Sex, Drugs, and Public Health

January 27, 2016

The Next Big Public Health Epidemic

Filed under: Uncategorized — cbmosher @ 11:00 am

Among the on-going challenges of contaminated water, cases of communicable disease, and various Public Health emergencies, I’ve noticed a larger pattern. Almost every decade, some major Public Health problem grows into an epidemic that plagues us for years. So, what’s coming next?



                                                                                                                   (photo by Sarah Mosher)


In the early 1980’s after I’d returned from South America, a patient walked into a doctor’s office, terrified that he had melanoma. He was young – too young for a fatal disease, he told his doctor – just 27. But these spots on my skin – – –

The doctor, after examining him, was reassuring. Doesn’t look like melanoma. A biopsy will tell us.

It turned out to be Kaposi’s sarcoma. A disease I’d heard of – once – in Med School, but never seen. Not even in towering teaching hospitals in New York City or Los Angeles. My 2400 page textbook of Medicine mentioned it just once, in only eighteen words, within a table of multiple other obscure skin conditions. It was endemic to Africa, but exceedingly rare in the U.S.

Or had been, up until the 1980’s.

AIDS soon erupted into the number one Public Health epidemic in the U.S. and, quickly, in much of the rest of the world. Jet travel accelerated this disease’s spread, unlike the inevitable but slower spread of Tuberculosis or Syphilis – both major Public Health epidemics in prior centuries.



It’s not much in the news anymore. The non-journalistic reasons include discovery of some very good suppressant drugs and an impressively effective Public Health education effort.

So what is the most likely candidate as the next major epidemic which Public Health physicians and other professionals will be combatting for a decade or two?

Just as AIDS was the underlying condition which spawned outbreaks of Kaposi’s, of unusual lymphomas, and of uncontrolled invasion by microbes previously classified as “benign,” Climate Change will spawn multiple Public Health outbreaks.

Think of Climate Change as the growing epidemic of the 2016 – 2036 decades. What health problems will spring from it?

1. As the planet warms, mosquitoes, ticks and other insect vectors can expand their territories to the north (2015 was the hottest year, planet-wide, since we began keeping records 136 years ago. It quickly surpassed what is now the second-hottest year – 2014).



As the vectors move north, and travellers to tropical vacation spots return home during some virus’ infectious period, the potential for spread of seldom or never seen diseases increases at these latitudes.

For example, Lyme-infected ticks have been increasing in numbers and have been found further north in Canada. Species of the Aedes mosquito which can carry Yellow Fever, Dengue, Chikengunya and now, Zika viruses have been found in the southern U.S. Some species of Aedes have been found as far west as California and as far north as New York.

*Chikengunya, originally of Africa, spread to the Caribbean, right next door, in 2013. Within a year, it had hit the U.S.

*Dengue, originally of the Caribbean, showed up in Texas in 2004 and Florida in 2009.

*Zika virus, originally of Africa and Brazil, is already in northern Mexico. As of January 20, there have been a dozen imported cases of Zika in the U.S..

Are all these diseases certain to become established in the U.S.? Nothing is certain in Medicine. But now, because of Climate Change, it is very possible.

2. Other than these arthropod-borne diseases, other Climate Change triggered Public Health problems will be Emergencies caused by Extreme Weather events (earlier and more powerful hurricanes, floods, heat waves, fires, drought).


                                       (drought and beetle-killed trees in Mariposa, Calif)


3. Also, we anticipate more frequent and severe Air Pollution emergencies from increased smog, more pollen allergens, and smoke from fires.


What can you do?

1 Start acclimating and adapting. Stop hiding in the AC on a daily basis. Use the AC only when really necessary (the hottest summer days), and set it higher than 68 – like 80.

2 Install Solar panels and house batteries to run the house and you don’t have to worry about power outages.

3 Start conserving water. Catch rain water and reuse greywater.

4 Eliminate mosquito breeding areas around your home including old tires, birdbaths, pails and other containers and flower pots outside your home.


And for the Visionaries and Leaders among you, do what is necessary to get us all off fossil-fuels and on renewable sources as quickly as possible.

The Health of the Public (which includes you and your children) depends on us taking action.


December 15, 2015

Harvesting Currier & Ives

Filed under: Uncategorized — cbmosher @ 5:16 pm



The anemic sun, unimpeded by even a single cloud, illuminated a white world beyond my frosted window. Snow still covered our hills, muffling everything to the hush of a church. We kids were growing weary of struggling into layers of thick clothes, just to venture out. Anyway, it was too cold to do anything outdoors. But stuck indoors was even more boring.

The phone rang.

“Hey, Jimmy from up the road is asking if we want to go with him to help harvest maple syrup.”

A trip to the grocery store? I wondered

Jimmy’s dad dropped us from his pickup truck into snow so cold it squeaked when our boots hit it. Even at this temperature, the smell of cow manure wafted from the pickup’s bed.

“I’ll pick you boys up in a couple of hours,” the kid’s dad said. Then he was gone in a cloud of snow.

I looked around. Just the typical wood-sided farmhouse, much bigger barn, and multiple tractor implements dormant in the yard beneath mounds of snow. My every exhalation was a puff of steam; every inhalation a sting to my lungs.

Except for us three kids, the place was deserted.

Something jingled in the barn. We stood there, exhaling clouds. Two horses came out the open door. They were harnessed side by side. Their hair was long and thick. Winter coats. They walked over the packed snow, pulling something. A large sled glided from the doors.

A sleigh! I envisioned.

“Whoa!” some deep, well-used voice graveled.

An old man walked out of the barn, then slid the door closed as his horses waited, blowing steam into the crystalline air.

“Come along, boys,” he said, not even looking our way.

I started for the sled, anticipating a ride, but the neighbor kid stopped me. I followed him, walking alongside the rig.

In silence, except for our squeaking boots, we walked toward the leafless forest behind the farmhouse. The horses and sled, guided mostly by the farmer’s voice, occasionally by tugs on the leather harness, led us among the silent trees.

The trees protruded from the white ground, black, stiff, in varying trunk thicknesses. All their branches stood naked, yet did not make me feel death. Nor did I sense that they were awake – they were too stiff.

One tree – and only one – still had a leaf on it. A single leaf. With three thick points, and colors of yellow, rust, and decaying brown. I peered closely at it, but didn’t touch it. When I saw that the steam of my breaths jostled it, I backed away, not wanting to be the cause of its demise.

At the base of another tree, I saw the characteristic pattern of rabbit’s tracks. Two paw prints side by side in front, and two in a line in back. My eyes followed their chaotic path from the tree trunk into the forest.


I watched the farmer go up to a dormant tree, and remove a bucket hanging on a hook in the bark. He poured the liquid from the bucket into a tank on the sled.

“Come on!” the neighbor kid prompted us. I found a bucket hanging from another tree. Above the handle, a hollow steel tube protruded from the tree at a downward angle. Clear liquid dripped from it, into the bucket. The bucket was half full of clear liquid.

I took the bucket off its hook and moved it to watch the sap inside. I expected to see a slow, barely perceptible movement. The maple syrup I knew from the breakfast table was frustratingly slow. But it sloshed in the bucket like water.

I stuck my nose down to the opening of the bucket and took a deep breath. There was no odor of any kind, let alone the smell of maple syrup I expected.

“Whatcha’ doin’?” the neighbor kid asked.


I carried it over to the sled. In the flat bed above the runners was a steel tank. It had a thin layer of liquid over its bottom. I added my pail-full, returned the bucket to its hook, and took off in search of another.

We all scampered among the trees, carrying the freezing buckets in our mittened hands, getting warmer from the work. The horses moved slowly within the forest to lead us to other trees not yet harvested.

After 45 minutes, the tank was ¾ full.

“That’s enough,” the farmer declared. He turned his team and we followed the sled in another direction.

We squeaked through the universe of snow at the slow horses’ pace, weaving among the forest of black maples. Then, a whiff of maple syrup awoke me from the trance of black and white.

I saw a shed – nothing more than a roof on stilts, beyond a dozen more trees. Under the shed, thick clouds of steam slowly billowed into the frigid air.

The pungent sweetness increased in our noses the closer we got. I approached this Sorcerer’s laboratory slowly, bursting with curiosity, trembling with fear. The farmer stopped his sleigh alongside the shed. When I reached the edge of the roof, I could hear bubbling. Thick bubbles, like some Pleistocene mud pit.

Beneath the roof, a large sheet metal rectangle, mounted off the ground by about two feet, occupied almost all the space, like some Pagan altar. Split hardwood was stacked on the frozen ground near the steaming, bubbling trough. Beneath it, a fire crackled red and yellow, munching thru a dozen or so logs, atop many days’ worth of ashes.

I approached it, led by my drooling nose. Up on my toes, I peered in. The cloud of sugared steam enwrapped my head and fogged my glasses. I took them off.

Molten gold bubbled there. What had been clear sap in our buckets was slowly concentrating down to this. It mesmerized me: bronze-colored bubbles bursting on the surface; gossamer veils of steam rising, tantalizing; crackling hardwood near my feet; the coating of snow over the world beyond this cook shed.

“Give a hand,” the farmer’s voice graveled.

I broke from my trance and saw him scooping bucketfuls from the tank on the sled.

“Pour careful,” he fixed my eyes. “That there’s hot if’n it splashes.”

We added to the trough’s volume, until everything we’d collected was in there. I watched the amber syrup grow pale and its bubbling decrease.

“How long do you cook it?” I asked the farmer.

“ ‘Til it’s done,” he elucidated. “Then you stop.”

I stood there, attached to the sweet odor in the air like a bull tied by a golden chain to the ring in his nose.

“Here,” the farmer finally thought of something else to do. He scooped out a small ladleful of syrup. “Make a snowball.” Then he drizzled some syrup onto my snow sphere.

I took a crunchy, gooey bite. As it oozed over my tongue, releasing its perfume into my nose, one word came from I-don’t-know-where:



October 25, 2015

Persephone, from Where?

Filed under: Uncategorized — cbmosher @ 11:18 pm

(at two and a half months)

You’re waking into our world. As your eyes grow, you watch our smiles, explore the dangling toys we put there for you, perhaps even begin to differentiate colors (I’m assuming there were no colors in the uterus; surprise me and tell me otherwise !).

As your ears grow, you hear a sequence of rising, then falling notes – a song. You hear it so often that it must stand out from the cacophony around you. Notice how it’s frequently accompanied by visions of smiles?

It’s your name.

As your muscles strengthen, you’ve shaped your mouth into a triangle that helps you eat. You explore those noises you can make – your first feeble attempts to express yourself, which will grow, over the years, into the feeble attempts we adults make to express ourselves.

And your hand, that loyal friend from the other world, does it come into view increasingly often? Do you understand that it’s your hand that pushes this toy? That squeezes my finger? And that it is YOU making the hand do that?

Are you beginning to understand how we connect to things here in this world?

Brave little Persephone, you keep smiling as you explore our world. Keep it up; we’ll bequeath this world to you soon enough.

But before you get too deeply in, and ultimately forget where you came from – – –

Tell us – – –

Please – – –

All about Blake’s dell you so recently left.



August 10, 2015


Filed under: Uncategorized — cbmosher @ 6:09 am


Upon watching her as we rocked

Swirling. Slowly. Within the amniotic fluid. Celestial liquid bathing her skin. Filling her lungs. Transmitting vibratory sounds. For a small eternity, magic built her floating body from an amorphous clump of cells. Cells composed of atoms precisely arranging themselves into molecules. Molecules precisely arranging themselves into latticeworks. Latticeworks of molecules creating cells of specific, vastly different intent.

Some of the atoms were created by the sun five billion years ago. Some were created yesterday. Most came from previous incarnations: as a part of some pre-historic and long-extinct sea animal from the oceans of Pangaea; as a part of Achilles’ ship. Perhaps some had once been part of Jesus’ body.

At some time, unknown to us, she began to dream. Floating within the Celestial liquid, awash in atoms of stardust, her dreams were, perhaps, fueled by her connection to the Cosmic Flame that gifts us all with a miniscule part of Itself – a Spark – which we call “life.” Beyond that, we can guess nothing more of the nature of her dreams.

And at some other time, also unknown to us forever, she discovered something floating in the Celestial liquid. It touched her cheek, creating within her, awareness of her self. And some moment thereafter, in the immeasurable time that growing neurons take to transmit information, awareness of her finger. Her finger played for eons with her cheek. In time, it came to respond to her desire, whenever she wanted to feel her cheek. Her finger became her first friend.

Within the utter darkness, swirling, slowly, safe, awash in Comfort that knew neither hot nor cold, nor light, nor pain, a sudden rent. The Celestial amniotic fluid rushed out thru a Black Hole. A blindingly harsh Black Hole. It sucked her into itself, extracted her from her Comfort and quiet and sleep-like darkness.

Cold. Blinding light. The unknown pulling of gravity. And a sudden interruption of blood entering her. Of nourishment entering her. Of oxygen.

Her brain screamed for oxygen.

Her first inhalation bubbled air thru her fluid-filled lungs. Her first exhalation spewed out amniotic fluid. Her next inhalation brought cold into her. But also, oxygen.

Her heart frantically re-shunted her plumbing. Ductus closing. Pressures of her blood surging where it had been low, dropping where it had been high. Her Foramen Ovale – little window between her atria – began to close, separating left from right in her heart.

Her intestinal tract, conduit for nothing but amniotic fluid and sloughing cells, prepared to go to work.

All this demanded energy at an accelerated rate. She began burning fat. Her weight dropped.

Instinct and hunger combined to send her on an expedition for food. With Sarah’s help, she found the breast and learned to use it.

Sleep from exhaustion.
Eat again.

And while the plumbing and neuro-circuitry evolved methodically under pre-programmed guidance, she slept. Her eyes closed, her body cradled, she returned to her Celestial dreams. Her body hummed its internal song of construction, and beyond her body, her infinite memories of the galaxies and nebulae of her intra-uterine world swirled around her. Slowly. Liquid. Watched over by the Cosmic Flame.


Music :“Echoes” Pink Floyd



June 14, 2015

BLOG from the Sea of Cortez 7

Filed under: Uncategorized — cbmosher @ 12:05 pm



Tres Vírgines

After a warm afternoon at Bahia Balandro, admiring the famous mushroom rock and less famous sandy beach, we sail toward our final mooring in La Paz. Tom Uno is retracing his previous route.




“I’m following my breadcrumbs,” he points to his GPS navigation device. “The red line is where we sailed coming north to Loreto. Now we follow it going back south.”

Or, you could – – –




“Look!” Tom Dos points behind us. Our wake dissolves back into the sea’s surface after 50 yards; a few hundred yards from our transom, we see white, disturbed water. Then, up from the surface like a nose-first submarine, a humpback spears the air, twists 180 degrees, spreads his flippers, and crashes back.

The foaming splash, like a monstrous water lily, spreads its tsunami petals to all compass points and rises on the horizon higher than our mast. Then a second whale breeches, twists, and crashes back with an explosion of water.

A dozen times over five to ten minutes, the two repeat the anticipatory breeching and monumental splashes.

“Why do they do that?” I muse aloud. Just in case one of the Toms has the answer. Mr. Google is unavailable.

“It’s always either food or sex,” Tom Uno philosophizes.


Sounds ridiculous to me. I take a breath, preparing to rebut. My mind races thru several species – including our own – looking for the debate points to negate his axiom. I end up having to exhale, wordless.

Once in the slip, Tom Uno assesses the wounds inflicted on Ketch 22 by its nine years of sailing. Like the skin of a mariner’s face – tanned to leather by sea salt, cracked by the sun, wrinkled by work and cold rain – his boat wears the evidence. (The Catch: The only way to keep your sailboat pristine is to not sail it.) The pump on the head doesn’t work (see BLOG # 2), the zipper on his dodger is so corroded it snaps in half, but most annoyingly, his wind vane atop the mast is broken.

“That damned osprey did it,” Tom Uno shakes his mop of salt-impregnated hair. “Let’s fix that.”




And he rigs a paint roller with plastic spikes, which we hoist on a broom handle. Goal is to make it uncomfortable for the bird to perch on – and break – the wind direction vane while looking for food.




Or sex.

I need a new belt. Not so easy to find one with quality and without gaudy spangles. We wander many blocks, beyond the tourist zone, to a neighborhood where we find dozens – maybe hundreds – of sidewalk kiosks. Belts, of soft leather un-adorned, hang in one kiosk. A young girl staffs the place. She jumps up, and is quite helpful. At her feet I glimpse a cradle and infant. I look at her again. She is, maybe, sixteen. Already, most of life’s doors have been slammed and locked to her.

I buy the belt. No haggling to reduce the price, as Gringos like to do. She’ll need every penny. I grit my teeth as we walk away, sad, and a bit angry, thinking of her abbreviated childhood.


Birth control !


“Anybody hungry?” asks a Tom. “Best restaurant in town is Tres Vírgenes.

“There are three of us,” someone retorts sophomorically, “so – perfect choice.”

My surgically manipulated knee, still swollen, and inflamed by the walking, proposes that we take a taxi.

“Let’s go by the cathedral,” Tom Dos requests, clutching his i-phone like a camera.

You can take the boy off the altar, I think about all three of us, but you can’t eradicate the Altar Boy.

The cab driver rolls us, low-rider like, slowly past the old Spanish Mission style cathedral.

“You know,” Tom Dos philosophizes, “the Vatican needs to make Judas a saint.”

Is this flippancy, hypoglycemia, or a well-thought-out Heresy? I wonder. “Interesting statement. Explain.”

“Without Judas, there is no final, dramatic climax to Jesus’ story,” Tom Dos discloses his logic, “and the myth would probably not have persisted through today. Can you imagine Judas saying ‘no way, God. I’m not doing that to my friend?’ No crucifixion; Jesus becomes just another of many prophets, lost in history. But, thanks to Judas, God’s script played out perfectly.”

I’m impressed with his Borges-like thinking. And I recall, again, the short story which I consider the most brilliant of any I’ve ever read:


Three Versions


So now there are Four Versions of Judas.


As we drink in the architecture of the cathedral, a young girl, 14 maybe, walks past, carrying books, on her way to somewhere. As she transects that magical and invisible line which, we were taught, extends from the tabernacle, out thru the closed doors, and deep into the world, she crosses herself. She does it so reflexively, that you know Catholicism is deeply imbued within her. In spite of the books.

Recalling the girl of the kiosk, my brain wants to warn her:


Birth Control !!


The restaurant has arisen from an old Spanish style interior patio. The house was once a series of rooms, now converted to bar and kitchens, that surround the patio on all four sides.

The menu is in English. Maitre ‘de is fluently bilingual. This is, initially, disappointing to me as I prefer, when in Latin America, to use Spanish and avoid Gringos. But that’s impossible in this town and this restaurant. For a long time now, I’ve considered myself to be a citizen, not of any single country, but of Everywhere.

Borges said it better, as he always does:

“As I think of the many myths, there is one that is very harmful, and that is the myth of countries.”

“So,” I embark, feeling a need for resolution at this end of ten days on the water and 70 years on the planet, “what is the Meaning of Life? Quick! Before civilization fucks up our brains again.”

“Don’t know,” one of the Toms throws it back at me. “What do you think?”

Do I go Serious or Smart-ass? They want me to set the tone.

“Maybe it’s the Meaning of Your Life. Each of us with his own. So, for me – – – it’s getting to the place, finally, where I’m comfortable with who I am.”

“Take long, did it?”

“Shit, Man.”


Post-prandial stroll along the Malecón. The sea on our left, tiled promenade underfoot, undulating palm trees above, incessant parade of fat grandmothers, little girls blowing bubbles, skateboarders, geriatric sailors, hand-in-hand lovers and Saturday evening primped-up flirters.

Tres Vírgenes. Kiosk girl. Catholic Schoolgirl. I’m watching for number three.

The Toms walk (and I limp) toward the marina and bed, taking in the show. “Taxi,” says one of the Toms. “Let’s give your knee a break.”

Our flagged-down taxi does a u-turn across the busy street, pulling in from of the Hotel Perla. Five girls stand around in front in their nicest dresses, excited for Saturday night.

Chica bonita!” the elderly taxi driver nods toward them.

Four of the five are victims of their own bodies: skinny, gangly girls in their almost-but-not-quite-yet-grown-into-their-women’s figures stage. They’ve done their Latin American best with their hair, eye makeup, and dresses. They teeter on high heels like kids trying out stilts for the first time.

It’s lovely to see – teen similarity world-wide. The only way to know how it is to be an adult is to practice, after all.

But the fifth girl is that one in every High School who provokes envy and distain from the other girls, and incites uncontrollable erections from the boys. She, too, wears make-up which attempts to add years to her face. For her, it succeeds at bit more than it did with her friends. But it’s the genetics and hormones of her body that have sprinted her far ahead of her buddies. She has poured all her curves into an exceedingly tight skirt which ends at mid-thigh. She poses atop her high heels with the balance and ease of Venus standing on her half-shell.

“Babies,” the driver says in English.

I inquire in Spanish if he meant they are in danger of getting pregnant.

“No,” he clarifies. “They are ‘babes.’ ”

I glance again at Virgin number three.








(photos by me and Tom Marlow; see also )

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