Sex, Drugs, and Public Health

October 29, 2022


Filed under: Uncategorized — cbmosher @ 7:30 am

When I was finally old enuf to count, I counted years. “Wow,” I thought, “I may see the 1900’s become the 2000’s. We’ll learn so much more by then.” But then another thought hit me. “That’s 50 years. A half century. Heck, I’ll be dead by then.”

            And so it is that the words “wisdom” and “children” are seldom used together.

            Over time, experience brings knowledge that can sometimes grow into wisdom. We add to that knowledge by sharing experiences. Schools do this.      And so it is that, in Med School, the professors discussed Pain. It’s subjective, they said. Some writhe and whimper from slivers or stubbed toes. Others shrug at cuts or when they hit a fingernail with a hammer. It’s difficult to know which drugs to use to relieve “pain.”

            How, I wondered, can a powder in a capsule make pain go away? Ice decreased the soreness of bruises. Aspirin evaporated my headaches. But I never had enuf pain to test other analgesics – pain relieving drugs. Then one day (as the story tellers say) I had a serious injury in South America. I sliced open my hand, severing the main nerve that allows fingers to feel and operates the muscles in the hand.

            As I lay in the hospital bed, my bandaged hand suspended above my head and the rest of me and my glitching brainstem writhing in unrelenting pain, they injected something into the IV line. Then they moved me onto a gurney. I recall the lights in the hallway ceiling flowing past like marching soldiers. I became aware of a strange feeling: I was relaxed for the first time in three days.

            I looked at my bandaged hand. The pain was still there. All of it. My hand was in a vice, being slowly crushed. My fingers were being ripped away from each other like drumsticks from a cooked turkey. A blowtorch was blasting against my palm. Everything was the same since leaving South America.

            “That’s a lot of pain,” I thought. “I bet it must hurt.”

            But it didn’t.

            Not gone, like some headache after aspirin. I still felt the pain, but it was no longer – – – mine.

            I leaned over to vomit. Small price to pay for such relief.

            Learned a lot from that experience about the connection between Pharmacology (the study of how various drugs – including herbal extracts – effect the body) and Neurology (the study of how the brain and nerves function). More than I could ever learn from a textbook.

            Other experiences added to the knowledge. Judges in Mariposa asked me to evaluate people arrested for offenses related to the use of illegal drugs. The drugs that these folks were using were often different. Some used opioids (known medically as “narcotics” from the Greek meaning “to make numb”). Some used meth or “speed” (stimulants, not narcotics). Others used benzodiazepines (sedatives, drugs that  decrease awareness and response to stimulation). Not surprisingly, each person described both the effect of their drugs and the reason for using it very differently.

            And over the years, many patients I’ve treated have been dealing with a complicated relationship between the pain of their problems in life (some, but not all, medical problems) and their use of drugs, both legal and illegal.

            And so it is that I’ve learned three major things thru all these experiences:

  • – just because a drug is legal does not mean it’s free of hazards; conversely, just because a drug is illegal does not mean it is hazardous;
  • – each drug – legal or not – has a very different effect on the human body;
  • – the way some drugs are used can cause harm.

When we say (or hear) “drugs,” many folks have a powerful emotional reaction. This may be due to some tragic personal experience with a loved one or maybe is just integrated into a belief system. We think of the psycho-active chemicals, often, those purchased on the street. We don’t think of medications. But in addition to the drugs called Antibiotics, Blood Pressure modulators, Hormones etc. there is a long list of psycho-active drugs available to physicians. 

            All these can do positive things – otherwise, no one would use them. But they also have potential to harm if used incorrectly. And a couple of them are notorious.

  • – Blood-borne Diseases. Hepatitis, AIDS, and bacterial sepsis can result from injecting with dirty needles. These are devastating diseases and the reason that some jurisdictions have needle exchange programs for those who use IV injection of drugs.
  • – Social Destruction. Loss of family, loss of job, and the cost to society of medical and psychological care can be extreme.
  • – Crime. Because several of the psycho-active drugs are illegal, criminals get involved. Violence has ripped thru more than one country because of the money. Reminds us of the Prohibition era (1920 to 1933). Thousands are imprisoned , often for mere possession.
  • – Death by Overdose. Those who obtain their opioids from pharmacies rarely overdose. They know exactly how many milligrams of morphine or hydrocodone they are getting, and the drug is “clean” of contaminants. Thus folks like healthcare workers or patients who are addicted can function for years without detection. But those who use street opioids never know the exact dosage, and often the heroin (a drug that is prescribed in Britain) is contaminated with fentanyl (a very powerful synthetic opioid) or with benzodiazepines. So  you can see how easy it would be to overdose accidentally.

Drugs other than opioids that can kill by overdose include alcohol (a sad consequence of “hazing” at some colleges) and Tylenol. CDC reports six alcohol overdose deaths per day and 500 Tylenol / acetaminophen deaths a year.

If a person wants to avoid the harm, why don’t they just quit?

In 1875, the medical syndrome of addiction was described, associated

 with morphine. Addiction has these characteristics:

  • – an overwhelming urge to use the drug, in spite of the risk of harm
  • – the phenomenon of Tolerance, whereby the patient uses increasing doses to get the same effect. Often, people use doses that would be lethal to others.
  • – Physical Dependance where the body incorporates the drug into its normal chemical balance.
  • – Withdrawal symptoms when the drug is stopped – a very painful and sometimes fatal process.

Several legal drugs can cause addiction, which increases the likelihood of harm. Alcohol is notorious for a withdrawal syndrome that can be lethal. Even without the withdrawals, alcohol kills 140,000 a year in the U.S. (CDC). Tobacco is extremely hard to quit because of addiction to nicotine. This drug kills 480,000 a year (CDC). Caffeine, when daily users (like me) stop for a few days often punishes us with headaches that are a withdrawal symptom.

But it is the opioids (morphine, heroin, codeine, fentanyl) – the classical drugs of addiction – that has grown into a horrendous epidemic. Even if the initial doses were prescribed by a physician, patients, once addicted, have a much bigger problem than pain (physical or psychological). Snagged by the claws of addiction, they have fallen into a catastrophic quagmire of harm or accidental death. Just how extreme this can be is exemplified by James Fisher, a man who, like me, rode a gurney to an O R. But for very different surgery.

James had become addicted to opioids a decade earlier and tried to escape its clutches multiple times. He had been yanked back from the brink of death from contaminated drugs several times and had tried every addiction therapy available. He always relapsed. Desperate times, desperate measures.

And so it was that a neuro-surgeon implanted electrodes into a very specific part of James’ brain and attached these to a pacemaker-like electronic stimulator implanted under his skin. This artificial modification of his brain has allowed him, so far, to remain off opioids. This case shows how desperate people can be to escape the clutches of opioid addiction.

Here in the U.S., the response to this major Public Health epidemic was to make certain drugs illegal. This approach grew into the War on Drugs. “War” requires a military, and that’s where tens of BILLIONS of your tax dollars have gone in the attempt to cut down the supply of drugs. More money was poured into the law-enforcement / judicial system, chasing after those who possessed the illegal drugs. A small, inadequate amount went to treatment of addiction.

How well has this “War” worked out since 1971?

In 1986 and again in the 1990’s, the government contracted with the RAND corporation to look at that question. RAND reported that the “armed forces had little to no effect” on drug supply except to increase prices. They recommended moving billions from law enforcement to treatment which they assessed as “23 times more effective.” In 2001 the National Research Council reported that the “War” had shown no evidence of success. The journals “Foreign Policy” and “Journal of Crime and Justice” deemed the War on Drugs “a failure.”

On the human side, there are an estimated 21 million people addicted in the U.S. per the Association of American Medical Colleges. The Federal Bureau of Prisons reported that 45.3% of all criminal charges were drug-related. And thru all this, the opioid death rate has kept climbing. It hit an all-time high in 2021 at 108,000 deaths, up 15% from 2020 and 53% from 2019. (CDC).

These disappointing results should not be a surprise. We’ve done this before. Prohibition made alcohol illegal between 1920 and 1933 and the result was a dramatic rise in crime (remember Al Capone?), the creation of illegal speakeasies (an estimated 100,000 in New York alone), increased harm from bad moonshine (blindness) and an increase in the price of alcohol. If, as a kid, I was wrong about what we would learn over 50 years, this failure to learn over the course of a century speaks poorly of human wisdom.

Isn’t it about time we looked at this Public Health epidemic from a different angle?  Shouldn’t we invest the money wasted on the “War on Drugs” into Treatment of the victims of these drugs (legal and illegal) and Prevention measures against future addiction? 

May 23, 2022

It’s Not Over

Filed under: Uncategorized — cbmosher @ 8:29 am

            But it’s not your fault.

            Oh, oh, I just wrote the punch line. So what’s left to write? Ah, well, the Middle, of course.

            Giddy with the joys of Spring, of my daughter, of my egg-hunting grand-daughter and of days of playing with a six year-old (made me feel – and act – like a kid), I experienced a sudden, nauseating hit in my gut. It wasn’t the jelly beans. It was the news that a political appointee in Florida had just yanked the “Health” out of Public Health. And my flight home was the next day.

            Knowing that the latest variant, Omicron BA-2, was jeopardizing the supply chain of Air Fryers and Christmas Toys (lock-down in China), and had hopped from South Africa to New England in just eight weeks, I wore my N-95. But only one third of the passengers did.

            For the other two thirds, it was like exercising “freedom” from their seat belts just before merging into the truck traffic on 99.

            I take my guidance from multiple studies and a couple of case reports in particular. Case # 1 was a man who sat thru a flight from China to Toronto and was diagnosed with Covid after he landed. They tested 25 people near him on the plane. No one was infected. He and everyone on the plane had worn masks. Case # 2 involved a couple of hairdressers in Missouri who were diagnosed. But all 140 customers they exposed during their infectious period were negative because everyone in the salon was required to mask up.

            Question # 1: what are the most accurate Public Health data points? We all know that conspiracy mongers have tried to convince us that people who were reported as Covid deaths did not die from that cause. If you swallow that, it may lead you to believe Covid is a mild disease (or a non-existent disease if you want to go that far). So let’s ignore the cause of death and just look at the numbers of deaths.

            Births and deaths are the most solid data we use in Public Health. Pretty binary. From as far back as at least 2010, Average Daily Deaths (from any cause) in the U S have fluctuated between 7,000 in summer and 9,000 in Winter. Like a baby roller coaster, up and down; up and down for over a decade. But suddenly, in 2020 and 2021, the roller coaster graph became erratic. It burst out of its seasonal pattern with spikes as high as 12,000 deaths a day. Even tho these were “All Causes” deaths – that is, no cause reported – it’s pretty clear what was responsible for these “excess deaths,” as they’re called.

            But many folks are not concerned about the possibility of death from lung failure. However, a large number of survivors – over 18 million in the U S (the exact number can’t be counted at this point) end up with Long Covid. Months of profound fatigue, shortness of breath, brain fog and / or insomnia. Investigators believe this is either persistent infection or an auto-immune syndrome where a patient’s immune system attacks the body itself. Similar to Rheumatoid Arthritis, Crohn’s Disease, Lupus and other auto-immune diseases.

            You know by now what “Pandemic” means. We’ve studied this new virus enuf so far to see that the constant parade of variants means that it’s become “Endemic” here in the U S. That is, it’ll be with us for a long time.

            So what do we do about this Public Health crisis?

  1. Wear a respirator-mask in crowded, enclosed areas. And make it an N-95, not a cloth mask or paper surgical mask. Oh, and cover your nose, too.
  2. Get / remain fully vaccinated. Studies from Israel and the U K show that this greatly reduces the likelihood of Long Covid. Immunity from this vaccine wanes over time, so stay boosted.

            Question # 2: What is the safest age group for humans?

            If people get thru their first year of life, the period of lowest mortality is from there to age 19.

            Then they start to drive.

            Question # 3:  what’s the leading cause of death in children aged 1 to 19 in the U. S. ?

            Not anymore. It USED TO BE motor vehicle accidents. For years. But in 2020 that changed. That year, 4357 kids were killed by firearms. That was the year when gun-related deaths first eclipsed deaths from MVA’s in that age group. 

            Know what else happened in 2020? Gun sales (per the FBI) hit an all-time high at 21 million.

            What can we do about Public Health crisis number 2?

            Lobby legislators, both local and federal, for sensible gun control laws.

            Question # 4: How many Earths do we need to maintain our current rate of resource use and destructive emissions?

            Answer: 1.75.  Obviously, more than we’ve got.

            “Earth provides enuf to satisfy everyone’s needs, but not everyone’s greed.” (Gandhi)

            There’s BIG GREED and LITTLE GREED. The Big one is corporate. The Little one is what each of us has. But both need to be dealt with because the Quality of Life on this planet is so much more important than uncontrolled economic growth.

            This requires VISION.

            “As human beings we base our conception of time on our life-span. This is unfortunate when it comes to planning for what industrialization is doing to make earth inhospitable to life in our children’s lifetimes let alone 1,000’s of years from now.” (source forgotten). 

            Many of us (me included) will be gone before it gets really bad. But do we want to take our last breaths realizing that we fiddled like Nero and left an un-fixable catastrophe of fires, droughts, floods, crop failures, new Infectious Diseases, and worse of all, possible human extinction to our kids and grandkids?

            What can we do right now about Public Health crisis # 3?

  1. Lobby the politicians. Local and federal.
  2. Use our feet or bicycles rather than cars when possible
  3. Go solar. Don’t waste electricity (check out Ohm Connect). Insulate.
  4. Move toward much more plant-based food (60% of Ag land is for grazing animals, which releases tons of methane into the atmosphere).
  5. Shop locally to avoid transportation of food. Grow your own. Farmer’s Market.
  6. Don’t waste food (currently 30 to 40% is wasted).
  7. Adjust what you wear. The Fashion industry causes 8 to 10% of CO2 emissions. Recycle. Repair.
  8. Plant trees. They eat CO2 for lunch.
  9. Invest intelligently. Avoid carbon polluters.

            Question # 5: How’s the Mental Health of our descendants doing?

            “I love my students at school. But I want to be child-free. People are envious of us. We’ve had people confide and say ‘You guys are so lucky’.” (A 30-something teacher).

            Fertility rates in the U S have been falling since the mid 60’s. From 110 births per 1000 women aged 15 – 44 down to 58.3 by 2019. Counter-intuitively, they fell even more during the Covid Pandemic. 44% of non-parents say it’s unlikely that they will have children. Reasons? “Medical,” “Financial,” “State of the World” and “Climate Crisis.” (Pew Research).

            More globally, from a survey of 2100 people aged 18 to 29, done by Harvard:

  1. 51% feel “down, depressed, hopeless”
  2. 25% have had thoughts of self-harm
  3. 56% say Climate Crisis is already impacting or will impact future decisions
  4. 52% say “Democracy is “in trouble” or “failing”

            And now this: a 93 year-old veteran of International Politics recently said “We’re approaching the most dangerous point in human history.”

            When I was in Junior High, I lived in a fallout shelter. Dad obtained a lead-lined door from the Radiology Department and built a room of cement blocks in the cellar. Seemed like a natural extension from the “Duck and Cover” drills we had in grade school. I’d almost forgotten those days of cowering under our school desks until Putin declared “Any country that interferes (with his invasion) will face consequences greater than you have faced in history.”

            Big issues. And real. But we can’t ignore them. That wouldn’t help the kids. So, on top of the Public Health crisis of war (see Gazette of March 3) we have a generation with serious Mental Health issues.

            What can we do about Public Health crisis # 4?

  1. Check in with the kids (and adults) to be sure they’re not hiding depression
  2. Don’t dismiss signs of depression. In others, or yourself. There are specialists who can help.
  3. Stay connected. In person, by phone, e-mail or even that quaint (but frequently appreciated) ink-on-paper. 
  4. Stay physically active and include others.
  5. Do what you’re good at.
  6. Find ways to serve others.
  7. Fight for Democracy. Everyone, especially the kids, must have a voice and a vote that gets counted. We can teach the kids techniques we learned in earlier struggles.

            We need to remind ourselves that these big issues are not our fault. But there’s a lot we can do to start fixing stuff.

Little by Little, Piece by Piece

Filed under: Uncategorized — cbmosher @ 8:11 am

            Some patients can take it. Some can’t. It’s not something they teach you in Med School. But over the years, I had to learn how to speak to patients. For instance, how I explain the damage to the body from hypertension differs depending on whether the patient is a sweet little grandmother or a 280 pound miner.

            So when the miner came to my office and joked that “my friends are starting to say nice things about me, Doc. I must be dying,” I knew two things. First, he was scared. Second, he had enuf sense of humor to allow me to explain what he was facing with my “Little by Little, Piece by Piece” metaphor. That’s the way our bodies deteriorate after a lifetime of use. With some obvious exceptions like “parachute didn’t open” or “couldn’t swim.”

            It’s a concept I’m now experiencing personally. Testing my own sense of humor. After having been constructed many decades ago, my body has, like everyone’s will sooner or later, begun the process of de-construction.

            Turns out we can apply the same description of de-construction to the world that we depend on to survive.

            Is there Life beyond the County line?

            Let’s focus on how this is playing out in the Sierra. Because it’s instinctive for us to be concerned about that which impacts us in our immediate surroundings.

            Had any trouble getting Fire Insurance for your home? It’s an increasing problem. Know what else is increasing? The Fire Season. “California continues to experience longer wildfire seasons as a direct result of Climate Change” (CalFire). Now we are seeing Winter fires crop up all around us: Big Sur in January, Inyo and Orange in February, Shasta, Santa Barbara, Siskiyou and Riverside in March. 

            Of the 20 largest Calif wildfires, 8 occurred in the past five years. And the average temperature during peak fire months is increasing. (Dana Nuccitelli, astrophysicist and Sierra climate expert).

            We’re all aware that drought is what’s driving this worsening phenomenon. As the planet’s average temperature rises, we’re seeing less rain in Autumn and Spring, more rain and less snow in Winter. The Sierra snowpack is shrinking and melting earlier. The trend over the past 30 years is that the eastern half of the U.S. is getting wetter, the west, drier.

            Smell the wild coriander? The menagerie of flowers?

            Deep breath. In the Sierra, we all know that the beautiful air is likely to change in Summer. Studies show that E. R. visits rise by a factor of five times when the Air Pollution is wildfire smoke as opposed to pollution from other sources.

            And it’s increasing: over the period 2009 to 2013, there were 15 to 20 smoke Air Pollution days in California. Over the period 2016 to 2020 that number was 60 days.

            Just as our delicate lungs, when clogged with smoke particles, can make us sick, the increasing days of Air Pollution show us that the planet, too, is sick. 

            Hot enuf for ya?

            There was a time when some people decided to believe that increasing heat events were “part of some normal cycle.” That belief in spite of data proving otherwise. Now, the Gray Areas of this debate are dissolving.

            The nationwide Heat Wave of 2006 caused 600 deaths, 16,000 E R visits and 1,100 hospitalizations. Between 1850 and 1900 there was one lethal Heat Wave every 50 years. Now it’s every ten years. Anyone who’s lived in the Sierra knows heat.

            The Antarctic Conger Ice Shelf disintegrated last month. This will likely increase the speed of nearby glaciers reaching the sea and calving. A harbinger of accelerating ice loss and sea rise. Our planet is suffering from a Fever. And it’s increasing. The ice shelf collapse is a symptom of how bad things are getting.

            Seen any good Pandemics lately?

            “Emerging Infectious Diseases” are now a major area of study in Medicine. There’s a journal dedicated just to this. Increasing average temperatures have caused invasion of diseases into new areas or prolonged the time such diseases can hang around. This is most obvious with mosquito and tick-borne diseases like West Nile and Lyme, which we now have in the Sierra. Similar process to the Ponderosa bark beetles are now flourishing rather than freezing in the winter. We’ve seen what they can do.

            As the clock goes Tick / Tock / Tick / Tock.

            Do we care how difficult it’ll be for our children, our grandchildren, and all the other children of God over the Earth to survive after we’re gone? I know it’s hard – we focus on the here and now.

            Like when the old miner told me as I was explaining his hypertensive issues, “Never mind that, Doc. Check my eyes. I don’t wanna go blind from that Immaculate Degeneration like my brother.” I didn’t want that for him, either. But he had bigger problems to address.

            The planet is sick, de-constructing, as do human bodies. Will it die like humans do? Well, the rock’s not going away. But the Earth will change. Drastically. So drastically that it’s entirely possible that many species – including humans – will go extinct.

            What can we do?

            A reader said recently, “Humans are the ones failing to care for the earth properly. Humans have been terrible tenants.”

            I propose that we think of our place on Earth differently, similar to how the physician thinks of bacteria in the human body. Many bacteria live in the gut, helping us digest food and providing us with nutrients in return for their cozy living quarters inside us, the host. This relationship is symbiosis. Other bacteria, like Staph or Meningococcus are destructive. This is parasitism.

            Earth is our host.

            We need to live with it symbiotically.  

            We all feel a bit impotent because (1) it’s such a massive problem, (2) politicians in a position to do something are slow to act or outright destructive of efforts, and (3) we’ve grown to like and depend on the two leading causes of this impending Public Health catastrophe.

            But there IS stuff we can do.

            Quiz Time:  What is the leading cause of the Climate Crisis? (Sorry. No prizes for correct answer).

            As we all know, excessive release of carbon dioxide, acting as a Green House Gas (GHG) traps heat above and around us. We also know that fossil fuels are the major (but not the only) contributor. Carbon dioxide does not rapidly decay (remember the CO2 tests from Antarctic ice, still there after 800,000 years as discussed in “The Snowflake and the Virus” in September 3, 2020 Gazette).     We’re already seeing some positive efforts here. As of 2021, Renewables (solar, wind, hydro, biomass, geo-thermal, waves) have eclipsed coal in energy production in the U.S.  Renewables and Nuclear together eclipse the number one source, fossil gas.

            Because CO2 doesn’t decay, its impact is very LONG RANGE. We need to push hard on eliminating fossil fuel use. How?

  1. Next vehicle, make it electric or at least, hybrid.
  2. Lobby your Congress-critters on this
  3. Go solar to heat (passive) and generate electricity on your buildings.

            Those efforts will diminish the release of CO2 into our atmosphere. But it won’t REMOVE the CO2. However – – – 

            Quiz # 2:  What is the second biggest contributor of Green House Gas?

            Methane is a more potent GHG than CO2. But – good news ! – this one DOES decay quickly (over just a few years). So methane is a SHORT RANGE problem. If we can reduce its release (while working on the CO2 issue simultaneously) we could do something spectacular. A study out of Stanford University shows how we could reduce GHG emission by 52% and hold global warming to scientists’ 2 degree (C) target, avoiding disastrous effects. 

            But even better, there a way to ABSORB atmospheric CO2, reducing the warming dome over us even further. 

            And this is something we all can do. Starting right now. Without politicians.

            It will require a very significant change for us, and many will see it as a sacrifice in the short term.

            The major source of methane is animal agriculture. Livestock, especially the industrial type with dense populations of cattle and mountains of manure (I’m sure you’ve seen this). The duo of humans and big Ag animals has exploded to become 96% of all mammals on Earth.

            Luckily, we’re OMNIVORES. Unlike most other animals, while we CAN digest meat, we can survive on plants alone. The Stanford study projected that, if we phased out animal agriculture, this happens:

  1. The methane release goes down
  2. Methane decays in the short term
  3. It reduces the deforestation currently occurring to create grazing land (we’ve been losing one acre of Rain Forest every second) would allow the regenerating forests and meadows to absorb CO2 like sponges.
  4. By 2050, the GHG emissions would be paused, allowing us time to replace fossil fuels.
  5. And you already know about the health benefits of such a diet change (less cancer, heart disease, diabetes, lower body mass etc.)

            Not easy.

            But worth it for the kids.

            Little by Little, Piece by Piece.

February 1, 2022


Filed under: Uncategorized — cbmosher @ 8:10 am

            Sometimes, whether writing on paper or two-fingering on the ‘puter, an issue reduces me to a hopeless tangle of glitching neurons. Shaking the Magic 8 Ball for the hundredth time, hoping for different answers, I asked people what the Covid pandemic had taught us about ourselves. Our list includes many lessons – some painful, some hopeful. You may have your own list. 

            Americans thought that our Health Care system was resilient – the best in the world. To be more accurate, most of those who believed this did not work in health care. To hold this belief, you’d need to ignore the two most basic facts about U S “Health Care.” First, that it’s been the most expensive system in the world for decades. Currently costing $10,500 per person each year. Second, that the Health RESULTS from our system have been among the worst in the industrialized world. And I’ve seen “Third World” countries with better health outcomes than we get for our massive investment.

            (Stops typing to face-palm himself about this yet again).

            OK. I’m back.

            How could so many people ignore these realities for so long?

            Answer: the “Sunk Cost Fallacy,” a Cognitive Bias which states that we invest more in things that have already cost us something, even if that results in a negative outcome. “Investment” can be money or emotional commitment.

            What Covid did was rip the bandage of denial from this Sunk Cost fallacy with wave after wave of variants overwhelming every aspect from ambulances to ICU’s. Nurses and physicians have been stressed, exhausted, heart broken and have been attacked by hostile families. Patients in need of non-Covid care (planned surgeries, heart attacks, cancer treatment) have been triaged to the back of the line, to their detriment.

            One of the most eloquent synopses of this situation was written by an E R doctor and dean of the School of Public Health at Brown University (Rhode Island). Some out-takes:

  • many beds are closed in the emergency department and across the rest of the hospital (including ICU) because of a lack of staffing.
  • patients have been waiting on emergency department stretchers for hours, until an intensive care unit, medical or surgical bed becomes available.
  • Health Care Workers suffer emotional exhaustion from caring for horribly sick Covid patients — especially now that the disease is so preventable. Said one, “I feel like we’re rats on a sinking ship. Do I jump off now or hope that someone saves us?”

            Added to this, a friend who is a cancer specialist in SoCal reports that blood donations have fallen off so drastically that there is no longer enuf for leukemia patients who need blood regularly to survive. 

            An E.R. nurse recently wrote about why she (like many others) is quitting. “A patient in critical condition who was waiting outside, coded in the ambulance bay, I learned that the patient had an active bleed and was given two units of blood at the previous facility where he was being treated. They ran out of blood there. ‘Would you like me to run and get STAT blood, doctor?’ I asked as I looked down at the pale, motionless body in front of me. ‘No,’ he replied. ‘We only have two units left, and we are saving it for any emergency pregnancy complications.’ I am watching my country’s health care system crumble in front of me.” 

            “I feel like we’re rats on a sinking ship.” (E R physician)

            So it took getting to this point, where our Health Care system is being held together with fraying twine and chewing gum to realize that it’s been run like a profit-making business, and is so lean that anything more than the short-term crush of several trauma victims at once or of sick folks during Flu season is too much for it. What we need, what you deserve for all that $10,500 per person, is a system that stresses Prevention. Keep as many people healthy and out of the E R and hospital as possible. Take the stress off Health Care Workers. And put together a system that serves the Public (not just those with good insurance), eliminating the profit motive which thrives on admitting as many “heads-in-beds” as possible. Meanwhile – – –

         Topless Urgent Care Centers !

            This satirical line from, “Don’t Look Up” is not as far from reality as I’d like. As politicians early on in the pandemic undermined Public Health professionals and the virus ran thru us as gleefully as an 8 year-old in Disneyland, Quacks and Scammers moved in for the kill. These are the descendants of the Old West’s Dr. Feelgood, who, from his covered wagon hawked magical elixirs (chief ingredient in “elixir” is alcohol) and snake oil.

            Exhibit 1: in Florida and Texas, they set up Covid testing sites which take your money and Social Security number, give you a swab, then disappear. 

            Exhibits 2 thru 5:  bleach, U-V light, Ivermectin, drinking pee.

            Exhibit 6: people that demand hospitals perform malpractice on critically ill family members by administering some of these fake cures.

            How can people BELIEVE this stuff?

            This question keeps popping up when people get together outdoors to drink and eat. Comes from both sides of the political chasm and is, apparently, applicable to most any human behavior these days.

            Answer is found in two more Biases – the “Dunning-Kruger Effect” wherein the less knowledge one has, the more confident he / she is. And the “Bandwagon Effect” where beliefs grow as more people adopt them.

            Ask not what your Society can do for you – – –

            Thought we’d learned that (paraphrased) lesson back when our skin was smooth and our hair wasn’t gray. But :

            Exhibit 7– flight # AAL38, one hour into its journey to London, had to turn around and return to L A because of one person acting out her distorted concept of “freedom” by repeatedly refusing to wear a mask. 

            Exhibit 8 – recently, another person in Virginia threatened to shoot local school board members who were discussing following State law about masks to protect the children.

            Exhibit 9 – people who study the genes of viruses and others who study the virus’ behavior (“epidemiology”) have found that the un-vaccinated population has become the breeding grounds for Covid variants. So we’re not waking up anytime soon from this nightmare. There are places in the world where people are begging for the vaccine but there’s not enuf available. Here, it’s the opposite. We are begging folks to take the (free) vaccine to protect, not only themselves, but everyone around them. But – – – nope.

            My Flabber is exceedingly Gasted at what Covid has revealed – the depth to which America’s concept of Rugged Individualism seems to have degenerated into flat-out self-centeredness. What Public Health does to protect people in a situation of a highly contagious virus  can only be successful if everyone (or some large majority) of Society co-operates. Society is people who do things for you (road repair crews, flight attendants, Health Care Workers, waiters, store clerks, teachers) AND you doing things for them (not running them over with your car, paying a living wage, getting vaccinated, wearing a mask or – failing that – staying away from them).

            A sizable segment of people has basically abandoned Society, endangering others with their behavior and justifying it with words. “Personal Choice.” “Pure Blood.” “Freedom.” There’s a Bias working here, too, “Reactance,” wherein we do the opposite of what we’re told. (Kind of thing we were supposed to out-grow around age 16).  

            We’re seeing the damage this is causing as the unchecked spread of Covid, but an even more profound damage to our Society comes from what underlies that: the subversion and rejection of our Public expertise and government service, which is dragging our Society off a cliff.

O.T.O.H. – – –

            Got a friend here in Mariposa and another off in Texas who had simultaneous epiphanies, not too long into the closure of schools in an effort to protect the kids and to control the outbreak.

            “Have a renewed appreciation of teachers,” they wiped their sweaty brows.

            Teachers’ jobs got even harder with Covid, what with re-working their curricula to fit the Zoom app. But family members had to keep the kids at the computer, urge them thru lessons, drill-sergeant their assignments. Teachers (along with the citizen-volunteers who make up School Boards,     nurses, restaurant servers, flight attendants, store clerks) are the previously underappreciated heroes, revealed to us by this pandemic. 

            We saw restaurants and other businesses struggling, failing. And we responded by supporting them with take-out orders, outdoor dining (in the snow, some places) and ordering for curb-side pick-up.

            Neighbors helped those who were afraid to go shopping because of their age or medical conditions.

            We reconnected more intensely with family and friends.

            Flip side of that coin: we came to see ourselves as Citizens of the World. Now a virus from an animal half the world away can hitchhike in someone’s pharynx and de-plane into a virgin population in mere hours. We’re all in this together. 

            We learned what Public Health does to keep all of us safe.

            Covid revealed how valuable Public Education is. With a constant whirlwind of mis-information and outright lies bombarding us and confusing us (not only about Covid), it reminded us that teaching young people to know how to find accurate facts and how to detect flawed information is crucial to a Free Society.

Punchline: as a physician friend said: “Life is short, sweet, precious and highly fragile.”

October 20, 2021

What We’re Made Of

Filed under: Uncategorized — cbmosher @ 5:47 am

            The same stuff that makes up the world around us – rocks, soil, grass, trees, air – makes up our bodies. The same water that covers 71 % of the Earth makes up 60 % of your body. The Calcium which makes rocks hard is in your bones and teeth. The Iron which turns red with rust makes your blood red. The Nitrogen that grows plants and trees is in your DNA.

            You shrug. So did I when a Native American said this, but then it made me look at a picture larger than what I’d learned in Med School. And it forced me to see the even larger picture that looms for all of us on a fast-approaching horizon.

            Goes like this: the Sun is a gigantic Hydrogen bomb in the midst of its explosion. It, and many other suns (which we call “stars”) are fusing atoms of the smallest element – Hydrogen – into larger, heavier building blocks. These include Carbon, Oxygen, Silicon, Iron and Nitrogen. These elements make up our atmosphere (Nitrogen, Oxygen, Carbon) and our Earth (rocks, water, sand, various minerals).

            These building blocks become molecules, like di-hydrogen oxide (AKA “water”), and build plants and trees. Carbon, Nitrogen and Oxygen unite to form proteins, fats, carbohydrates and nucleic acids. These molecules keep living things (from viruses to plants to us animals) functional. Silicon provides elasticity to our cartilage, skin and connective tissue.

            And we get our energy from the same engine that powers everything from grass to hurricanes. Radiation from our Sun stores its energy in our food. And the bio-chemical reactions I learned about in Med School do the rest.

                        “Existence is a free gift from the Sun.”


            One of the great gifts of Mariposa is just beyond my back deck. On occasions when I ignore the i-phone and ‘puter  and go out there, I drink in the sound of breezes thru the pine needles, the smell of late Summer grass or Springtime flowers, the almost-too-high-to-hear voices of the hummingbirds, the definitely audible “thwack” of the hummers when they fly into each other, the soft undulations and subtle colors of the mountains, the dances of the leaves on trees, the daily cavorting of turkeys, rabbits, deer, snakes and quail like some circus parade across my yard.

            I’d like to believe it’ll go on forever.

            But the drought has the deer abandoning their natural wariness. They approach us, looking for water and something to eat. Of California’s twenty largest fires since 1932, the increasing heat has birthed nine of these over just the past two fire seasons. Abnormal heating of the ocean’s water has spawned increasingly powerful, increasingly wet hurricanes in the last few years. The Carbon Dioxide level in our planet’s very thin atmosphere is higher than it’s been in the last 800,000 years. And it continues to climb.

            If you too, go out on your back porch to take in the Beauty, do yourself a favor and take an apple. Wrap it in a single layer of Saran Wrap. If the Earth were the size of that fruit, the part of our atmosphere we call “the air” – the part in which we can survive – would be as thin as the plastic wrap. This layer supports life with oxygen and is where we find “weather.” It’s both very thin and very vulnerable.

            As can happen to our bodies, our planet has a fever. You can feel it in the air. You can measure it in the ocean’s water which then swirls up into the vortex of growing hurricanes.

            As can happen to our bodies, our planet has a chemical imbalance. You can measure it as Carbon Dioxide levels. You can measure the smoke contaminating our atmosphere. It’s like a worsening case of emphysema.

            As can happen to our bodies, our planet is starving. It is becoming depleted of the minerals we mine and the chemicals we suck out thru our oil and gas wells. Seems counter-intuitive, but our supply of sand, composed mostly of the element Silicon which suns have created, is  becoming scarce. This high-demand commodity (second only to water) is used to make concrete for roads, buildings, cities. Desert sand won’t work – has to be beach or river sand, created by water, not wind. Additionally, crop yields are down about 5% since 1981 due to increasing heat.

            As can happen to our bodies, our planet has a fluid imbalance. The engines that produce weather (air pressure systems, ocean currents, warming seas) are causing two opposing extremes: expanding deserts and more powerful, wetter cyclonic storms. California’s getting drier and the Sahara desert is enlarging. While hurricane frequency has not changed much in 150 years, their intensity is worsening. Can you imagine living thru a storm that dumps 60 inches of rain? That happened in the U.S. in 2017, breaking a record set in 1950. Meteorologists project a pattern of tropical storms bringing even more precipitation in coming years. And those massive storms are moving progressively poleward, away from the equator which has been their historic stomping grounds. Storm surges are greater, causing worse flooding, due to rising sea levels (2.6 inches higher since 2014).

            And we humans?

            We creatures made of the elements the stars created and which makes up our planet? How we doing?

            On September 16, The New England Journal of Medicine, America’s most prestigious Medical journal, and multiple other Medical publications world-wide sounded an alarm. They documented that deaths from excessive heat events among those over age 65 have increased by 50% over the past 20 years. More specific human illness related to the changing environment includes pregnancy complications, increasing and emerging new infections, Mental Health issues, kidney insufficiency and increasing death from heart and lung illness.

                        “We can not wait for the Pandemic to pass

                   to rapidly reduce emissions.”

                                                                        (Medical Scientists in N.E.J.M.)

            As anyone who can fog up a mirror with their nose could figure out, disruption of the planet’s health doesn’t only affect humans. 23 species were recently removed from the Endangered Species list. Not because they’re no longer endangered. They are no longer found, and believed to have gone extinct. Including the “Lord God bird,” a spectacular woodpecker of southern U S forests whose beauty has triggered people to exclaim that reference to God in awe at seeing it. At the current rate, its is projected that half the animal and plant species alive today may be extinct within 80 years. 

What we’re running out of:

            Let’s do this as a Quiz.  Ask Mr. Google or go old-fashioned – read a book.

            1. Clean Water –  

                        What percent of Central Valley wells are contaminated?

                        What % of California’s water is used by the Ag Industry?

                 In return, what % of California’s Gross Domestic Product comes from Ag?

            2. Clean Air – 

                        How many weeks in the year does smoke contaminate the

                                    atmosphere we breathe?

            3. Clean Food – 

                        What chemicals end up in the meat we eat?  In the veggies?

            4. Sand –

                        How many tons of sand are taken from beaches and riverbeds each

                                     year to make concrete?

            5. Beauty – 

                        How much Natural Beauty has been lost to cities, industrial activities, 

                                    freeways and suburbs?

                         How much Natural Beauty has been lost to wildfires?  To droughts?

            6. Shelter – 

                        What percent of humans can’t shelter from excessive heat waves?

                        What percent of humans can’t shelter from hurricanes / typhoons /


            7. Happiness – 

                        What’s the goal of your life’s work?

                        Does pursuit of money stress you out?

                        Is Wealth fairly distributed ?

                        Has Capitalism degenerated into Greed?

            8. Love –  

                        What do you do to make the lives of others at least tolerable, 

                                    and, perhaps, enjoyable?

                        Who is it that Jesus called our “neighbors” when He said 

                                    “Love – – – your neighbor as yourself” ?

                        Has pursuit of money gotten in the way of Giving love? 

                                    Receiving Love?

                        “The world is violent and mercurial – we are saved

                  only by love – – – love for each other and the love

                  we pour into the art we feel compelled to share.” 

                                                                                                            (Tennessee Williams)

            There’s more to HEALTH than the simple absence of disease.

            This free gift from the Sun, this – – – Existence we experience for a while – is doomed if we continue our destruction of the health of the planet, whose atoms and molecules we share.

            Want a healthier planet and atmosphere to live in?  For your grandkids to live in?

         DO SOMETHING.

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