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Dr. Gottlieb for FDA

Tuesday, March 14th, 2017

This is a great story and Trump is to be commended in his selection to run the FDA. Scott Gottlieb is a fine physician who knows this area well and can sharply articulate efforts to alter the problems in this agency.

Scott Gottlieb, Trump pick for FDA, is on the side of the little guy

WASHINGTON EXAMINER

March 14,2017

 

President Trump’s pick for the Food and Drug Administration, Dr. Scott Gottlieb, is qualified and capable. He will do great work if confirmed, but his nomination provides a great opportunity to lay out a crucial lesson that regulation often serves to protect big business from competition, harming the consumer.

The Democrats’ attack on Gottlieb is easy to predict. Reporters have already provided the template. “He is seen as a strong supporter of [the pharmaceutical] industry and has championed deregulation,” NPR wrote in a story.

NPR also cited Gottlieb’s lucrative consulting for drug companies, and quoted a liberal critic saying, “He has spent most of his career dedicated to promoting the financial interests of the pharmaceutical industry, and the U.S. Senate must reject him.”

This is standard stuff from Democrats and Left-liberal media, of which NPR is a leading member. They always simplistically see arguments against regulation as helping corporate interests.

Gottlieb’s scholarly work, however, shows the truth is different. He is a scholar at the American Enterprise Institute — disclosure: so are Washington Examiner writers Michael Barone and Tim Carney — and has chronicled consolidation in the hospital and insurance industry, and argues that regulation has contributed to the trend. He’s also shown how regulations dampen competition in pharmaceutical industry.

Obamacare regulations, for instance, prevent new entrants into the health insurance markets, thus protecting incumbent insurers from competition, Gottlieb argues. He points out that the law regulations governing how much an insurer may spend on overhead and marketing penalize a new company for its start-up costs. “Spending on things like marketing a new plan to consumers, developing provider networks, and credentialing doctors” are effectively punished by these regulations because they don’t count as “medical” spending.

Further, “new carriers also have a hard time bearing the fixed costs of compliance.” Smarter and lighter regulation would allow more competition. Incumbent insurers might not like this, but customers would.

The same goes for hospitals. Obamacare “favor[s] the consolidation of previously independent doctors into salaried roles inside larger institutions,” Gottlieb wrote in 2014, “usually tied to a central hospital, in effect ending independent medical practices.”

Gottlieb argued against the hospitals’ dominance: “A true legislative alternative to Obamacare would support physician ownership of independent medical practices, and preserve local competition between doctors and choice for patients.”
Obamacare’s regulations and subsidies dampened such competition.

And drugmakers? The largest drug lobby, the Pharmaceutical Research and Manufacturers of America supported Obamacare, as did the American Hospital Association. So Gottlieb and the drug lobby are not of the same mind on major issues.

Second, Gottlieb’s proposed reforms of the drug industry generally aim at getting more competition, often in the form of generic drugs, to drive down prices and profit margins.

In August 2016, Gottlieb wrote in the Wall Street Journal that “a flurry of new regulations is raising production costs and reducing competition for branded drugs. The key to the generic-drug economic model is to keep entry prices low enough to attract multiple competitors.”

Gottlieb’s central goal in policy prescriptions has been more competition in a sector where it is scarce. A major barrier to entry and a major cause of consolidation has been regulation.

This is true not only in the health sector, of course. Banking has consolidated further under Dodd-Frank regulations. Major tax preparers such as H&R Block supported Obama-administration regulations on their industry in order to crowd out smaller practitioners. Mattel supported federal toy regulations and Philip Morris supported regulation of tobacco.

But no sector needs an injection of market competition as badly as healthcare does. Republicans would do well to remember that when fighting for market reform of healthcare, industry is not a reliable ally.

Gottlieb deserves rapid confirmation to head this crucial agency. We hope the Trump administration can learn from this that more regulation often means less competition, protecting the big guys instead of everyone else.

Angle for Anglo-Saxon, or Enlighten with Latin?

Monday, February 6th, 2017

For those who read my blog and who are writers, this short article should be quite helpful. Sent to me by my good friend, Stephen Dubel.

http://www.dailywritingtips.com/should-you-angle-for-anglo-saxon-or-enlighten-with-latin/

Should You Angle for Anglo-Saxon, or Enlighten with Latin?

By Mark Nichol

Arguments for and against favoring Latinate words over Germanic ones, or vice versa (or, if you prefer a non-Latinate phrase, the other way around), have been heard over the years. What’s best? How about the status quo?

The vocabulary of Modern English is the result of a unique admixture of words (and phrases) from a variety of languages. But only about one-fourth derive directly from Old English, or Anglo-Saxon, and other Germanic languages. More than that come from Latin — and Latin’s progeny (mostly Spanish and French) account for as many more words. Admittedly, many Latin words are used primarily in legal, scientific, and medical contexts, whereas Germanic words tend to be more practical for everyday life, but the Latinate contribution is still predominant over native words, and the language is richer for the widespread borrowings.

Given the choice between words from the Germanic root and those of Latin origin, which should one choose? How about one or the other, on an ad hoc basis, or as your mood strikes you? Various movements have attempted to eradicate non-Germanic vocabulary from the English word-hoard, or at least minimize it, but these absurd endeavors, which have sometimes included efforts to create or calque (translate) new words, have been prompted by nationalism, not by any sensible motive.

To communicate plainly, Germanic words, which tend to be shorter, are often preferable, but the Latinate pain, for example, is as simple as the Germanic ache, and Germanic anger and wrath are slightly more complicated than ire and rage, both of which are of Latin provenance but could easily be misidentified as Germanic words.

If you do want to introduce more Germanic words into your writing, it’s easy, for instance, to target classes of words with specific suffixes: For example, words that end in the Latinate suffix -age have more concise synonyms: Think of advantage (gain), marriage (wedlock), savage (wild), and voyage (trip). But where would we be without parentage? “Mother and father” may be more concrete, but the Latinate term is more concise, more precise, and more flexible when it comes to nontraditional families.

For another example, words ending in -ity are often more complicated; why not, for example, write selfhood instead of identity? Unfortunately, identity often refers to a collective, rather than individual, impression. (And often, when one considers alternatives for Latinate words, the first synonym that comes to mind is non-Germanic, too: Quick, what’s another word for fidelity? Loyalty? That’s from French. Allegiance? French.) For yet another example, though words ending in -ology are of Latin origin, there’s no suitable Germanic equivalent for the suffix.

Ultimately, word choice depends on various factors, but the ground a word sprang up in shouldn’t be one of them.


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EXTINCTION

Friday, January 27th, 2017

A most interesting article attempting to explain the destruction of the dinosaurs. If correct, we better hurry up and build all those space ships necessary to get us out of here soon, or in the far future, when the next asteroid comes our way.

Lights Out:Asteroid Triggered Freezing Darkness That Killed       Dinos
By:Laura Geggel, Senior Writer
1/20/17
The study was published online Jan. 13 in the journal Geophysical Research Letters. Original article on Live Science.
When a giant asteroid careened into Earth about 66 million years ago, the enormous collision led to the formation of an airborne “curtain” of sulfate molecules that blocked the sun’s light and led to years of freezing cold and darkness, a new study finds.

The finding shows how these droplets, or aerosols, of sulfuric acid formed high in the atmosphere, and likely contributed to the deaths of 75 percent of all animals on Earth, including nonavian dinosaurs such as Tyrannosaurus rex and long-necked sauropods, the researchers said.
Earlier studies suggested that the dino-killing asteroid kicked up dust and debris that hung in the air and blocked sunlight in the short term. But by using computer simulations, the researchers of the new study showed how droplets of sulfuric acid contributed to long-term cooling. [Wipe Out: History’s Most Mysterious Extinctions]

Moreover, the sudden, drastic drop in temperature likely caused the surface of the oceans to cool, which would have massively disturbed the marine ecosystems, the researchers said.
“The big chill following the impact of the asteroid that formed the Chicxulub crater in Mexico is a turning point in Earth history,” the study’s lead researcher Julia Brugger, a climate scientist at the Potsdam Institute for Climate Impact Research (PIK) in Germany, said in a statement. “We can now contribute new insights for understanding the much debated ultimate cause for the demise of the dinosaurs at the end of the Cretaceous era.”
Brugger and her colleagues employed a type of computer simulation typically used for climate modeling. The model showed that gases containing sulfur evaporated during the violent impact. These sulfuric molecules were the main ingredients that blocked the sun’s light on Earth and led to plummeting temperatures, they said.

For instance, before the asteroid hit, the tropics were an average temperature of 81 degrees Fahrenheit (27 degrees Celsius). But after the massive impact, the average temperature was 41 F (5 C), the researchers said,”It became cold, I mean, really cold,” Brugger said. Globally, temperatures fell at least 47 F (26 C). For at least three years following the asteroid’s crash, the average annual temperature fell below freezing, and the polar ice caps grew in size.

“The long-term cooling caused by the sulfate aerosols was much more important for the mass extinction than the dust that stays in the atmosphere for only a relatively short time,” study co-researcher Georg Feulner, a climate scientist at PIK, said in the statement. “It was also more important than local events like the extreme heat close to the impact, wildfires or tsunamis.”

In all, it took 30 years for Earth’s climate to recover, the researchers said.
As the air cooled, so did the ocean’s surface waters. This cold water became denser and thus heavier, and sank into the depths of the ocean. Meanwhile, warmer water from the deeper ocean rose, bringing up nutrients that likely led to giant algal blooms, the researchers said.
It’s possible these algal blooms produced toxic substances that affected life along the coasts, the researchers said. But regardless of whether they were toxic or not, the ocean’s massive mixing would have disrupted the marine ecosystem, and likely contributed to the extinction of its species, including the ammonites and the reptilian sea beasts known as plesiosaurs.

The new research illustrates what might happen to Earth if another asteroid were to cross its path, the researchers said.“It is fascinating to see how evolution is partly driven by an accident like an asteroid’s impact — mass extinctions show that life on Earth is vulnerable,” Feulner said. “It also illustrates how important the climate is for all life-forms on our planet. Ironically today, the most immediate threat is not from natural cooling but from human-made global warming.”

A Few Brief Notes About Heart Attacks For a Lay Audience

Monday, December 12th, 2016

When I was first in the practice of cardiology, a heart attack was a fearsome problem. Our tools for handling it were primitive especially in light of what we know about the process and its management with today’s technology. Over the years, the understanding of coronary artery disease, coronary thrombosis, lipids, etc. have blossomed along with a greater and greater sophistication in dealing with a heart attack. In addition, with time, research, and the burgeoning of our tools, the understanding of the variability in the presentation of heart attacks have led to an increased capability in handling such cases.

Despite our new technology, a major element in cardiac diagnosis for over a century has been, and still is, the electrocardiogram invented in 1903 by Willem Einthoven, a Dutch physiologist. It remains today a critical tool in much of cardiology, including in the diagnosis and management of heart attacks. The alterations in the EKG during a heart attack can help assess the possible severity of the attack and possibly the prognosis.

What exactly is a STEMI Heart Attack?

A STEMI is a full-blown heart attack caused by the complete blockage of a heart artery. A STEMI heart attack is taken very seriously and is a medical emergency that needs immediate attention. STEMI stands for ST elevation myocardial infarction. “ST elevation” refers to a particular pattern on an EKG heart tracing and “myocardial infarction” is the medical term for a heart attack. So STEMI is basically a heart attack with a particular EKG heart-tracing pattern.

When someone is being evaluated for chest pain the EKG tracing is done as soon as possible to help see if it’s the heart. An ST-elevation myocardial infarction (STEMI) is a combination of symptoms of chest pain and a specific STEMI EKG heart tracing. The EKG has to meet what is called STEMI criteria to make a correct diagnosis, just like an NSTEMI will provide another set of specific diagnostic criteria. The EKG also provides information as to which part of the heart the blocked artery is supplying, for example an anterior vs. a posterior STEMI vs. an inferior STEMI. An anterior STEMI is the front wall of the heart, and the most serious. A posterior STEMI is the back wall of the heart. An inferior STEMI is the bottom wall of the heart.

What Happens to the Heart?

In a heart attack there is sudden rupture of an unstable part of the wall in a heart artery (coronary artery). This leads to a build up of clot in an attempt to heal it. However this clot formation results in total blockage of the artery. Unfortunately, this total blockage leads to loss of blood supply to the heart beyond that point. The heart muscle stops working within minutes of this and dies within minutes to hours unless the artery can be opened up and illustrates what is the primary goal in tratment –––– to rescue as much heart muscle as possible. For this reason every minute from the onset of a heart attack is absolutely critical. Often the patient doesn’t make it to the hospital due to sudden death due to a malignant heart rhythm. For those that leave it too long to get help or for those in whom the heart attack isn’t treated, the heart muscle dies and is replaced by a non beating scar.

Treatment

The most important part of any STEMI treatment protocol is to get to the hospital as quickly as possible, so basically to call 911 immediately!!! In a STEMI, an artery is blocked and treatment centers on opening this up as quickly as possible. The preferred way to do this is by performing something known as an angioplasty and stent placement. In this procedure the artery is opened up working through a small tube passed into the heart either from the wrist or the groin. In some cases this cannot be performed quickly enough (less than 90-120 minutes) because of being too far away from a hospital equipped to do these things, and in order to avoid a significant delay in any treatment, clot busting drugs are used. Unfortunately these clot busters are not as good since they are less likely to open the artery and are also associated with bleeding complications. However, they are better than no treatment at all. So sometimes we have to use them.

In addition to this, a number of other treatments are used. Painkillers such as morphine are required to settle down pain and reduce anxiety. Oxygen is administered to those who are breathless or have heart failure. EKG monitors are attached so that potentially lethal arrhythmias such as ventricular fibrillation or even less dangerous but still significant arrhythmias such as inappropriate sinus tachycardia or atrial fibrillation with a rapid heart rate can be identified and treated. Blood thinners such as heparin, aspirin and other platelet inhibitors (clopidogrel/ticagrelor) are used to improve outcomes and prevent more heart attacks.

Post-STEMI Recovery

Educating patients and their families is one of the most critical aspects of care after a STEMI. Several new medicines are started after a heart attack, several of which may be needed lifelong. Patients need to be sure they take the medications prescribed to have a benefit. I’ll address these briefly later. Stopping smoking is essential. It’s important patients follow up with their doctors. Drugs should be used to control blood pressure. After a STEMI patients will be enrolled in cardiac rehabilitation that is a program they should attend on a regular basis. This involves exercise, addressing questions such as time of return to physical activities and dietary concerns. Following these things after the STEMI is arguably as important as treating the STEMI itself.
What exactly is a Non-STEMI Heart Attack

As previosly indicated, ST refers to the ST segment, which is part of the EKG heart tracing used to diagnose a heart attack. NSTEMI stands for Non-ST segment-elevation myocardial infarction. Nevertheless, a NSTEMI is still a type of heart attack, although presenting in a somewhat less acute manner than a STEMI. A myocardial infarction is, of course, the medical term for a heart attack.
How is a NSTEMI diagnosed?

In addition to signs such as chest pain, a heart attack is diagnosed mainly two ways. First is a blood test that shows elevated levels of certain markers of heart damage such as cardiac troponin. Secondly is by looking at the EKG heart tracing. As we have already shown, if there is a pattern known as STsegment-elevation on the EKG, this is called a STEMI, short for ST elevation myocardial infarction. If there is elevation of the blood markers suggesting heart damage, but no ST elevation seen on the EKG tracing, this is known as a NSTEMI, a non ST segment elevation myocardial infarction. A NSTEMI may be associated with other EKG changes such as ST segment depression. Often looking at the EKG helps us to locate the area of the heart that is affected.

Treatment of Non STEMI Myocardial Infarction

In addion to the EKG, part of the way of diagnosing a NSTEMI is by a blood test called troponin that is indicative of heart damage. Although the troponin test is great in that it does not miss heart attacks, it is not specific for heart attacks alone. Once the patient’s problem is diagnosed as a NSTEMI, the treatment strategy will typically include an echocardiogram to look at heart muscle functioning. Initially, blood-thinning agents will be given such as aspirin and the blood thinner heparin. These medicines have been proven to improve outcomes in patients with NSTEMI. There may be other medicines given such as a beta-blocker or nitrates. Many patients will then go for a heart catheterization. This test involves injecting dye into the heart arteries to look for blockages. In the case of severe blockages, treatment in the form of a stent or multiple stents may be required. Sometimes there are so many blockages that bypass surgery is advised.

Prognosis after a NSTEMI

A NSTEMI IS a heart attack, so the treatment of that applies here as well. Medicines are prescribed that have been proven to save lives in the long term for heart attack sufferers. Depending on factors such as symptoms and heart function, a number of medicines may be prescribed. Lifestyle changes and modification of risk factors are key in preventing recurrence. It is important for smokers to stop smoking. Blood pressure control and control of diabetes are key. A post-heart attack exercise plan should be incorporated into a daily lifestyle if possible. Often NSTEMI patients will be sent to cardiac rehab to receive education on the important of exercise and begin a program in a supervised environment.
Common Medicines Prescribed After a Non STEMI or STEMI Myocardial Infarction
Aspirin, antiplatelet agents, Beta-Blockers, ACE-Inhibitors and Statins are often prescribed.
STEMI vs NSTEMI – Which is Worse?

The bottom line is that both are bad. STEMI is seen as more of an immediate emergency because there is a known total occlusion of a heart vessel that needs opening urgently. In terms of long-term outcomes, they have equal health implications. Patients with NSTEMI often have other illnesses such as ongoing critical illness, diabetes, kidney disease, and other that means they have a generally high risk over the long term. Both STEMI and NSTEMI need aggressive treatment over the short and long term.

Krauthammer on the “New” Trump

Sunday, September 18th, 2016

This is an interesting article by Charles Krauthammer who apparently prefers Trump to Clinton. Apparently, even brilliant individuals do not understand that either as President will be destructive to the USA. Nothing either says can be believed. Both are psychologically damanged and dangerous. Dr. Krauthammer is a psychiatrist! Can’t he see that! Don’t indicate that anything either one says or does should be lauded.

Hillary Sharpens, Trump Softens. He’s Rising, She’s Falling
By Charles Krauthammer
September 16, 2016, 7:14 am

WASHINGTON — If you are the status quo candidate in a change election in which the national mood is sour and two-thirds of the electorate think the country is on the wrong track, what do you do? Attack. Relentlessly. Paint your opponent as extremist, volatile, clueless, unfit, dangerous. Indeed, Hillary Clinton’s latest national ad, featuring major Republican politicians echoing that indictment of Donald Trump, ends thus: “Unfit. Dangerous. Even for Republicans.”

That was the theme of Clinton’s famous open “alt-right” speech and of much of her $100 million worth of ads.

Problem is, it’s not working.

Over the last month, Trump’s new team, led by Kellyanne Conway, has worked single-mindedly to blunt that line of attack on the theory that if he can just cross the threshold of acceptability, he wins. In an act of brazen rebranding, they set out to endow him with stature and empathy.

Stature was acquired in Mexico whose president inexplicably gave Trump the opportunity to stand on the world stage with a national leader and more than hold his own. It’s the same stature booster Sen. Barack Obama pulled off when he stood with the French president at a news conference in Paris in 2008.

That was part one: Trump the statesman. Part two: the kinder gentler Trump.

Nervy. Can you really repackage the boasting, bullying, bombastic, insulting, insensitive Trump into a mellow and caring version? With two months to go? In a digital age in which every past outrage is preserved on imperishable video?

Turns out, yes. How? Deflect and deny — and pretend it never happened. Where are they now — the birtherism, the deportation force, the scorn for teleprompters, the mocking of candidates who take outside money? Down the memory hole.

Orwell was wrong. You don’t need repression. You need only the sensory overload of an age of numbingly ephemeral social media. In this surreal election season, there is no past.

Clinton ads keep showing actual Trump sound bites meant to shock. Yet her numbers are dropping, his rising.

How? Trump never goes on the defensive. He merely creates new Trumps. Hence:

(1) The African-American blitz. It’s a new pose and the novelty shows. Trump is not very familiar with the language. He occasionally slips, for example, into referring to “the blacks.” And his argument that African-Americans inhabit a living hell and therefore have nothing to lose by voting for him hovers somewhere between condescension and insult.

But, as every living commentator has noted, the foray into African-American precincts was not aimed at winning black votes but at countering Trump’s general image as the bigoted candidate of white people.

Result? A curious dynamic in which Clinton keeps upping the accusatory ante just as Trump keeps softening his tone — until she finds herself way over the top, landing in a basket of deplorables, a phrase that will haunt her until Election Day. (Politics 101: Never attack the voter.)

(2) The immigration wobble. A week of nonstop word salad about illegal immigration left everyone confused about what Trump really believes. Genius. The only message to emerge from the rhetorical fog is that he is done talking about deportation and/or legalization. The very discussion is off the table until years down the road.

Case closed. Toxic issue detoxified.

Again, that’s not going to win him the Hispanic vote. But that wasn’t the point. The point was to soften his image in the Philadelphia suburbs, pundit shorthand for white college-educated women that Republicans have to win (and where Trump trails Romney 2012 by 10 points). Which brings us to:

(3) The blockbuster childcare proposal. Unveiled Tuesday, it is liberalism at its best, Big Government at its biggest: tax deductions, tax rebates (i.e. cash), and a federal mandate of six weeks of paid maternity leave. The biggest entitlement since, well, Obamacare.

But wait. Didn’t Trump’s acolytes assure us that he spoke for those betrayed by the sold-out, elitist, GOP establishment that for years refused to stand up to Obama’s overweening mandates, Big Government profligacy and budget-busting entitlements?

No matter. That was yesterday. There is no past. Nor a future — at least for Ivanka-care. It would never get through the GOP House.

Nor is it meant to. It is meant to signal what George H. W. Bush once memorably read off a cue card. “Message: I care.”

And where do you think Trump gave this dish-the-Whigs cradle-to-college entitlement speech? Why, the Philadelphia suburbs!

Can’t get more transparent than that. Or shameless. Or brilliant.

And it’s working.


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