Quotulatiousness

December 8, 2015

Still more to learn about the human immune system

Filed under: Health, Science — Tags: , , — Nicholas @ 03:00

A brief post at Real Clear Science on a recent discovery in human immunology:

Think again if you thought that doctors had long since identified and described exactly how the body defends itself against microorganisms.

Scientists have recently discovered a whole new side to the immune system: a rapid immune response that kicks in well before any of the other known mechanisms.

“I hate to use the term ‘text books will write about this’, but this [discovery] really is brand new and we will need to write a new chapter,” says co-author Søren R. Paludan, professor of virology and immunology form the Department of Biomedicine, Aarhus University, Denmark.

In collaboration with groups from the US and Germany, the scientists showed that when the body’s outer defence, the mucosa lining that surrounds certain organs, is disturbed by a virus, the underlying layer of cells are the first to react and sound the alarm. They summon the body’s cell soldiers, which attack the invading virus.

Both this alarm system and the ‘soldier’ cells operate completely separately from what were believed to be the first responders to immune system attacks.

December 2, 2015

Maximizing Profit under Monopoly

Filed under: Economics, Health — Tags: , , , , , — Nicholas @ 05:00

Published on 18 Mar 2015

AIDS has killed more than 36 million people worldwide. There are drugs available to treat AIDS, but the price of one pill is incredibly high in the U.S. — coming in at 25 times higher than its cost. Why is that? In this video, we show how patent rights have created a monopoly in the U.S. market for AIDS medication, causing pills to be very expensive. In other countries, however, such as India, which does not recognize patents on AIDS medication, prices remain low. Using this example, we go over how monopolies use market power to increase prices.

October 28, 2015

Reducing the costs of regulation

Filed under: Bureaucracy, Government, Health, USA — Tags: , , — Nicholas @ 04:00

Henry I. Miller discusses a worthwhile regulatory change that would increase the availability of medicines in the US marketplace without reducing public safety:

The FDA would be a good place to start. Bringing a new drug to market now requires 10-15 years, and costs have skyrocketed to an average of more than $2.5 billion (including both out-of-pocket and opportunity costs) – largely because FDA requirements have increased the length and number of clinical trials per marketing application, and their complexity.

The detrimental effects of FDA delays in approving certain new drugs already available in other industrialized countries are well-documented and deserve as much attention as drugs’ high costs. An example is the three-year delay in the approval of misoprostol, a drug for the treatment of gastric bleeding, which is estimated to have cost between 8,000 and 15,000 lives per year.

[…]

A practical workaround to overcome regulators’ risk-aversion and capriciousness would be “reciprocity” of approvals with certain foreign “A-list” governments, so that an approval in one country would be reciprocated automatically by the others. That would make more drugs available sooner in all of the participating countries, increasing competition and putting downward pressure on prices.

Such an innovation would also help to alleviate another critical problem: The United States is experiencing shortages of certain critical pharmaceuticals, many of which have been essential in medical practice for decades. The majority are generic injectable medications commonly used in hospitals, including analgesics, cancer drugs, anesthetics, antipsychotics for psychiatric emergencies, and electrolytes needed for patients on IV supplementation. Hospitals are scrambling to assure adequate supplies of drugs that are in short supply, or to find substitutes for them. Reciprocal approvals would make numerous alternatives available.

As referenced yesterday, the FDA regulations also create temporary monopoly situations where only one company has the permit from the regulator to produce this or that medicine, so there’s nothing standing in the way of massive price increases if there are no close substitutes to provide price competition.

October 27, 2015

Update on that $750 pill and the regulatory system that made it inevitable

Filed under: Bureaucracy, Business, Health — Tags: , , — Nicholas @ 05:00

Tim Worstall follows up on all-world scumbag Martin Shkreli and his enabled-by-the-regulator insane price increases for a decades-old drug:

We have an interesting and important economic lesson for public policy here: markets, they work. More accurately, we don’t have to worry about someone attempting to exploit their possession of a contestable monopoly. We only have to worry, possibly take action, if someone has an uncontestable monopoly. And given that there’s very few of them that we don’t create ourselves for other reasons, this means that monopoly is just one of those things we can keep a wary eye upon but not worry over excessively.

Our example comes from Martin Shkreli. The basic background is that this entrepreneur thinks he’s found a pretty cool business model. There’s a number of pharmaceuticals out there that are well out of patent but still have small and useful markets. FDA regulations (no, we’ll not go into the details of how or why this happens) mean that it’s not as easy as one might think to produce generic versions of these out of patent drugs. So, as a business plan, buy up the rights to the permit-ed (as in, with a permit, not just those allowed, as in permitted) generics and as a result of the difficulty someone else will have in getting into the same market, some pricing power is available. You can then raise the price and start to bank your considerable profits.

This caused outrage when Shkreli announced that this was exactly what he was doing:

    Turing Pharmaceuticals, the company that last month raised the price of the decades-old drug Daraprim from $13.50 a pill to $750…

A 5,000% price rise certainly indicates that Turing thinks it has pricing power and thus that it has considerable monopoly power.

[…]

Markets, they work. As Mr. Shkreli is just finding out:

    Turing Pharmaceuticals, the company that last month raised the price of the decades-old drug Daraprim from $13.50 a pill to $750, now has a competitor.

    Imprimis Pharmaceuticals, Inc., a specialty pharmaceutical company based in San Diego, announced today that it has made an alternative to Daraprim that costs about a buck a pill — or $99 for a 100-pill supply.

This is not the same drug: it’s a slight variation, a close substitute. But it’s close enough that Turing isn’t going to be making much money from what it thought was monopoly pricing power. Because it was a contestable monopoly, not an absolute one.

October 8, 2015

“[P]harmaceutical companies … make out like bandits from the existence of the patent system”

Filed under: Bureaucracy, Business, Health, Law, USA — Tags: , , , — Nicholas @ 05:00

The current US patent system is set up to create and maintain — for a limited time — monopolies that can be exploited by pharmaceutical companies:

The Wall Street Journal has a puzzling piece complaining about how the pharmaceutical companies seem to make out like bandits from the existence of the patent system. What puzzles is that the entire point and purpose of the patent system, in an economic sense, is so that inventors of things can make out like bandits. The background problem is that of public goods, something I’ll explain in a moment. That problem leads us to thinking that a pure free market in things which are public goods isn’t going to work as well as something a little different. So, we design something a little different. And the point and purpose of our design is so that people who innovate can make vast mountains of cash out of having done so.

It’s then more than a bit odd to point out that our system enables people who innovate to make vast mountains of cash.

[…]

Which brings us to the subtlety of those pricing decisions. With drugs, pharmaceuticals, close enough the cost of manufacturing a dose is zero. All of the costs go in the original research, the clinical testing (the lion’s share) and getting it through the FDA. Profit is therefore determined, since marginal production costs are zero (they’re not, accurately, but close enough for this comparison), by gross revenue. And we want to maximise the incentive for people to innovate, that’s the very reason we’ve got this patent system in the first place, and thus we would rather like the pharma companies to be maximising revenue.

And thus, from this economic point of view, we should be quite happy with people raising their prices. Demand does fall as they do so, yes, but as long as gross revenue increases, the price rises more than compensating for the fall in unit demand, then we should be happy with the way the system is working. Gross revenue is being maximised, profits are being maximised, incentives to innovate are being maximised. That’s what we want our system to do after all.

Far from being worried about this price gouging we should be welcoming it. Because, obviously, someone making bajillions out of having innovated a drug to cure a disease increases the incentives for many other people to go and invest bajillions of their own to cure other diseases. Far from complaining about it we should be celebrating the system working.

September 14, 2015

An Introduction to Externalities

Filed under: Economics, Health, Science — Tags: , , , , , — Nicholas @ 04:00

Published on 18 Mar 2015

What are externalities and what are the different kinds of costs? And what does this have to do with the rise of “superbugs”? This video is an introduction to externalities, including the concepts of private cost, external cost, and social cost. Using the example of antibiotics and viruses, we take a look at how costs are passed along to different members of society beyond the producer and consumer. We’ll use a chart to illustrate how to calculate the effects of a Pigouvian tax, and we provide definitions for the other key terms that will be used throughout this video series.

September 6, 2015

How the Division of Knowledge Saved My Son’s Life (Everyday Economics 3/7)

Filed under: Economics, Health — Tags: , , , — Nicholas @ 03:00

Published on 24 Jun 2014

In this video, Professor Boudreaux explains how the specialization of knowledge helped his two-year old son overcome a life-threatening illness. The science of medicine has enjoyed significant progress since the 19th century thanks to the vast size of the market and demand for health care services. Despite his foresight, Adam Smith never could have imagined the degree of expertise held by some of today’s medical specialists.

June 23, 2015

QotD: The Physician

Filed under: Health, Humour, Quotations — Tags: , , — Nicholas @ 01:00

Hygiene is the corruption of medicine by morality. It is impossible to find a hygienist who does not debase his theory of the healthful with a theory of the virtuous. The whole hygienic art, indeed, resolves itself into an ethical exhortation, and, in the sub-department of sex, into a puerile and belated advocacy of asceticism. This brings it, at the end, into diametrical conflict with medicine proper. The aim of medicine is surely not to make men virtuous; it is to safeguard and rescue them from the consequences of their vices. The true physician does not preach repentance; he offers absolution.

H.L. Mencken, “Types of Men 5: The Physician”, Prejudices, Third Series, 1922.

April 19, 2015

The latest “breakthrough” in helping schizophrenics take their medicine

Filed under: Health, Humour — Tags: , , , — Nicholas @ 03:00

Scott Alexander recently attended a local psychiatry conference, with some essential themes being emphasized:

This conference consisted of a series of talks about all the most important issues of the day, like ‘The Menace Of Psychologists Being Allowed To Prescribe Medication’, ‘How To Be An Advocate For Important Issues Affecting Your Patients Such As The Possibility That Psychologists Might Be Allowed To Prescribe Them Medication’, and ‘Protecting Members Of Disadvantaged Communities From Psychologists Prescribing Them Medication’.

As somebody who’s noticed that the average waiting list for a desperately ill person to see a psychiatrist is approaching the twelve month mark in some places, I was pretty okay with psychologists prescribing medication. The scare stories about how psychologists might prescribe medications unsafely didn’t have much effect on me, since I continue to believe that putting antidepressants in a vending machine would be a more safety-conscious system than what we have now (a vending machine would at least limit antidepressants to people who have $1.25 in change; the average primary care doctor is nowhere near that selective). Annnnnyway, this made me kind of uncomfortable at the conference and I Struck A Courageous Blow Against The Cartelization Of Medicine by sneaking out without putting my name on their mailing list.

But before I did, I managed to take some notes about what’s going on in the wider psychiatric world, including:

– The newest breakthrough in ensuring schizophrenic people take their medication (a hard problem!) is bundling the pills with an ingestable computer chip that transmits data from the patient’s stomach. It’s a bold plan, somewhat complicated by the fact that one of the most common symptoms of schizophrenia is the paranoid fear that somebody has implanted a chip in your body to monitor you. Can you imagine being a schizophrenic guy who has to explain to your new doctor that your old doctor put computer chips in your pills to monitor you? Yikes. If they go through with this, I hope they publish the results in the form of a sequel to The Three Christs of Ypsilanti.

– The same team is working on a smartphone app to detect schizophrenic relapses. The system uses GPS to monitor location, accelerometer to detect movements, and microphone to check tone of voice and speaking pattern, then throws it into a machine learning system that tries to differentiate psychotic from normal behavior (for example, psychotic people might speak faster, or rock back and forth a lot). Again, interesting idea. But again, one of the most common paranoid schizophrenic delusions is that their electronic devices are monitoring everything they do. If you make every one of a psychotic person’s delusions come true, such that they no longer have any beliefs that do not correspond to reality, does that technically mean you’ve cured them? I don’t know, but I’m glad we have people investigating this important issue.

February 9, 2015

Paradoxically, rising cancer deaths are a form of good news

Filed under: Britain, Health, Science — Tags: , , , , , — Nicholas @ 03:00

Last month, in his Times column, Matt Ridley explained why — until we discover a treatment for aging itself — rising cancer rates are a weird form of good news:

If we could prevent or cure all cancer, what would we die of? The new year has begun with a war of words over whether cancer is mostly bad luck, as suggested by a new study from Johns Hopkins School of Medicine, and over whether it’s a good way to die, compared with the alternatives, as suggested by Dr Richard Smith, a former editor of the BMJ.

It is certainly bad luck to be British and get cancer, relatively speaking. As The Sunday Times reported yesterday, survival rates after cancer diagnosis are lower here than in most developed and some developing countries, reflecting the National Health Service’s chronic problems with rationing treatment by delay. In Japan, survival rates for lung and liver cancer are three times higher than here.

Cancer is now the leading cause of death in Britain even though it is ever more survivable, with roughly half of people who contract it living long enough to die of something else. But what else? Often another cancer.

In the western world we’ve conquered most of the causes of premature death that used to kill our ancestors. War, smallpox, homicide, measles, scurvy, pneumonia, gangrene, tuberculosis, stroke, typhoid, heart disease and cholera are all much rarer, strike much later in life or are more survivable than they were fifty or a hundred years ago.

The mortality rate in men from coronary heart disease, for instance, has fallen by an amazing 80 per cent since 1968 — for all age groups. Mortality rates from stroke in both sexes have halved in 20 years. Cancer’s growing dominance of the mortality tables is not because it’s getting worse but because we are avoiding other causes of death and living longer.

It is worth remembering that some scientists and anti-pesticide campaigners in the 1960s were convinced that by now lifespans would be much shorter because of cancer caused by pesticides and other chemicals in the environment.

In the 1950s Wilhelm Hueper — a director of the US National Cancer Institute and mentor to Rachel Carson, the environmentalist author of Silent Spring — was so concerned that pesticides were causing cancer that he thought the theory that lung cancer was caused by smoking was a plot by the chemical industry to divert attention from its own culpability: “Cigarette smoking is not a major factor in the causation of lung cancer,” he insisted.

In fact it turns out that pollution causes very little cancer and cigarettes cause a lot. But aside from smoking, most cancers are indeed bad luck. The Johns Hopkins researchers found that tissues that replicate their stem cells most run the highest risk of cancer: basal skin cells do ten trillion cell divisions in a lifetime and have a million times more cancer risk than pelvic bone cells which do about a million cell divisions. Random DNA copying mistakes during cell division are “the major contributors to cancer overall, often more important than either hereditary or external environmental factors”, say the US researchers.

(Emphasis mine.)

To sum it up, until or unless medical research finds a way to stop the bodily effects of aging, cancer becomes the most likely way for all of us to die. Cancer is a generic rather than a specific term — it’s what we use to describe the inevitable breakdown of the cellular division process that happens millions or even trillions of times over our lifetime. As Ridley puts it, “even if everybody lived in the healthiest possible way, we would still get a lot of cancer.” I’m not a scientist and I don’t even play one on TV, but I suspect that the solution to cancers of all kinds are to boost our immune systems to more quickly identify aberrant cells in our bodies before they start reproducing beyond the capability of the immune system to handle. The short- to medium-term solution to cancer may be to make us all a little bit cyborg…

February 7, 2015

Is there a relationship between physical illness and depression?

Filed under: Health, Science — Tags: , , , — Nicholas @ 02:00

Last month, Scott Alexander tried to show the evidence, pro and con, on whether we have detected a causal relationship between physical ailments and depression:

Start with From inflammation to sickness and depression [PDF], Dantzer et al (2008), who note that being sick makes you feel lousy [citation needed]. Drawing upon evolutionary psychology, they theorize this is an adaptive response to make sick people stay in bed (or cave, or wherever) so the body can focus all of its energy on healing. A lot of sickness behavior – being tired, not wanting to do anything, not eating, not wanting to hang around other people – seems kind of like mini-depression.

All of this stuff is regulated by chemicals called cytokines, which are released by immune cells that have noticed an injury or infection or something. They are often compared to a body-wide “red alert” sending the message “sickness detected, everyone to battle stations”. This response is closely linked to the idea of “inflammation”, the classic example of which is the locally infected area that has turned red and puffy. Most inflammatory cytokines handle the immune response directly, but a few of them – especially interleukin-1B and tumor necrosis factor alpha – cause this depression-like sickness behavior.

[…]

Here are some other suspicious facts about depression and inflammation:

– Exercise, good diet and sleep reduce inflammation; they also help depression.

– Stress increases inflammation and is a known trigger for depression.

– Rates of depression are increasing over time, with the condition seemingly very rare in pre-modern non-Westernized societies. This is commonly attributed to the atomization and hectic pace of modern life. But levels of inflammation are also increasing over time, probably because we have a terrible diet that disrupts the gut microbiota that are supposed to be symbioting with the immune system. Could this be another one of the things we think are social that turn out to be biological?

– SSRI antidepressants, like most medications, have about five zillion effects. One of the effects is to reduce the level of inflammatory cytokines in the body. Is it possible that this is why they work, and all of this stuff about serotonin receptors in the brain is a gigantic red herring?

– It’s always been a very curious piece of trivia that treating depression comorbid with heart disease significantly decreases your chances of dying from the heart disease. People just sort of nod their heads and say “You know, mind-body connection”. But inflammation is known to be implicated in cardiovascular disease. If treating depression is a form of lowering inflammation, this would make perfect sense.

– Rates of depression are much higher in sick people. Cancer patients are especially famous for this. No one gets too surprised here, because having cancer is hella depressing. But it’s always been interesting (to me at least) that as far as we can tell, antidepressants treat cancer-induced depression just as well as any other type. Are antidepressants just that good? Or is the link between cancer being sad and cancer causing depression only part of the story, with the other part being that the body’s immune response to cancer causes inflammatory cytokine release, which antidepressants can help manage?

– Along with cancer, depression is common in many other less immediately emotion-provoking illnesses like rheumatoid arthritis and diabetes. The common thread among these illnesses is inflammation.

– Inflammation changes the activity level of the enzyme indoleamine 2,3 dioxygenase. This enzyme produces kynurenines which interact with the NMDA receptor, a neurotransmitter receptor implicated in depression and various other psychiatric diseases (in case your first question upon learning about this pathway is the same as mine: yes, kynurenines got their name because they were first found in dog urine).

– Sometimes doctors treat diseases like hepatitis by injecting artificial cytokines to make the immune system realize the threat and ramp up into action. Cytokine administration treatments very commonly cause depression as a side effect. This depression can be treated with standard antidepressants.

– Also, it turns out we can just check and people with depression have more cytokines.

There’s also some evidence against the theory. People with depression have more cytokines, but it’s one of those wishy-washy “Well, if you get a large enough sample size, you’ll see a trend” style relationships, rather than “this one weird trick lets you infallibly produce depression”.

[…]

So in conclusion, I think the inflammatory hypothesis of depression is very likely part of the picture. Whether it’s the main part of the picture or just somewhere in the background remains to be seen, but for now it looks encouraging. Anti-inflammatory drugs do seem to treat depression, which is a point in the theory’s favor, but right now the only one that has strong evidence behind it has side effects that make it undesirable for most people. There’s a lot of room to hope that in the future researchers will learn more about exactly how this cytokine thing works and be able to design antidepressant drugs that target the appropriate cytokines directly. Until then, your best bets are the anti-inflammatory mainstays: good diet, good sleep, plenty of exercise, low stress levels, and all the other things we already know work.

January 25, 2015

Prescribing modern drugs for Richard III

Filed under: Britain, Health, History, Science — Tags: , , , — Nicholas @ 02:00

In Richard Lehman’s BMJ journal review, there was an amusing bit of interest to Ricardians:

King Richard III of England was 32 when he died at Bosworth and then famously suffered the indignity of being buried in a Leicester car park. I think I probably drew your attention to this account of his post-mortem examination when it appeared online last September. Had Richard III been spared avoidable mortality in the form of a bashed-in skull and a spear through his spine, he would probably have needed a walking frame by the age of 70. He was never in the best shape:

I, that am curtail’d of this faire Proportion,
Cheated of Feature by dissembling Nature,
Deform’d, unfinish’d, sent before my time
Into this breathing World, scarse halfe made up,
And that so lamely and unfashionable,
That dogges bark at me, as I halt by them.
(from The Tragedy of Richard the Third: with the Landing of Earle Richmond , and the Battell of Boʃworth Field by Wm Shakespeare c.1592, First Folio text 1623)

With his nasty scoliosis and his habit of moving around castles with smoky rooms and no hand rails on the stairs, Richard III would have needed an OT assessment and a dosset box containing all the drugs which are now compulsory for elderly people in the UK:

simvastatin 40mg to add 2 days to life and cause muscle aches
tramadol 50mg to fail to ease pain & cause dependency, falls, confusion
naproxen 500mg to cause GI bleeds and fluid retention
furosemide 20mg to reduce fluid retention due to naproxen
omeprazole 20mg to prevent GI bleeds, encourage C diff
senna 7.5mg to counter tramadol constipation
citalopram 20mg to cause serotonin syndrome with tramadol
trazodone 50mg for agitation due to serotonin, to worsen it & cause falls
gababentin MR 800mg to see if it will help pain
paracetamol 500mg because it hasn’t helped the pain
tamsulosin 400mcg for nocturia due to age and furosemide
lisinopril 5mg for “grade 2 CKD” due to furosemide & naproxen
Seretide inhaler for low FEV1 due to scoliosis
etc.

My kingdom for a bit of horse-sense.

December 6, 2014

Fran Tarkenton on the NFL’s long-standing drug problems

Filed under: Football, Health, Law — Tags: , , , , — Nicholas @ 10:57

In an interview with Jenny Vrentas, former Viking great Fran Tarkenton discusses this year’s crop of rookie quarterbacks (including the Vikings’ Teddy Bridgewater), the NFL’s ongoing disciplinary issues with Ray Rice and Adrian Peterson, the long-term issues with NFL doctors dispensing painkillers, and the advent of performance-enhancing drugs. On the issue of league discipline, he believes the league should not allow Rice or Peterson to play again:

VRENTAS: Are you saying the Vikings should move on from Peterson because of his age, or because of the child abuse case that led to his suspension?

TARKENTON: I followed the Clippers thing. That owner [Donald Sterling] didn’t get indicted for any crime, but the racial comments he made were totally inappropriate, and we took a stand. The whole world and the NBA, we have zero tolerance to racism. And I think that’s right. I agree with that. But I also think we ought to have zero tolerance to child abuse and domestic violence. I don’t think [Peterson] should play again in the NFL. I don’t think Ray Rice should play again. Either we have zero tolerance, or we don’t. And what is more egregious than domestic violence and child abuse? I don’t know of anything, unless you kill somebody.

VRENTAS: Peterson has not played since the child-abuse charges first surfaced in September, and now he’s been suspended for the rest of the season, pending appeal. Do you think the response shows that teams and the league are starting to take these issues more seriously?

TARKENTON: Kind of. They have been a little bit wishy-washy. [The Vikings] were going to play Adrian Peterson [before reversing course in September]. Other teams were going to play other players [involved in cases of domestic violence]. And the NFL was going to give just a two-game suspension to Ray Rice. I don’t think we’ve gotten beyond “win at any cost” yet. And I think we need to get there. We should have zero tolerance to racism. We don’t believe that, right? Is that more important than zero tolerance to domestic abuse and child abuse? Unless we as a society think that way, then we won’t make progress. And the whole domestic violence thing, that has been tolerated universally, but certainly in the NFL. We can’t tolerate that. All these behaviors that are so egregious continue. We need to set an example.

And on the topic of team doctors and the use of drugs to get players back into games (but which had potentially serious long-term health implicatons:

VRENTAS: You wrote a letter to the New York Times regarding painkiller abuse, in response to the DEA’s recent spot checks of NFL team medical staffs. This has been a subject you have been vocal about. What was your experience with painkiller use during your playing career?

TARKENTON: This has been going on forever. I was playing for the New York Giants, and I hurt my shoulder in a game against the Pittsburgh Steelers. I came in at halftime, and the doctor had a great big long needle, punched a few different places, and told me, “Show me where it hurts the worst.” I said, “Ow,” and he jammed a combination of xylocaine and cortisone into my shoulder. That’s not good for my shoulder, but he’s my team doctor. I don’t think he’s going to do something that hurts my career, right? He’s like my family doctor. If my family doctor tells me to take a pill, I’ll take a pill. So every Friday, I went on the subway from old Yankee Stadium, where we practiced, all the way down to lower Manhattan to St. Vincent’s Hospital, and they did the same thing they did at halftime. They shot my shoulder. It didn’t really help me, but it allowed me to play. Now, when I come back to Minnesota, my shoulder is worse. The year we played the Pittsburgh Steelers in the Super Bowl in New Orleans, my shoulder was already deteriorating, and I hurt it early in the season in Dallas. The rest of the year I could not throw a ball in practice; I could not throw a ball in warm-ups over 10 yards. When I got in the game, I could throw it maybe 40 yards, because my adrenaline was up, but there was nothing on it. But every Friday, guess what they shot me with? Butazolidin. That’s what they shot horses with. Shot me up every Friday, all the way to the Super Bowl. I retired at age 39, and I see my doctors down here [in Atlanta] because my shoulder is killing me. They say, “You’ve got the shoulder of a 75-year old man. You need your shoulder replaced.” I talked to a lot of the old guys — Roger Staubach, Otto Graham, Sammy Baugh, Johnny Unitas, Y.A. Tittle ­— and none of them had shoulders replaced. I had my shoulder replaced, because they shot me up. Where was the conscience back then? People say, “You knew what they were doing.” I knew what they were doing, but I didn’t think they would hurt me. I didn’t think my shoulder was going to fall apart.

December 4, 2014

QotD: Roman medical advice

Filed under: Books, Europe, Health, History, Media, Quotations — Tags: , — Nicholas @ 00:01

Before I forget it, I must record two valuable health hints that I learned from Xenophon. He used to say: “The man is a fool who puts good manners before health. If you are troubled with wind, never hold it in. It does great injury to the stomach. I knew a man who once nearly killed himself by holding in his wind. If for some reason or other you cannot conveniently leave the room — say, you are sacrificing or addressing the Senate — don’t be afraid to belch or break wind downwards where you stand. Better that the company should suffer some slight inconvenience than that you should permanently injure yourself. And again, when you suffer from a cold, don’t constantly blow your nose. That only increases the flow of rheum and inflames the delicate membranes of your nose. Let it run. Wipe, don’t blow.” I have always taken Xenophon’s advice, at least about nose-blowing: my colds don’t last nearly so long now as they did. Of course, caricaturists and satirists soon made fun of me as having a permanently dripping nose, but what did I care for that? Messalina told me that she thought I was extremely sensible to take such care of myself: if I were suddenly to die or fall seriously ill, what would become of the City and Empire, not to mention herself and our little boy?

Robert Graves, Claudius the God, 1935.

November 14, 2014

QotD: The difference between medicine and recreational drugs

Filed under: Health, Quotations — Tags: , , , — Nicholas @ 00:01

I do occasional work for my hospital’s Addiction Medicine service, and a lot of our conversations go the same way.

My attending tells a patient trying to quit that she must take a certain pill that will decrease her drug cravings. He says it is mostly covered by insurance, but that there will be a copay of about one hundred dollars a week.

The patient freaks out. “A hundred dollars a week? There’s no way I can get that much money!”

My attending asks the patient how much she spends on heroin.

The patient gives a number like thirty or forty dollars a day, every day.

My attending notes that this comes out to $210 to $280 dollars a week, and suggests that she quit heroin, take the anti-addiction pill, and make a “profit” of $110.

At this point the patient always shoots my attending an incredibly dirty look. Like he’s cheating somehow. Just because she has $210 a week to spend on heroin doesn’t mean that after getting rid of that she’d have $210 to spend on medication. Sure, these fancy doctors think they’re so smart, what with their “mathematics” and their “subtracting numbers from other numbers”, but they’re not going to fool her.

At this point I accept this as a fact of life. Whatever my patients do to get money for drugs — and I don’t want to know — it’s not something they can do to get money to pay for medication, or rehab programs, or whatever else. I don’t even think it’s consciously about them caring less about medication than about drugs, I think that they would be literally unable to summon the motivation necessary to get that kind of cash if it were for anything less desperate than feeding an addiction.

Scott Alexander, “Apologia Pro Vita Sua”, Slate Star Codex, 2014-05-25.

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