest son is the product of a high school romance, and is actually a half brother to my other two children.  Because I was a single mother for the first part of my oldest son’s life, I had to work to support us.  The day care he went to was in the home of an older German woman, who also watched 4-5 other children.  One of these children got measles when Dear Eldest Son (DES) was 12 or 13 months old (14 mo?).  DES got it shortly thereafter.  And so did I.  Now, DES was too young to receive the MMR yet; it was given at either 15 or 18 months of age then (I can’t remember for sure which).  I, however, had been fully vaccinated as a child and *should* have been immune.  Yes, well.  So, at the age of 19, I spent a week with my child in a darkened house, both of us feverish, rashy, and suffering from headaches and light sensitivity.  And then we got better.

This is the normal course of measles, by the way, in a basically healthy population with good sanitation.  Between 2000 and 2005, I believe there were less than 10 deaths from measles.  There have been ZERO deaths since 2005 from measles.  It’s not exactly a terrifying horrible disease that kills millions in the US every year.  And you should know that the side effects *of* the measles vaccine are the SAME as the measles:  encephalopathy, pneumonia, febrile seizures, death.  Adverse effects per the package insert.  Oh, and you can get measles *from* the vaccine.  This is because it is a live virus vaccine.  12 month old with lab confirmed measles, vaccinated Jan 2015.  The difference is that vaccine induced immunity wears off.  That’s why I got it even though I had been vaccinated.  And that’s why DES got it even though he was breastfed, because my waning vaccine induced immunity couldn’t protect him.  We both are PERMANENTLY immune now, though, because we have actually had measles.  My titers reflect this. 

Contrast my story with this:  Doctor fed up with measles outbreak takes controversial stance.  Oh, yes, those children with measles are such a threat.  It’s such a deadly disease that ZERO people have died in the past near-decade.  Terrible risk, isn’t it Dr. Goodman?

Well, here’s the thing.  The strain of virus in the vaccine is no longer the wild type strain of measles.  This is well documented and can be easily (though expensively) checked when measles is confirmed in lab testing.  So people who are vaccinated, AND up to date on their vaccines, can still get and transmit measles, thanks to genetic drift away from the vaccine strain that causes a less than robust immune response.  The body doesn’t quite recognize measles because it’s not quite the same, but sort of the same, so the immune system can’t decide if it should respond with the antibodies it has already made against the vaccine strain or if it’s something else entirely.  Here is a study that documents the differing immune type responses (in cell cultures) between the two.  Notice the statement that the vaccine strain doesn’t induce the strong immune response that the wild type does.  That’s key to this discussion.  Now I should say that my original major was microbiology and immunology, but I do not pretend to be any sort of an immunology specialist or expert, and this is what I get from the studies I have read.  A less than robust immune response is why people are not immune and get subclinical or atypical disease.

So you get measles, you feel crappy (sometimes) but you don’t look like you have measles.  The good thing is that after you *get* measles, you will actually be immune.  Here are some studies that document measles infection in vaccinated populations:  Subclinical measles in Greenland,   Measles and subclinical measles in Africa,  just for a very small sample.  Google “subclinical measles in vaccinated people” for many many more examples.  In fact, the CDC admits this in the MMWR (Morbidity and Mortality Weekly Report) for August 24, 2013:  “Thirteen (8%) of the patients had been vaccinated, of whom three had received 2 doses of measles, mumps, and rubella (MMR) vaccine. “  You can read the rest of the report here.

It’s not that uncommon for outbreaks to occur, and the hype over how dangerous it is is dreadfully overstated.  For instance, this Wikipedia  article quotes the CDC as stating in the 20 years after the measles vaccine was introduced, it prevented an “estimated 5200 deaths”….that’s 260 per year.  Now I’m not trying to denigrate 260 people dying every year from measles, it’s still tragic, but hardly on the same level as, say, heart disease in which the CDC estimates 600,000 deaths every year – 1 in 4 deaths EVERY YEAR from something mainly lifestyle related.

My personal suspicion is that, since the CDC makes $36.22 per 10 pack of vaccines it sells to licensed vaccine providers (that’s your local doctor), it has a pretty profound vested interest in making sure the population is forced into receiving the MMR.  This is especially true since the two main virologists who worked at Merck, the ONLY licensed M/M/R vaccine producers in the US, are being allowed to proceed with their lawsuit  against Merck for fraudulently inflating the effectiveness of the mumps portion of the vaccine.

So, in conclusion, I think the CDC is as corrupt as any private pharmaceutical company, and just as financially reliant on vaccine sales for their existence.  And because I think this, I believe they are deliberately chumming up hysteria and mongering fear about a relatively harmless childhood disease in order to protect a part of their revenue stream.  Vaccinate, don’t vaccinate, it’s up to you.  I’m just not that worried about a measles outbreak in my community.  Vitamins A and D, decent nutrition, lots of fluids, sunglasses, and common sense should be all we need to recover without sequelae.  And that’s it.

And now back to the regularly scheduled knitting and studying frenzy that is my life until my final exam on February 18.


Angelina’s breasts are hers to do with what she chooses.

“How Angelina Jolie was duped into having a double mastectomy for cancer she never had”

A soon to be relative linked to that and made a small rant about it.

I am a member of the ethnic group these gene mutations are derived from.  As a result, it is a topic close to my heart — literally — and that if having a test, and then a surgery, could remove my risk of undergoing cancer treatment, I would do it in a minute.  They are just fleshy appendages.  They served their purpose, they provided sustenance to my three children, and I want to live to see my grandchildren grow up.

One of my aunts had ovarian cancer at the same age I am now, and had a hysterectomy.  My own risk is very high because of such a close relative having this particular cancer.  Do I know for certain we carry the gene?  No, because I haven’t had insurance since before this was a test that was covered by insurance, and I surely don’t have the $3000 it costs for the test.

My grand daughters are at risk for these diseases.  Simply because of heritage.  This is a mutation that allows for passing on of the mutation to the rest of the offspring because the children are already birthed and nursed before the disease reveals itself.  I can’t even imagine what Angelina must have gone through as a teenager, having her mother fall ill with this genetically linked cancer and die when she was only in her early 20’s.  Especially since if the technology had been available earlier to test her mother, they may never have had to go through that horror.

Then I read the following link:

Angelina Jolie part of a clever corporate scheme…

Here’s the thing.  The risks are real.  I don’t think there is any amount of money imaginable that could induce an already fabulously wealthy woman to have this type of surgery, as painful and disfiguring (temporarily at least) as it is, to give publicity and a positive spin on a Supreme Court case that would benefit a private company trying to patent a human gene.

What the hell are these people thinking???

For one thing, the guy who wrote that article obviously knows how to massage statistics.  The numbers he gets don’t exactly add up to what he’s saying they do if they are taken in context with his actual data.  I hate it when people do that to prove a point.  F*ing either make your point honestly, without massaging data, or find some other way to convince people.  And that goes for medical trials too.

I personally think it is utter BS for the company to even ATTEMPT to patent this, and for them to withold/prosecute other companies for trying to offer the testing at more reasonable rates.  If this were any other country but the US, we would not even be having this discussion!  Frankly, if the Supreme Court were going to be influenced by public opinion, Monsanto would be out of business, abortion would still be illegal, and the election of 2004 might have come out very, very differently.

Now the Arizona cops are in on the setups for assault rifles too!

Phoenix shooter found dead in his car

Yesterday there was a shooting in Phoenix; a man walked into an office building and shot several people, killing one. WITH A PISTOL.

Yesterday, he disappeared. WITH THE PISTOL IN HIS POSSESSION.

Today, his body was found. With a pistol shot to his head, apparently self inflicted. YET THERE IS AN (supposed) ASSAULT RIFLE FOUND IN HIS POSSESSION????

I’m sorry, I really can’t believe that story. Why the hell would he pack a an AR 15 in his car but shoot 5 or 6 people with a pistol??? That doesn’t even make sense.

Nope, not buying it. Just not buying it.

It’s Hobson’s Choice. Nosalgia for an economic model whose time has passed, whose time has come again.

I watched an excellent documentary from the 80’s on The Shakers the other night.  Contained within it was a quote from a Shaker made shortly after the Civil War, when mass produced cloth became so common it was cheap.  Too cheap in fact.  He lamented that it’s cheaper to buy cloth than to make it.  But it’s cheaper to weave it than buy it because of the quality of the hand made so exceeds the quality of the mass produced.  Thus, garments and items made from the cheaper cloth must be replaced sooner and mended more than those made from hand woven cloth.  He went on to say basically, that it’s a predicament for which there are no good solutions.

140-something years later and this is still a true statement.  A hand woven dish towel will last 20 years easily; the dish towels bought from Costco, even though of ‘higher quality’ than the dollar store versions, will last no more than 5 at best.  But you can buy at least four dollar store towels for less than even one hand woven one.

For clothing, the difference is even more striking.  There is an additional problem though, at least in industrialized parts of the world; even the majority of hand weavers are afraid to cut their cloth because they do not know how to make cloth that is meant for clothing.  Daryl Lancaster is one of the few American weavers – Laura Frye is another (Canadian) – who has kept that knowledge alive and is passing it on to other hand weavers.  Cloth that drapes well isn’t necessarily cloth that will make a garment that will last more than a few washings.  Our body-conscious culture prefers lycra to fitted linen; it requires a good understanding of cloth manufacture from an engineering standpoint to make hand woven cloth that can be used for quality garment construction and still both look attractive and be durable.  The word ‘sleazy’ referred originally to sheer cloth or cloth made poorly; somewhere along the line it became a word used to mean cheap/tacky/vulgar/low class/whore.  It can mean any of those meanings, or all of them depending on context.

I try not to romanticize the past; our ancestors mostly lived hard, short lives and  I have already exceeded my probable life expectancy compared to 100 years ago.  I would not have even survived to bear children were it not for antibiotics.  I do think, though, that in many ways living standards for the average person, as compared to the wealthy, have declined since the Middle Ages.  It seems to me that while a serf might have been effectively a slave, it was also the case that the lord was perfectly aware that their wealth derived from the work of the serfs on the land they all shared.  Not shared in the sense that the serf owned it, but that they were entitled to live on it, they were entitled to work it, and their time was basically their own once the work for the lords was done.  Work that didn’t require hours of time every single day but rather sporadically and in bursts as the seasons dictated.  The lords did not have access to much better medicine or treatments than the serfs; they didn’t live much longer lives, and they didn’t live (too much) in a way that was drastically better than the serfs.  The plague took as many of the gentry and nobility, percentage wise, as it did the serfs, just as an example.

The Industrial Revolution finished the decline that began more than 200 years previously.  It destroyed sustainable peasantry, their leisure time, their self determination (within limits, of course), and concentrated wealth in the hands of a few who DID live drastically differently and better than their peasants.  This is the time in history when money became essential to life for all classes. Which, of course, puts the poor at a serious disadvantage and effectively makes them slaves to the wealthy in a far more dehumanizing way than serfdom ever did.

I think perhaps this is why Jane Austen’s novels are so beloved by so many knitters and crafters in America.  They romanticize the time without realizing how very destructive that time was to their ancestors, those who were lucky (or unlucky) enough to survive the final destruction of an entire way of life.  They see the leisure of Jane’s characters as indicative of a time gone by without stopping to think that, for the vast majority of us, we would NOT have been the ones with the leisure time, we would have been the ones working 7 days a week as a servant, going without adequate sleep for the entirety of our lives.  Or we would have been factory workers, working 7 days a week in a dark workhouse, straining to see by candlelight, being always hungry.  The grace and beauty of that time period belonged only to the wealthy.

In the Middle Ages, even noble-born women were expected to spin, to weave, to sew and embroider, and to mend, as well as manage their households and act in the name of their husband.  They did not — could not — leave those tasks to their servants.  It was expected that all people in a household, nobility included, would contribute to the production of household goods.  Just as a late example:  Queen Katherine, Henry VIII’s first wife, continued to make his shirts for him until Anne Boleyn demanded he stop accepting them.

Distributism is the technical term for the economic model that arises from re-localization.  And it is an economic model that allows for hand woven cloth, the economy of chickens, and of small farms, and community self sufficiency.  It does not require money as the only coin of exchange.  It is the model of the Middle Ages, the model of the Shakers and other religious communes of the 18th and 19th centuries, the model that was destroyed in favor of savage capitalism.  It is the model that values the economy of hand woven cloth, and the clothing and items made from it, over mass produced inferior cloth.  If we rely on money alone, hand woven items are something only the wealthy acquire and value.  If we rely on interconnectedness, on trading within and among communities for those things we don’t or can’t produce, it is the only affordable choice.

I hate my job.

According to my charge nurse, EIGHT new administrative positions have been created in the last 18 months or so. Which trumps my count of FIVE by almost half. At a salary of $250K minimum.

Yet they are pleading poverty. And cutting staff. And making us take classes on ‘customer service’ and pointing to US as though the lowering of patient satisfaction ratings (publicly available) is OUR FAULT.

I have to find another f*ing job. Today made me sorry to be a nurse. Which was made even more poignant by the fact that a patient took the time to outline what I did for her, how much she appreciated it, and told me she was grateful. I don’t think she saw the tears in my eyes.

Since when does a nonprofit hospital have ‘competitors’….?

It’s not the nursing that I regret. It’s the job. Gotta find a new one where I can actually feel like I’m not being treated like a robot where you can just turn up the ‘speed’ button and get more productivity (work) out of it. Yes, you might get more work, but I don’t think any of us can speak for the quality of the job done.

I told one of the other nurses who said I should be grateful I have a job this: “as long as you are fearful for your job, you are the perfect employee, and exactly what they want, a corporate drone. That way you are too fearful for your job to speak up for what is right.”

I am a whore; I work there because I owe them time for paying for my degree, but I am no drone. I also told her, when she said that we really don’t have a choice, that I DO have a choice. I can work anywhere and be overwhelmed and treated like shit, I don’t need to do it here.

It’s just so frustrating, and angering, and sad. I’m a strong person, but I am close to the breaking point.

Tsunami of human need and dysfunction.

That about describes my day to day environment at my job.

I have applied for a transfer, to two different places. If you are of a mind to, please light a candle, send energy, or pray that one of these places deems me worthy of employment.

I never thought I would see the day that I would be afraid that I would lose my license because of decisions on staffing made by administration, people who don’t work the line and have no concept of the difficulties a line nurse faces.

The words completely overwhelmed, unbelievably fatigued, and frightened, about accurately describe my feelings.

Will miracles never cease?

Mr. TF and I have been stressed for most of the year, thinking we were going to owe tax money even though we’ve earned significantly less money this year than last (Mr. TF lost his full time job in 2009 and has only been working part time this past year). Our property taxes went up even though our valuation went down, why wouldn’t our income taxes go up even though our income went down?

Well, well, well. As Gomer used to say, “surprise, surprise, surprise!” We are getting a refund. Of course, it’s mainly because we’re both in school and got to deduct our school expenses.

Yay, a wood stove is definitely in my future now! The tax refund will go for that! Woo Hoo!