Quotulatiousness

November 23, 2009

NFL to finally address concussion problems

Filed under: Football, Health — Tags: — Nicholas @ 13:07

The NFL has been under fire recently for failing to address the serious problems players have had with concussions. A concussion is a potentially serious injury, yet the league has been unwilling to force teams to treat their injured players with due care: a player who has “had his bell rung” is often encouraged to return to play, which drastically increases the chance of further — and more serious — injury. Alan Scharz reports:

[. . .] the league will soon require teams to receive advice from independent neurologists while treating players with brain injuries, several people with knowledge of the plan confirmed Sunday.

For generations, decisions on when players who sustain concussions should return to play have been made by doctors and trainers employed by the team, raising questions of possible conflicts of interest when coaches and owners want players to return more quickly than proper care would suggest.

As scientific studies and anecdotal evidence have found a heightened risk for brain damage, dementia and cognitive decline in retired players, the league has faced barbed criticism from outside experts and, more recently, from Congress over its policies on handling players with concussions.

This is good, not only for current NFL players, but also for college and high school football players, as the professionals set an example to younger players about how to play the game and how to cope with injuries. You can’t just “walk off” a brain injury, and the NFL has to set the precedent of treating concussions as the serious injuries they are. Gregg Easterbrook has been calling for the NFL to show leadership on this issue for quite some time, most recently in his column last week:

The league’s position is that individual clubs set their own medical policies, but that is a transparent cop-out. Most teams will sit a player with a concussion so bad he can’t remember what he had for lunch. But as soon as the player recovers enough to recall the playbook, he may be cleared to resume competition — and may be pressured to do so. Yes, there is an assumption of risk to performing in the NFL, and players know the sport is dangerous. But going on the field with an elbow that hurts is very different from competing with an injured brain. Players recovering from concussions shouldn’t be allowed back on the field until after extended rest. It should not be the player’s decision to make — that is management evading its responsibility, as well as a form of pressure on athletes who are expected to be macho about knowing no fear. The NFL should prohibit concussed players from returning until they have had a mandatory recovery period, or been cleared by neurologists unaffiliated with the league, or both.

This is especially important because NFL behavior sets the tone for college and high school players — and there are 500 of them for each one in the NFL. When high school or college players see NFL athletes rushing back onto the field soon after concussions, or pretending to the trainer to be fine in order to be sent back in, that’s the behavior they emulate. If the NFL instead sent a message that all concussions should be treated seriously and conservatively, college and high school players would imitate that.

In addition to being more careful about treating injured players, the league should also change two pieces of equipment that could help to increase player safety in the area of concussions:

The league should mandate helmets with concussion-reducing designs — the Riddell Speed (successor to the Revo), the Schutt Ion and the Xenith. None are panaceas, but all are likely to lessen concussion incidence or severity. If the NFL set an example by allowing only helmets engineered against concussions, the NCAA and eventually high schools would follow.

The league should mandate double-sided mouthguards — which are much more affordable for high schools than advanced helmets. Boxing has long required double-sided mouthguards, exactly because they reduce concussions.

November 17, 2009

British health care becomes more equal

Filed under: Britain, Bureaucracy, Health — Tags: — Nicholas @ 12:41

. . . as even celebrities have to wait their turn for a doctor’s care, screaming in pain for hours:

“The racecourse doctor did a good job at the racecourse and gave me as much morphine as she could, but when I got to the hospital I was basically hysterical with pain and they wouldn’t give me any more painkillers.

“The race was at 2.20, and half past midnight was the first time that I saw a doctor. The leg was broken in two places, and the bone had come out through the skin. I’m usually fairly numb with injuries, but this time I was in so much pain that I was just saying, ‘knock me out, knock me out’. Still they wouldn’t give me any painkillers, and they said they would operate in the morning. There were people coming in with twisted ankles getting treated while I’m screaming next door, and they’re basically telling me to wait my turn.”

After a successful operation the following day, Crosse’s ankle swelled as he had not been told to keep it raised. “They came down and asked me why I didn’t have it up and I said no one had told me to,” Crosse says. “I had a very bad night again without enough painkillers to quieten me.”

After two days, Crosse says, he decided that enough was enough. “I thought, I’m getting out of here whatever happens. They told me they would get me an ambulance [to a hospital in Swindon] but they kept me hanging on all day and at 7pm told me I’d have to wait until the morning. I went on the internet and looked up a private ambulance. Basically I had to book my own ambulance to get out of there.”

I’m sure the government will swiftly move to address the issue Crosse raises here — by banning private bookings of ambulances.

November 11, 2009

The only surprise is that it’d only be 33%

Filed under: Cancon, Economics, Health — Tags: , , — Nicholas @ 08:22

Alison Martin summarizes a survey of Quebec workers which found (among other things) that 33% of men would show up for work even if they or a family member had H1N1:

According to a poll of Quebec workers, many employees in Quebec would still show up for work even if they had the H1N1 flu virus.

Close to one-quarter of respondents to the poll conducted in September 2009 on behalf of the Ordre des conseillers en ressources humaines agréés said that they would still go to work even if they or a member of their household had the H1N1 flu virus. This attitude is even more prevalent among men, with one in three (33%) reporting that they still intended to go to work if they or a relative caught the virus.

Close to 60 per cent of respondents said that they show up for work even when they really aren’t feeling well.

“We’ve already noted that employees in Quebec tend to show up at work even when they’re ill. They don’t seem to be sufficiently aware of the risks of such behaviour, which in the end benefits neither the employee nor the employer, and definitely should be stopped,” explained Florent Francoeur, CHRP, Ordre president and CEO.

The question was clearly worded to elicit the most newsworthy headline: it’d be an odd family if everyone stayed home if even one person in the family was ill . . . and a family with limited long-term employment prospects. Private sector employers tend not to have the same kind of generous sick time provision that public sector employees get, so employees don’t tend to take as much sick time as civil servants.

For many workers, if they don’t show up for work, they don’t get paid. This is especially true at lower income levels, where missing a few days pay can be a severe economic dislocation.

November 9, 2009

Coffee and the placebo effect

Filed under: Food, Health, Science — Tags: , , — Nicholas @ 13:45

Neuroskeptic reports on some interesting results from a coffee study:

The authors took 60 coffee-loving volunteers and gave them either placebo decaffeinated coffee, or coffee containing 280 mg caffeine. That’s quite a lot, roughly equivalent to three normal cups. 30 minutes later, they attempted a difficult button-pressing task requiring concentration and sustained effort, plus a task involving mashing buttons as fast as possible for a minute.

The catch was that the experimenters lied to the volunteers. Everyone was told that they were getting real coffee. Half of them were told that the coffee would enhance their performance on the tasks, while the other half were told it would impair it. If the placebo effect was at work, these misleading instructions should have affected how the volunteers felt and acted.

Several interesting things happened. First, the caffeine enhanced performance on the cognitive tasks — it wasn’t just a placebo effect. Bear in mind, though, that these people were all regular coffee drinkers who hadn’t drunk any caffeine that day. The benefit could have been a reversal of caffeine withdrawl symptoms.

H/T to Tyler Cowen for the link.

November 3, 2009

“Like Soylent Green, medicine is made of people”

Filed under: Health, Science — Tags: , , — Nicholas @ 13:04

Colby Cosh on the paradoxical nature of the public’s view of medicine:

We’re conditioned to think of “medicine” as a single, coherent planned enterprise, if not a conspiracy, and we often fear and despise it — until we decide we need it. At which point it cannot possibly move fast enough to please us. Like the state or the church, medicine is an impersonal abstraction, but one that seems to have common priorities and intentions, significant powers and one voice. Rationalists and believers in progress invoke it; nutcases and conspiracists resist it.

In a way, both are paying tribute to a fiction, much like Christians and Satanists. In real life, there is no pope or president of medicine, no temple where it can be consulted, no medical mandate of heaven. The emerging vaccine debacle, though mercifully likely to have fairly limited public-health consequences, reveals the terrible truth. Like Soylent Green, medicine is made of people. Not just doctors, but administrators, industrialists, economists and politicians — none of them angels, and none with an angel’s ability to predict mass behaviour, perceive and weigh risk, or foresee the judgment of future history.

[. . .]

People have always been prone to weird beliefs, but now there is a medium that compounds those beliefs, allows them to coalesce into a historical counter-narrative and unites their holders like never before. For the first time, there are people who seem not just weird, but positively, thoroughgoingly “weird-ist.” Try spelunking amidst the Internet detritus of the anti-vaccine movement. There is no philosophical reason that strange beliefs about vaccination should correlate with fringe beliefs about UFOs, reptilian elites, 9/11 “truth,” JFK, the world ending in 2012 you name it. Yet the correlation is real, and not hard to confirm.

October 27, 2009

Statistical measurements are important

Filed under: Bureaucracy, Health — Tags: , — Nicholas @ 07:52

So why, especially right now, have the US government’s key players in the public health arena stopped counting swine flu cases?

Part of the mystery comes from a federal government in such a tizzy to spread its vaccine and declare “national emergencies” that it doesn’t think it’s necessary to keep counting. Via CBS News:

In late July, the CDC abruptly advised states to stop testing for H1N1 flu, and stopped counting individual cases. The rationale given for the CDC guidance to forego testing and tracking individual cases was: why waste resources testing for H1N1 flu when the government has already confirmed there’s an epidemic?

Given that regular seasonal flu causes thousands of deaths annually, you’d think it would be good statistical discipline to count the cases of H1N1 separately, both the gauge the severity of the disease and to chart the effectiveness of the vaccination program. Lumping seasonal flu and “flu-like symptoms” together with H1N1 seems a big step backward from normal public health practice.

October 26, 2009

A partial answer about increasing body weight

Filed under: Economics, Food, Health — Tags: , — Nicholas @ 00:20

Here are some useful images that help to explain why North Americans have been getting heavier over the last few decades:

Over the past few decades, portion sizes of everything from muffins to sandwiches have grown considerably. Unfortunately, America’s waistbands have reacted accordingly. In the 1970s, around 47 percent of Americans were overweight or obese; now 66 percent of us are. In addition, the number of just obese people has doubled, from 15 percent of our population to 30 percent.

While increased sizes haven’t been the sole contributor to our obesity epidemic, large quantities of cheap food have distorted our perceptions of what a typical meal is supposed to look like. These portion comparisons, adapted from the National Heart, Lung, and Blood Institute’s (NHLBI) Portion Distortion Quiz, give a visual representation of what sizes used to be compared to what they are today.

Pizza_then_and_now
Bagels_then_and_now

H/T to John Scalzi for the link.

October 16, 2009

Friday links of possible interest

Filed under: Britain, Football, Health, Humour, Religion, Technology — Tags: , , , , , , — Nicholas @ 12:25

October 8, 2009

Not quite the solution they were looking for

Filed under: Health, Politics — Tags: , , — Nicholas @ 12:40

Jacob Sullum looks at a not-very impressive result in clinical testing:

A study reported this week in the Archives of General Psychiatry found that an experimental “cocaine vaccine” was mostly ineffective at reducing consumption of the drug. Less than two-fifths of the subjects injected with the vaccine, which is supposed to stimulate production of antibodies that bind to cocaine molecules and prevent them from reaching the brain, had enough of an immune system response to significantly reduce their cocaine use (as measured by urine tests). Even among those subjects, only half cut back on cocaine by 50 percent or more.

[. . .]

Vaccine boosters think the real money lies in an effective anti-nicotine treatment, which they believe would attract “inveterate smokers” who have repeatedly tried to quit with other methods. But as The New York Times notes (in the headline, no less), such a vaccine “does not keep users from wanting the drug.” If all goes well, their cravings are not diminished in the slightest; they just can no longer satisfy them. And that’s assuming the vaccine is fully effective (as opposed to maybe 10 percent effective, like the one in the study); if not, it could actually increase consumption by neutralizing a percentage of each dose. A partially effective nicotine vaccine could be hazardous to smokers’ health if it encouraged them to smoke more so as to achieve the effect to which they’re accustomed. In any case, it’s not clear how appealing the idea of biochemically taking the fun out of smoking will be; the success of such a product hinges on consumers looking for a way to frustrate themselves.

If you take the cynical view, it’s a perfect Puritan drug: take away the benefit without reducing the desire. That way, you see, the sinners would still get all the suffering they’re entitled to without any satisfaction at all. Hell on earth, just the way Puritans like it.

October 6, 2009

Another bulletin from the “Institute of Obvious Findings”

Filed under: Food, Health, Law, USA — Tags: , , — Nicholas @ 16:02

New York City has the most “progressive” laws on the books for labelling fast food menu items. The intent was to ensure that customers would be aware of the calorie and nutrition values of food before ordering, with the hope being that people would deny their tastebuds and order less fattening foods. A recent study found — to nobody’s surprise — that this hasn’t been working:

A study of New York City’s pioneering law on posting calories in restaurant chains suggests that when it comes to deciding what to order, people’s stomachs are more powerful than their brains.

The study, by several professors at New York University and Yale, tracked customers at four fast-food chains — McDonald’s, Wendy’s, Burger King and Kentucky Fried Chicken — in poor neighborhoods of New York City where there are high rates of obesity.

It found that about half the customers noticed the calorie counts, which were prominently posted on menu boards. About 28 percent of those who noticed them said the information had influenced their ordering, and 9 out of 10 of those said they had made healthier choices as a result.

But when the researchers checked receipts afterward, they found that people had, in fact, ordered slightly more calories than the typical customer had before the labeling law went into effect, in July 2008.

The laws were changed because paternalists in power thought that consumers were being gulled against their better instincts, and that merely pointing out the information in a hard-to-miss fashion would assist these poor, weak-willed eaters to trim back on calories and fat. It doesn’t work because people like eating food that’s calorie-rich and fattening. You’re not going to change that without instituting literal rationing: and don’t think they haven’t considered it.

October 1, 2009

Canada as prescription drug “parasite”

Filed under: Cancon, Economics, Health, USA — Tags: , — Nicholas @ 08:07

I guess the discussion on medical costs got boring without bringing international issues into play. Senator Bob Corker got into it with Liberal MP Carolyn Bennett:

An American legislator called Canada “parasitic” on Wednesday for siphoning U.S. dollars to Canada with low prescription drug prices while his country does “all the innovation.”

Canada benefits financially from America’s role as a world leader in medical advances, Republican Sen. Bob Corker charged in an exchange with a Liberal MP as she testified before a U.S. Senate committee.

“One of the things that has troubled me greatly about our system is the fact that we pay more for pharmaceuticals and devices than other countries, and yet it’s not really our country so much that’s the problem, it’s the parasitic relationship that Canada and France and other countries have towards us,” the Tennessee lawmaker told Carolyn Bennett.

Canadian provinces have a financial lever that is a direct result of the single-payer model: if you want to sell your drug in Canada, you have to sell to the government monopoly for each province. The market is small, and there are only a limited number of buyers, so the best price you can get for your product will end up being the price all of the geographical monopolies are willing to pay . . . or you don’t sell into that market at all. Under the circumstances, it’s rational for the companies to sell at close to cost: the bulk of their costs are already sunk in the R&D effort and the regulatory effort to get the drug on to the domestic market.

That doesn’t make the charge any more palatable, but there’s some justice to making it.

September 30, 2009

A different approach to healthcare reform

Filed under: Government, Health, Politics — Tags: , — Nicholas @ 09:03

“John Galt” has a different suggestion for fixing what ails the American healthcare field:

We have some real problems: Bizarre incentives that have led to runaway costs. Rescission. An employer stranglehold over workers’ healthcare. Overuse in the form of care prescribed to protect doctors from lawyers, rather than protecting patients from illness. Arbitrary requirements to carry coverage for other people’s expensive risks.

The truth is that every one of those issues could be addressed — right now, and in a bipartisan fashion — without a single-payer system, a mandate, or any other form of “universal healthcare.” It wouldn’t even take a single massive “reform” bill — just a few simple bills, mostly repealing existing regulation.

But the left has settled on universal healthcare. The “public option.” No other reform is acceptable. No other reform will be permitted. Nothing can actually be fixed if it will lower the number of people who might benefit from a universal system, or if it will reduce national dissatisfaction with market-based care.

It’s quite true that there’s already massive government involvement in the health market, and that a lot of that consists of regulations that have dubious health benefits, but measurable detriments to patients, doctors, and hospitals.

The intersection of the War on Drugs with the government’s role in healthcare, for example, has led to a number of doctors being imprisoned for “inappropriate” prescriptions of painkillers to patients with chronic pain issues. It has also led to a huge number of doctors being afraid to prescribe what their patients actually need, for fear of being charged and convicted of “drug trafficking”. Many patients now suffer prolonged pain because they can’t get an adequate dose of painkillers and can’t find doctors to prescribe them.

All this, in pursuit of getting tough on illicit use of prescription medicine. Government at its finest.

September 28, 2009

Random links of possible interest

Filed under: Health, Law, USA — Tags: , , , , , — Nicholas @ 07:38
  • More on the ongoing ammunition shortage in the US, as manufacturers are still unable to produce enough to satisfy demand.
  • Police at G20 take trophy photo including arrested protester handcuffed and kneeling in front of the group. H/T to Radley Balko.
  • Voyeurs rejoice! What sounds like a report from the Journal of Spike TV reveals that a mere 10 minutes of ogling well-endowed women provides as much benefit to men as 30 minutes in the gym, as far as heart disease, high blood pressure and stress are concerned. H/T to Ghost of a Flea.
  • New Zealand bans in-vehicle GPS navigation systems . . . but only if they’re running on a mobile phone. Non-phone based systems apparently don’t distract you with directions the way phone-based ones do. Or something.
  • Detroit Lions fans love the Washington Redskins.

September 23, 2009

A few random links

Filed under: Cancon, Health, Randomness — Tags: , — Nicholas @ 17:12
  • Nick Packwood on a reason to be proud of Canada: “Canada’s entire delegation is set to walk out of the United Nations General Assembly chamber when Persian tyrant, Twelver whack job and Holocaust denier/enthusiast Mahmoud Ahmadinejad takes the podium.”
  • Talking down to irresponsible American adults. “Secretary Chu said he didn’t think that the public would throw the same political temper tantrum over climate legislation has has happened with the healthcare debate.”
  • “You Can Have Either Sex or Immortality”
  • Pimp my . . . bed?
    “After years of catering to women, manufacturers are setting their sights on men. The new macho mattresses they’re introducing have “muscle-recovery properties” and cooling technology, on the theory that men are more likely to feel too hot in bed. The bed frames feature built-in TVs, iPod docking stations, wine coolers, safes and other guy-friendly gadgetry.”

September 10, 2009

More than you probably wanted to know about gender

Filed under: Health — Tags: , , — Nicholas @ 12:31

By way of John Scalzi’s Delicious bookmarks page, a thoughtful explanation of what people mean by ‘gender’ and why it is different from ‘sex’:

I have been asked at various times what people mean by “gender” and why it is different from “sex’. Also I’ve been asked to explain the multitudinous types of “trans” people, and why they often seen to be at each other’s throats. Hopefully I can traverse the various minefields involved without offending too many people, but sadly there are so many different perspectives out there that I’m bound to offend someone. My apologies in advance.

So, gender, what is it? Many people still think that gender and sex are the same thing. People, animals, even objects in many languages, are either male or female, one or the other, a very simple binary choice. Sadly life is never that simple. I’d like you to consider four different ways in which things are viewed as masculine or feminine.

Biological sex

That’s easy, isn’t it? People have one sort of dangly bits or the other. You either have XX chromosomes or XY chromosomes. You either produce sperm or eggs. Simple.

Well, no. Biology is a fickle thing. Many people are born with ambiguous biology. I don’t just mean genuine hermaphrodites, though such people do exist. All sorts of things can happen to us in the womb, and thereafter, that make our gender difficult to determine by physical tests. These conditions are known as “intersex”, and there are an enormous number of different ones. The Intersex Society of North America has a fairly comprehensive list of them together with data on how common they are. It is reasonably certain that as many as 1 in 1000 people have an ambiguous biological sex in one way or another, and as people get old and parts of their body wear out that can increase significantly.

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