Category Archives: Healthcare

Aerosol transmission of infectious agents

I don’t understand why this hasn’t been obvious from the start when it’s true of so many other infectious agents.

Recognition of aerosol transmission of infectious agents – NCBI –  free full-text PMC article – 2019

Although short-range large-droplet transmission is possible for most respiratory infectious agents, deciding on whether the same agent is also airborne has a potentially huge impacton the types (and costs) of infection control interventions that are required.

The concept and definition of aerosols is also discussed, as is the concept of large droplet transmission, and airborne transmission which is meant by most authors to be synonymous with aerosol transmission, although some use the term to mean either large droplet or aerosol transmission.   Continue reading

239 Experts Claim Coronavirus Is Airborne

239 Experts With 1 Big Claim: The Coronavirus Is Airborne – The New York Times – By Apoorva Mandavilli  July 4, 2020

These experts are only saying what I and certainly many others have been thinking since the start of this plague. Many other types of infectious agents are spread through the air.

The coronavirus is finding new victims worldwide, in bars and restaurants, offices, markets and casinos, giving rise to frightening clusters of infection that increasingly confirm what many scientists have been saying for months: The virus lingers in the air indoors, infecting those nearby.

If airborne transmission is a significant factor in the pandemic, especially in crowded spaces with poor ventilation, the consequences for containment will be significant. Continue reading

A virus walks into a bar…

Packed Bars Serve Up New Rounds Of COVID Contagion | Kaiser Health News – By Jordan Rau and Elizabeth Lawrence June 25, 2020

As states ease their lockdowns, bars are emerging as fertile breeding grounds for the coronavirus.

Public health authorities have identified bars as the locus of outbreaks in Louisiana, Florida, Wyoming and Idaho.

Bars are tailor-made for the spread of the virus, with loud music and a cacophony of conversations that require raised voices. The alcohol can impede judgment about diligently following rules meant to prevent contagion.  Continue reading

Higher Expectations from Patients than Doctors

Study Reveals Presurgical Expectations of Foot and Ankle Patients Exceed Those of Their Surgeons – by Hospital for Special Surgery – June 2020

In the first-ever study to compare surgeon and patient expectations in foot and ankle surgery, research performed at Hospital for Special Surgery (HSS) in New York City has determined that two-thirds of patients have higher presurgical expectations than their surgeons.

That’s probably because they’re desperate for relief – especially nowadays when effective pain relievers are so hard to get. Plus, these surgeries and so profitable there may be some bias on the surgeon’s side.

Somehow, I can’t imagine a surgeon asking a patient what they expect the result to be; they’re too busy *telling* patients what the results will be.  And they do the “telling” in vague language that doesn’t convey the full impact of this brutal assault on their body.

Patients aren’t informed how little or short-lived the improvements might be, or that surgery can often leave not just visible scars, but invisible internal scars that become the source of chronic pain later.

I can’t imagine a doctor telling a patient, in a way that really gets through to them, the critical message: “it will never be as good as the original“.

The paper, titled “Comparison of Patients’ and Surgeons’ Expectations in Foot and Ankle Surgery,” is available online as part of the AAOS 2020 Virtual Education Experience.

Patient expectations of orthopaedic procedures have been demonstrated to be strongly associated with clinical outcomes and postoperative satisfaction.

If patients have high expectations shouldn’t this create the placebo effect? Just like negative expectations (sometimes called catastrophizing) are alleged to worsen chronic pain and lessen functionality, shouldn’t positive expectations lead to less pain and more functionality?

If “patient expectations” determine the outcome of treatment, this would apply to all treatments; the placebo effect either is or isn’t a factor. A placebo can’t have different effects for different treatments like surgery where a placebo doesn’t work and chronic pain where a placebo supposedly does work.

If higher expectations don’t lead to better results, the placebo effect is not.

In reviewing the operative schedules of seven foot and ankle surgeons at HSS, Dr. Ellis and his colleagues hypothesized

  • that patients would have greater expectations for their outcomes than their surgeons,
  • that there would be greater differences in preoperative expectations between patients and surgeons in major versus minor foot or ankle surgery, and
  • that greater differences between patient and surgeon expectations would be associated with worse preoperative physical and mental health.

“Although most surgeons do their best to engage in open conversations with their patients about what they can expect from surgery, many find it difficult to tell patients that they are not going be as good as new postoperatively,

…patients completed Patient-Rated Outcomes Measurement Information System (PROMIS) computer adaptive tests in Physical Function, Pain Interference, Pain Intensity, Depression and Global Health prior to their procedures.

“We determined that

  • 66.3% of patients had higher expectations than their surgeons,
  • 21.3% had concordant expectations, and
  • 12.4% had lower expectations,” said Dr. Ellis.

“In addition, the study showed that the majority of patients who had worse preoperative PROMIS scores had higher postoperative expectations.

That makes sense because people who are worse off are more desperate for surgery and also more likely to see at least some improvement from it.

We also found that depressed and anxious individuals had greater expectations than their surgeons, as did patients with a higher body mass index.”

Again, these are the desperate ones, not the ones who can still tolerate their pain. Because their condition is so bad, there’s a lot of room for improvement so their high expectations seem logical.

Going forward, said Dr. Ellis, future research should delve into other potential factors such as medical literacy and patients’ knowledge of their condition, as well as the bond between surgeon and patient.

What “bonds” can there be within standardized Evidece-Based Medicine? Can a guideline be written to standardize the doctor-patient bond?

Would such a guideline be ike the scripts they give to flight attendants, the ones they are required to recite at the start of every flight?

I went with my mother to an appointment with her PCP at Kaiser which was unnecessary but required because she takes 2 Vicodin a day.

The doctor had to speed read to us over a dozen questions from her screen and quickly type in or select the answers (a click and a delay meant she was scrolling through a drop-down menu).

She wasn’t talking to us, she was reading. Everything my mother said was met with an utterly ineffective and obvious suggestion.

  • Pain? take more Tylenol.
  • Fatigue? You’re just old.
  • Hips so painful can’t walk? Do more walking exercise (!)
  • Piriformis pain? Here’s some Voltaren Gel. (I looked it up and there’s no way it can penetrate deep into a buttock where that muscle is but, hey, at least it’s not an opioid!)

I feel sorry for the doctors that are forced to “practice” like this because it’s clear they can be replaced by data entry clerks (and eventually robots). No medical knowledge or treatment is required, literally only the ability to read questions and transcribe answers.

In the meantime, we suggest that a preoperative educational class for foot and ankle patients would go a long way towards a rapprochement between patients and surgeons when it comes to expectations.

Indoor transmission of COVID NOT likely

Indoor transmission of SARS-CoV-2 from medRxiv preprint server – Apr 2020

Finally, they’ve studied and validated what has always seemed obvious and logical to me: of course, a disease will spread more easily in a confined indoor area than out in the open!

Yet, our officials cooped us up in crowded indoor spaces even though that’s where you’re most likely to get infected from the prolonged close contact. This practically guaranteed that everyone would get sick if any single household member got sick.

Still, I was in favor of the lockdown as a desperate measure to buy us time to start research, craft policies to mitigate harm, and prepare our healthcare infrastructure for the predicted surge of patients needing intensive care.

But that didn’t happen…  Continue reading

Medical Tribalism in the Era of Covid-19

John Ioannidis and Medical Tribalism in the Era of Covid-19BY JEANNE LENZER & SHANNON BROWNLEE – June 2020

I’ve posted about his contrarian views several times because I think it’s a good idea to see information and opinions from reliable scientific professional sources that are different from the panic-inducing click-bait spouted endlessly by the media.

It started on March 17, when Ioannidis published an opinion essay in STAT saying that the data on Covid-19 were not sufficient to know the disease’s true prevalence and fatality rate.

Ordinarily sober-minded researchers have attacked Ioannidis’ methods with hyperbolic and emotional arguments that suggest it’s not so much his science but his questions that they dislike.  Continue reading

Rethinking bias and truth in evidence‐based health care

Rethinking bias and truth in evidence‐based health care –  free full-text /PMC6175413/Oct 2019

This article points out that bias cannot be removed from human thinking because we all have different internal mental maps, assumptions, and concepts that guide our behavior.

It’s hard to see how “evidence‐based health care” can operate on individuals that are not the “average patients” that the evidence is built upon.

In modern philosophy, the concept of truth has been problematized from different angles, yet in evidence‐based health care (EBHC), it continues to operate hidden and almost undisputed through the linked concept of “bias.”   Continue reading

Super-potent human antibodies against COVID-19

Super-potent human antibodies protect against COVID-19 in animal tests: Scientists isolate powerful coronavirus-neutralizing antibodies from COVID-19 patients and successfully test in animals — ScienceDaily – June 15, 2020

Here’s a promising avenue: using antibodies from people who overcame and recovered from COVID as a prophylactic for others.

A team led by Scripps Research has discovered antibodies in the blood of recovered COVID-19 patients that provide powerful protection against SARS-CoV-2, the coronavirus that causes the disease, when tested in animals and human cell cultures.

In principle, injections of such antibodies could be given to patients in the early stage of COVID-19 to reduce the level of virus and protect against severe disease.   Continue reading

Forecasting for COVID-19 has failed

Forecasting for COVID-19 has failed – International Institute of Forecasters – by John P.A. Ioannidis, Sally Cripps, Martin A. Tanner June 2020

Here is another contrarian article, fact-based, but with a different view.

COVID-19 is a major acute crisis with unpredictable consequences. Many scientists have struggled to make forecasts about its impact. However, despite involving many excellent modelers, best intentions, and highly sophisticated tools, forecasting efforts have largely failed.

Experienced modelers drew early on parallels between COVID-19 and the Spanish flu that caused >50 million deaths with mean age at death being 28. We all lament the current loss of life. However, as of June 8, total fatalities are ~410,000 with median age ~80 and typically multiple comorbidities.   Continue reading

Drug Companies Will Make a Killing From Coronavirus

Opinion | Drug Companies Will Make a Killing From Coronavirus – The New York TimesBy Mariana Mazzucato and Azzi Momenghalibaf – March 18, 2020

Unless we fix the system, American taxpayers will get gouged on a vaccine they paid to produce.

The search for treatments and vaccines to curb transmission of the new coronavirus is in overdrive. Fortunately, there are a number of promising candidates thanks to the U.S. government’s investment in biomedical research and development.

As the world’s leader in public financing of biomedical research, the U.S. government has the opportunity to set a precedent to ensure that medicines developed with public funding are accessible and affordable to the public; this will have enormous implications not only how for we deal with the coronavirus, but also for the crisis of unaffordable medicines in America.   Continue reading