But What If He's Irrational Because He's Sick?

Perhaps you have seen the video of the outspoken candidate for US President who raised the issue of someone who has made the decision not to buy health insurance and then, at age 30, becomes sick and will die without medical care.  And perhaps you heard his audience response? See Krugman link.

People make economic decisions which affect health care for a variety of reasons, including their inability to pay for what they need. But one of the reasons that people make "bad" decisions is their own health.  Cancer may be associated with severe depression which makes a person incapable of making a rational decision on every day things, such as purchasing health insurance. Brain trauma, brain tumors, brain infections, diabetes, Alzheimer's disease and other dementias, metabolic disorders such as Wilson's disease - all may be associated with inappropriate decision making.

The solution - in America -  is not to throw these people (or their family members, including their children) onto the junk pile for easy disposal.  It is finding the compassion and common sense to treat them humanely and appropriately. It is surprising for someone from a medical family to miss this obvious point.  What else is he missing - and is there some medical reason for his missing it?

Food Safety: Safer Food Saves Lives, Suffering and Health Care Costs

Savings under Health Reform involve more than making health care more available, affordable/ accessible, and competent. One way to save money is to protect Americans  from everyday hazards that make them sick - including our food.

We are sickened by our food. The CDC estimates that foodborne diseases "...cause approximately 76 million illnesses, 325,000 hospitalizations, and 5,000 deaths in the United States each year. Known pathogens account for an estimated 14 million illnesses, 60,000 hospitalizations, and 1,800 deaths."   While unsafe manufacturers and food handling processors profit from their carelessness, Americans of all ages suffer and die. The public shoulders the considerable cost shift from dangerous operators in the food industry to America's families..

The Obama administration has begun the process of safeguarding our families by modernizing our  food safety laws, taking steps to implement hazard analysis and risk-based preventive controls, establish safety and performance standards, provide for safe transportation of our food, provide for safe importing of food from abroad, update government's ability to recall suspect food products, and taking other overdue major steps.

Protecting our families by protecting and safeguarding our food supply makes good sense.  Protecting outr health care budget by protecting and safeguarding our food supply makes good sense, too    Let's be sure that our Congressmen and Congresswomen don't through up roadblocks to this important change.  

The Perfect Storm?

As a person who practiced hematology, I learned to ask a few questions early in my career and early in my physician-patient relationships: what kind of work do you do now and what kind of work have you done?  Where do you live now  and where did you live before moving to your current location?  Do you have any occasion to handle toxic materials at work or in your personal life.  Do you live down-wind from a refinery?  When you were in the armed services, did you come into contact with toxic materials, including radiation and chemical warfare or biologic materials? Tell me about your hobbies, and specifically whether you are exposed to wood dust or fine shavings?.  Tell me about your use of alcoholic beverages, drugs and other substances. Tell me about your smoking history.

While all of this may be interesting to my readers, few probably think that it is relevant to them, but environmental toxic exposures play a major role in causing disease.  You may keep your weight under control, be careful about taking saturated fats, never pick up a salt shaker and exercise regularly, but if you are exposed to toxic substances in your environment, in your food and in your home, you may develop leukemia, cancers (bladder, lung, skin, testicles and others), black lung disease, serious infections, emphysema, brain disorders, and a host of other disabling, fatal and expensive-to-treat diseases. And if we allow our children to have those exposures, they are also at risk.

All of which, at a time when the country is working desperately to control its health care costs, makes me wonder why any political party would seek to weaken our environmental laws. Does it make sense to try to roll-back health reform and simultaneously roll back the environmental protections which America - with much effort - has invoked to protect its children, men and women?  Has this become a country in which we cannot trust one another to take reasonable care of our children, workers and vulnerable citizens?  Is the tension between financial interest and the well-being of our citizens always to be resolved in favor of financial interests?

About Alzheimer's Disease

In my medical practice, and particularly in my roles as Medical Director of a women's retirement home and its nursing unit, I frequently dealt with patients who had Alzheimer's Disease  and their families. The beautifully written article, by Arthur Kleinman in Harvard Magazine, "On Caregiving" is worth reading..

Olympics, China, Hand Foot & Mouth Disease

With the beginning of the Olympic games in China, days away, the outbreak of hand, foot and mouth disease ("HFMD") in that country, with associated childrens' deaths, is a cause for some concern. If visitors from the United States are exposed to the virus and bring it back to the US with them, there is a risk of an epidemic which may further test our already stressed health system.

Hand, foot and mouth disease, a highly infectious and easily spread viral disease, is causing death among Chinese children and is beginning to spread among children in Vietnam and Singapore, as well http://www.breitbart.com/article.php?id=2008-05-04_D90ETD5G1&show_article=1&cat=breaking. HFMD may be caused by either a coxackie virus A16 or EV71. EV71 may also cause viral meningitis and, rarely, more serious diseases, such as encephalitis, or a poliomyelitis-like paralysis. EV71 encephalitis may be fatal. Cases of fatal encephalitis occurred during outbreaks of HFMD in Malaysia in 1997 and in Taiwan in 1998.EV71 encephalitis may be fatal. http://www.cdc.gov/ncidod/eid/vol9no1/02-0112.htm

According to the CDC, hand, foot, and mouth disease (HFMD) is a common illness of infants and children which is characterized by fever, sores in the mouth, and a rash with blisters. It begins with a mild fever, poor appetite, malaise ("feeling sick"), and frequently a sore throat. Then, one or 2 days after the fever begins, painful sores develop in the mouth which begin as small red spots that blister and then often become ulcers. They are usually located on the tongue, gums, and inside of the cheeks. The skin rash develops over 1 to 2 days with flat or raised red spots, some with blisters. The rash does not itch, and it is usually located on the palms of the hands and soles of the feet. It may also appear on the buttocks. A person with HFMD may have only the rash or the mouth ulcers. http://www.cdc.gov/ncidod/dvrd/revb/enterovirus/hfhf.htm

According to the CDC, HFMD is moderately contagious. Infection is spread from person to person by direct contact with nose and throat discharges, saliva, fluid from blisters, or the stool of infected persons. A person is most contagious during the first week of the illness. HFMD is not transmitted to or from pets or other animals.

No specific treatment is available for this or other enterovirus infections. Symptomatic treatment is given to provide relief from fever, aches, or pain from the mouth ulcers.