AMERICAblog News http://americablog.com A great nation deserves the truth // One of America's top progressive sites for news and opinion Thu, 21 Aug 2014 14:40:07 +0000 en-US hourly 1 http://wordpress.org/?v=3.9.2 Advair, Symbicort charge Americans 5x what they charge Europeans http://americablog.com/2014/08/advair-symbicort-charge-americans-5x-charge-europeans.html http://americablog.com/2014/08/advair-symbicort-charge-americans-5x-charge-europeans.html#comments Thu, 21 Aug 2014 11:18:40 +0000 http://americablog.com/?p=122225 International pharmaceutical giants GlaxoSmithKline and AstraZeneca are charging Americans approximately five times what they charge the French for the popular asthma medicines Advair (Seretide in France) and Symbicort.

Advair 500 goes for $73 (55 euros) in France, while in America GlaxoSmithKline charges a whopping $391 for the drug (the most recent price at Costco). That’s 5.36x what they charge the French for the same exact drug.

And Symbicort goes for $60 (45 euros) in France, while in America AstraZeneca charges $272 for the drug, or 4.5x what it charges the French.

Advair sells as "Seretide" in France, where the drug is five times cheaper than it is in America.

Advair sells as “Seretide” in France, where the drug is five times cheaper than it is in America. And not because the French subsidize the price, but rather because they negotiate the price and the US refuses.

Merck is even worse. The pharmaceutical giant charges Americans $197 for Asmanex 200.

And how much does Merck charge the French? $25 (19 euros). Yes, Merck charges Americans 7.9x what it charges the French for the exact same drug.

Oh, and that’s the price the French pay BEFORE their insurance picks up most or the tab.

I confirmed the price discrepancies while shopping at a local pharmacy in Paris this week.

As the chart below shows, the drug companies’ actions are even more duplicitous than simplying charging customers more based on their American citizenship.

Over the past five years, GlaxoSmithKline (GSK) has raised the price of Advair by 43% in the US market. But in France, GSK dropped Advair’s price by 13% over the same period.

AstraZeneca similarly raised its prices for Symbicort in America by 40% from 2009 to 2014, while dropping its prices by 17% in France over the same period.

advair-symbicort-asmanex

We’ve written extensively about the incredible mark-up pharmaceutical companies charge Americans.  It’s the reason a growing number of US insurance companies are refusing to pay for Advair at all.

Of course, as I noted in a story earlier this year, the NYT got it wrong when it suggested that Advair competitor Symbicort was somehow charging a fair price in comparison. AstraZeneca’s price is only “fair” if you consider gouging Americans with a 4.5x markup better than gouging us with a 5.36x markup.

As economics professor Steve Kyle explains, the reason the prices are different in the US and France is because the French government negotiates drug prices while the American government does not.

In fact, it’s illegal for the US government to negotiate the price the Medicare program pays for prescription drugs. Why? Because of US senators like Delaware’s Tom Carper, who are a wholly-owned subsidiary of the drug companies — in Carper’s case, the company that owns him is AstraZeneca. (The Republicans are just as bad).

So the next time you consider giving Carper a donation, or voting for him, keep in mind that he’s the reason you’re paying nearly 5x what you should be for that asthma drug that’s saving your kid’s life — assuming you can afford it at all.

In fact, an American mom just posted the following on Facebook:

My son needs Symbicort for his asthma but even with insurance we cannot afford the $90 copay so we no longer buy it. There is no generic. We just keep our fingers crossed he does not have an asthma attack. This article really upsets me.

As Dr. Thoma wrote yesterday, high copays is one of the ways that insurance companies still manage to undercut health care for people they’re required to cover under Obamacare.

We’re #1.

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How health insurance companies still cheat customers under Obamacare http://americablog.com/2014/08/health-insurance-companies-still-cheat-customers-obamacare.html http://americablog.com/2014/08/health-insurance-companies-still-cheat-customers-obamacare.html#comments Wed, 20 Aug 2014 12:00:04 +0000 http://americablog.com/?p=122220 One of the things that the Affordable Care Act (aka ACA, aka Obamacare) was meant to do was make sure that people with pre-existing medical problems could get health insurance.

And that their insurance was affordable. 

But that may not be the case with some insurance companies.

What these insurance companies seem to be doing is targeting prospective patients who have medical illnesses that require a lot of treatment and placing obstacles in their way to getting insured with the offending companies.

These are patients who may require expensive medications, very frequent doctor visits, costly therapies and other treatments that the insurance company is loathe to pay for.  And these discriminatory actions are occurring nationwide, and to such an extent that a large number (~300) of groups (consumer, patient advocacy, medical support and others) have signed and directed a letter to Sylvia Burwell, the Secretary of the Department of Health and Human services to ask her to investigate and redress the situation.

The health insurance companies seem to be using one, or more, of the following approaches to blocking undesirable potential customers:

1.  Not putting expensive medications on their formularies, or charging prohibitively expensive copays (formularies are lists of the drugs that the health insurance company has agreed to pay for, but a copay may be required.)

Insurance companies negotiate with pharmacies and set the prices that they will pay for a specific amount and dosage of a given medication.  If you had to pay out-of-pocket for a specific prescribed blood pressure medication the cost might be $120 for a month’s supply.  The insurance company might agree to pay the pharmacy $9.97 and you pay a copay of $20 for that same antihypertensive medication on formulary.

However, some drugs are much more expensive than $120 for a 30 day supply. John has written before about his asthma drugs, Advair or Symbicort, which can run from $200 to $500 per month, depending on the dose.

Even more expensive is the injectable anticoagulant enoxaparin cost about $2800 per month a few years ago.  And some chemotherapy drugs are hugely expensive, as is one of the newer medications to treat hepatitis C, Sovaldi.  Sovaldi costs about $85,000 for the supply for the full treatment period.  Drugs to treat multiple sclerosis can also be very expensive.  As are many antiretroviral drugs used to treat HIV/AIDS.

Some patients may be on these high-priced drugs for years or a lifetime.  So how does an insurance company that wants to spend as little as possible deal with this (and manage to allow those highly expensive patient groups to go elsewhere)?  They’ve tried a number of options.

First, they can keep the drug off formulary.  That means that they don’t cover the drug at all, and the patient must pay full price out of pocket for each refill.  You don’t have $2,800 per month to pay for just one of your medications?  And a similar medication (if available) hasn’t worked for you?  Too bad.

Or the insurance company can put the medication on formulary, but then require a huge copay.  Some insurances might require that you pay 30% to 50% of the total cost of the medication.  So now you don’t need to pay $2,00 per month for that single medication.  Now you only have to pay about $1,400 per month.

For many people stuck in this situation the choice might be between buying the medication or paying the rent. So those who have diseases that require expensive medications will opt to not select those insurance plans that make them pay such a high cost.  That is, if they thought to look at the insurance company’s formulary and checked what the  copays might be before signing up for that particular plan.  If they didn’t, they may be stuck in this kind of a predicament until that can get out of the plan and into one that is more suitable.  Until that happens, they may not be able to get their medication(s).

Even for those who did check formularies and copays, there is more bad news.  Not only can insurance companies change the prescription copay rates after you sign up for the plan (i.e., your copay formerly was $20, now it is $50), they can also drop medications from the formulary at any time (as long as they continue to meet individual state regulations.)  So that lifesaving medication that you were covered for just last month, is now going to cost you full price.

2.  Another way that insurance companies can try to decrease costs to those expensive patient groups is to limit access to specialists.

Multiple sclerosis patients often see neurologists for their care.  Neurologists get reimbursed at a higher rate than primary care physicians.  The insurance company may just have a few neurologists “in network (meaning, they’re the only doctors the insurance company will cover, or you’re required to pay an absurdly high co-pay if you see someone not “in network”).

So the patient may have to wait a inordinate amount of time to get an appointment.  Or he may not get a neurologist with whom he feels comfortable.  So that high-cost multiple sclerosis patient will probably leave the plan to find a more expensive plan with a larger selection of neurologists.

One insurance company that I’m familiar with operates in a county that has just under 1,000,000 people.  This health insurance company has about 23% of the market, or roughly 250,000 patients.  For those quarter million patients they have 8 psychiatrists, 1 child psychiatrist, 0 pulmonologists that are currently accepting patients, 0 dermatologists and very limited numbers of other many specialists (line ophthalmologists.)  So if your doctor wants you to see a pulmonologist, he has to call and demand that the insurance company send you to an out of network pulmonologist.  He then has to document your need to see this specialist.  There follows a series of phone calls, data entry, faxes, conferences, etc. that can easily take a month, before the insurance company may grant you a single visit with a pulmonologist.  That is if you can find a pulmonologist who is willing to accept the low reimbursement rate that the insurance company will pay.  If you do successfully find one and you need to be seen by him again, the whole process starts over.  So people with this insurance who need to see dermatologists, psychiatrists, pulmonologists and other specialists will probably look for another insurance carrier.  Thus, the insurance company steers high cost patients away from itself in this way, too.

Again, as with the medication predicament discussed above, the insurance companies can drop doctors from their networks after their contracts expire, and may or may not replace them.  So even patients who have checked on providers before signing on with an insurance company may find themselves in a jam at a later date if the company drops the doctors they need.

What sometimes also happens is that the insurance companies may not update their lists of in-network physicians frequently.  So a prospective patient looks online and sees that yes, his HIV specialist, Dr. Brown, is in network.  He joins the plan and then finds out that Dr. Brown quit that plan several months previously — sorry, the Web site wasn’t updated yet.  Now the patient is trapped again and stuck, unable to see his HIV doctor unless he pays cash.

The insurance companies say that they are not trying to exclude certain patient groups from getting their insurance policies.  They say that if a drug isn’t on formulary, or the copay is too high, the patient may be able to upgrade to a gold or platinum plan where the medication is covered.  Of course, this upgrade might be so expensive (on the order of several thousand dollars per year) that the patient couldn’t afford the higher monthly rates, making this a no-win option for many.  And even with the “upgrade,” you might go from paying $1,400 per month to paying $1,400 per year for your medication, which is certainly an improvement, but still awfully expensive for a lot of people (especially if you’re on multiple medications for multiple conditions). The insurance companies maintain that this is just good business from a cost containment standpoint they need to control outlay to function optimally.

Secretary Burwell is looking at the letter and will make a formal reply.

In the meantime, what can you do to protect yourself if you’re thinking of switching, or getting health insurance?  Right now the options are limited since insurers can change formulary drugs, physicians, hospitals, etc. virtually at any time.  But a few things that may help, at least in the short-term.

If the insurance company’s website is not easy to navigate and doesn’t explain things clearly, ask to speak to someone in customer service.  Get that person’s name and write it down along with the date and time of the call.  Take notes.

Have the agent explain what the copays for medications and doctor’s visits are.   Ask him to give you the URL for the formulary  See if your medications are listed on the formulary.  (NOTE: Formularies can vary based on the particular plan that you select.  Not all patients with XYZ Health Insurance company will have access to all of the same covered drugs.  Make sure that all of your medications are available in the formulary for your plan.) If there is a copay, find out how much it is currently for each medication that you need. Ten dollars, twenty dollars or thirty percent?   Add the copays up to see what your monthly outlay will be.  Find out which pharmacies you can use.

(John tells the story of calling Carefirst Blue Cross Blue Shield in DC repeatedly, trying to find out what the copay was, under their various ACA plans, for his allergy shots. No one could tell him. Though one woman helpfully suggested that he sign up for the plan anyway, then submit his bill, and that way he’d find out for sure what his copay was.)

Ask how to access the list of physicians who are in network.  Go there and check that all of your physicians are participating.  Browse the list of specialists, hospitals, imaging centers, labs, etc. that accept your coverage.  If you don’t see a reasonable selection, you might want to try some other insurance plan.  Remember, you may not need a rheumatologist right now, but if you do in the future, are there any available in your prospective plan?  Don’t stop there.  Call the physicians’ offices and verify that they are still taking your particular plan.   Ask if they have any plans to drop your insurance company in the future.

If you find that you are stuck with an insurance company that has dropped one of your needed medications, has given you inaccurate information, has a difficult to navigate/confusing website or some other major problem, start off with the insurance company.  See if they can do something to correct the issue or otherwise help you.  If that doesn’t work, you can get in touch with your state’s insurance commissioner and see if you can file a complaint there.  Or you may want to contact your states health insurance exchange and see if they have any suggestions.  If you find can’t afford a necessary medication through your insurance company, look at the big box pharmacies’ $4 list and see if your medication is available there.  If not, try contacting the drug manufacturer.  Almost all of them have patient assistance programs that can sometimes help with getting free or lower-cost drugs for some people.

Even if you’re not looking to get or change health insurance it might be a good idea just to take a look at your insurance’s website and see if there have been any changes.  Especially if you see a specialist only rarely.  For example, if you only see an ophthalmologist once a year.  In the intervening months since your last visit the insurance company may have dropped him or vice versa.

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Lead GOP hate group ties Robin William’s suicide to “ex-gay” therapy http://americablog.com/2014/08/lead-gop-hate-group-ties-robin-williams-suicide-ex-gay-therapy.html http://americablog.com/2014/08/lead-gop-hate-group-ties-robin-williams-suicide-ex-gay-therapy.html#comments Tue, 19 Aug 2014 17:30:08 +0000 http://americablog.com/?p=122215 They don’t call the Family Research Council a “hate group” for nothing.

In a recent post on its Web site, FRC used Robin Williams’ suicide as a hook to push for the “cure” of all gays.

Because… hate group.

First, here’s FRC, then a little discussion:

In the wake of Williams’ suicide, many TV commentators and friends of the late star talked about the challenges of mental illness (Williams suffered from depression), addictions — and rehab. I saw comedian Andy Dick say, “I’ve been to rehab seventeen times.”

In light of this history, I have only one question for socially liberal political activists — why aren’t you trying to outlaw rehab?

I ask the question because such activists are trying to ban a form of mental health treatment — not drug and alcohol rehabilitation, but “sexual orientation change efforts” (“SOCE”), also known as “sexual reorientation therapy.” Such therapy involves assisting people with unwanted same-sex attractions to overcome them.

Why would someone want to change their sexual orientation? Some such individuals are simply disillusioned by their experiences in homosexual relationships. Some have legitimate concern about the well-documented health problems associated with homosexual conduct (especially among men), such as high rates of sexually transmitted diseases, of which HIV/AIDS is only one example. Others may seek help in conforming their behavior and lifestyle to the teaching of the religious faith to which they are committed. Some may aspire to a traditional family life, raising children in a home with both their mother and father present.

Whatever the motivation, there are those who have simply made a choice to walk away from the homosexual lifestyle, without clinical help — much like how Robin Williams simply stopped using drugs and alcohol in the 1980’s. Others have sought professional help, perhaps at the urging of family members, in the form of “sexual reorientation therapy” — much like when Williams entered a formal alcohol rehab program in 2006. Whether simply through personal development, religious counseling, or with the help of a licensed or unlicensed counselor, thousands (if not millions) of people have experienced significant changes in one or more of the elements of their sexual orientation (attractions, behavior, or self-identification). [emphasis added]

So being gay is like being an addict, or something.

Tony Perkins of the Family Research Council

Tony Perkins of the Family Research Council

Mind you, FRC has been pushing its “pray away the gay” fairy tale for about twenty years now, and they have as many success stories now, two decades later, as they had then.  Actually, they have fewer, since many of their “ex-gay” poster-children are now fallen angels who have admitted that they were gay all along.  (As if that’s a surprise to anyone.)

The “you can cure gays” lie was debunked decades ago, by the way.

Former FRC head Gary Bauer. The masculinity oozes.

Former FRC head Gary Bauer. The masculinity oozes.

You might recall that in addition to having presidents who come across as awfully fey, the FRC regularly carries water for, and works with, the Republican party —  former FRC head Gary Bauer even ran for president as a Republican.  Well, FRC’s two decades of lies about gay people finally won them the official designation as a “hate group” a few years back, and they weren’t terribly pleased about it.

But even for FRC, trying to use Robin Williams’ death for political gain is really a new low.

Then again, they’re a hate group.

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Russian anti-gay Nazi leader sentenced to 5 years NOT for his anti-gay crimes http://americablog.com/2014/08/russian-anti-gay-neo-nazi-leader-sentenced-5-years-anti-gay-work.html http://americablog.com/2014/08/russian-anti-gay-neo-nazi-leader-sentenced-5-years-anti-gay-work.html#comments Mon, 18 Aug 2014 21:13:40 +0000 http://americablog.com/?p=122205 Russian neo-Nazi leader Maxim Martsinkevich has been sentenced to 5 years in prison, but not for any of his anti-gay crimes.

Martsinkevich, among other things, is the leader of the Russian group Occupy Pedophilia, while claims to have kidnapped and tortured around 1,500 young men, many of them gay.  (The group records the abductions, and then posts them on Russian social media site VK.com (Vkontakte), which generally refuses to remove them.

I’ve written extensively about Occupy Pedophilia, and about the Russian government’s refusal to take any serious action against the Nazi extremist group.

russian gay

Maxim Martsinkevich with one of his kidnapping victims.

And even in Martsinkevich’s case, the Russians refused to include any of the gay-related kidnaping and torture charges in the case against him. Instead, he was convicted of posting “racist” videos online.

Also troubling is the fact that Occupy Pedophilia continues to operate in Russia, and Ukraine, to this day. The last time I checked, there were nearly 4,000 Occupy Pedophilia videos on the VK, a company that was recently taken over by Putin crony Alisher Usmanov.  VK was also home for nearly 700 Occupy Pedophilia community pages. (The company’s indifference to the apparent criminal activity being broadcast on its site began under Pavel Durov’s reign, and continues to this day.)

So the problem continues, in terms of VK’s refusal to abide by what seems to be a clear violation of its own terms of service, and the Russian government’s continued coddling of a nationwide Nazi criminal conspiracy.

And as far as we know, most of Occupy Pedophilia’s members, including the kidnappers, who have no problem showing their faces in the many videos still posted on VK.com, remain at large.

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Man tries to kill woman for eating 3 choco chip cookies for breakfast http://americablog.com/2014/08/man-tries-kill-woman-eating-3-choco-chip-cookies-breakfast.html http://americablog.com/2014/08/man-tries-kill-woman-eating-3-choco-chip-cookies-breakfast.html#comments Mon, 18 Aug 2014 18:11:01 +0000 http://americablog.com/?p=122203 A Decatur, Illinois man reportedly tried to strangle to death his female roommate after he found out that she had eaten 3 Chips Ahoy chocolate chip cookies for breakfast.

It’s unclear if the man was upset that the woman was eating his cookies, or rather that she was eating cookies for breakfast.

Though there is a third possibility. I mean, eating Chips Ahoy? Please.

These are my personal chocolate chip cookies, and let's just say, they're to die for.

These are my personal chocolate chip cookies, and let’s just say, they’re to die for.

While I admittedly would be pretty ticked with a roomie had they stolen my freshly-made chocolate cookies without asking, I’m not sure I’d literally try to strangle them to death.

According to the report in the local paper, the man banged on the bathroom door and said he was going to kill her. Thinking he was joking, she opened the door and told him to get it over with. So he lunged and her neck and threw her into the bathtub. That’s when the victim’s husband and landlady fortunately heard he ruckus and jumped in to save her.

Nice.

This definitely ranks up there with the South Carolina woman who stabbed her husband with a ceramic squirrel after he forget to buy beer.

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“When the Social Contract breaks from above, it breaks from below as well” http://americablog.com/2014/08/ferguson-when-the-social-contract-breaks-from-above-it-breaks-from-below-as-well.html http://americablog.com/2014/08/ferguson-when-the-social-contract-breaks-from-above-it-breaks-from-below-as-well.html#comments Mon, 18 Aug 2014 14:00:40 +0000 http://americablog.com/?p=122178 A photo essay. This is about the police, though that may not be obvious at first.

It’s also about Ferguson and the Social Contract.

When the Social Contract breaks from above …

The Song of the One Percent — "Who stole the people's money? Not me, I got it from this guy ..."

The Song of the One Percent — “Who stole the people’s money? Not me, I got it from this guy …”

… it breaks from below as well:

The Song of the Hopeless

The Song of the Hopeless

To see how this applies to Ferguson, read this, from Time (my emphasis and paragraphing):

Why Ferguson Was Ready to Explode

… Metrolink, St. Louis’s light rail system, completed its second line in 2006. It provided African Americans of East St. Louis, one of the poorest cities in the country, and of north St. Louis county much easier access to the St. Louis Galleria Mall and the central cultural corridor of the city, including the hip Delmar Loop district. Concurrently, the Galleria has since seen an astronomical increase in shoplifting, and there has also been an increase in general crime and hooliganism in the Delmar Loop.

This has led many to think that the Metrolink, as it has crossed racial boundaries, has enabled African American teenaged crime. This vicious cycle of young African Americans’ antisocial hostility and acting out, hardly unique to African Americans or even to Americans, and ever increasing white fear and barricade building, have intensified racial tensions, as people find the problem intractable and increasingly impossible to discuss honestly.

The current riot in Ferguson is largely a war between police and the young African Americans who think cops exist mostly to prevent African American from harming whites.

The War on the One Percent, the War on Crime, and the War on Terror are becoming three names for the same thing — forced by the One Percent. Soon they may be nearly identical. Witness this:

Salinas CA police with their new toy (and urban-friendly camouflage). Note the kick-ass sunglasses.

The Song of the Guardians — Salinas CA police with their new toy (and urban-friendly camouflage). Note the kick-ass sunglasses.

Peacekeepers, serving and protecting … the broken Social Contract.

A scheduling note

I’m back from much travel and will be posting intermittently for a while. Check here for new posts.

First up, three interviews I did at Netroots Nation, part of my Five Questions series. This year I spoke with Congressman Keith Ellison, economics professor and guru Stephanie Kelton, and political writer and activist Robert Cruickshank. Stay tuned for those. Each one was revealing.

GP

Twitter: @Gaius_Publius
Facebook: Gaius Publi

(Facebook note: To get the most from a Facebook recommendation, be sure to Share what you also Like. Thanks.)

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Could statins help treat Ebola? http://americablog.com/2014/08/statins-help-treat-ebola.html http://americablog.com/2014/08/statins-help-treat-ebola.html#comments Mon, 18 Aug 2014 12:00:57 +0000 http://americablog.com/?p=122194 In an article in the New York Times, two physicians propose using drugs that are currently available to treat Ebola.

Ebola causes a derangement in endothelial cells (cells lining blood vessels), and this can lead to decreased ability of the patient’s blood to clot. This can lead to internal and external bleeding, and shock and damage to visceral organs like the liver and kidneys.

The doctors note that this process is similar to sepsis, a condition where the body is trying to cope with an overwhelming infection. In severe sepsis, there is often bleeding, shock, organ failure and death.

There have been a number of studies where statins have been given to patients with sepsis because some work has shown that statins can help prevent or slow the above process.

The physicians also note that two other classes of drugs, angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers, seem to have similar effects to statins in prevention or halting the above process.

The doctors suggest that members of those three classes of drugs might be helpful in treating Ebola patients. However, to date, these drugs have not been given to Ebola patients because their effects have not been studied in those patients. Just because they have been shown to help in patients with sepsis, does not mean that they will necessarily help in Ebola. Since that is the case, the World Health Organization is notably reluctant to suggest that these drugs be used in Ebola patients. However, it is an interesting proposal and will require much thought. If numbers of Ebola patients continue to increase, and other treatment options are lacking, these drugs might be given.

Ebola life cycle, from the CDC.

Ebola life cycle, from the CDC.

A vaccine, untested in humans, is being sent to the area. The drug, developed by the US and Canada was given to the WHO to use in the area. About 1,000 doses were sent.

Mapp Biopharmaceuticals will attempt to make more ZMAPP. (ZMapp is the experimental drug given to Brantly, Writebol and a few others.) They have shipped all of what they had on hand to the affected area. Tekmira, maker of TKM-Ebola (a drug that can be given after someone is exposed to the virus) has approval to fast-track the drug through the FDA. They are considering how to release what supplies that they have available. Another US research lab may be able to start testing its vaccine in early trials as early as next month. That would make two vaccines going into testing.

The bad news is, this is a process that will take months (for ZMapp production) to years (vaccine testing and production) before any measurable amount of drug is available. Realize that Liberia has a population of about 4,000,000. Lagos, Nigeria has an estimated population of about 21,000,000. There would be a need for a vast number of medicines and vaccines to treat/protect just those people. The production of enough medicine for all to those people, if needed, would be a staggering task. So these drugs aren’t going to be what stops Ebola now. Quarantine and control will be the chief agents to stem the disease. And, in more bad news, there are now scammers now who are offering anti-Ebola “medications” and anti-Ebola “vaccines” and other treatments both online and in the marketplaces of the affected countries.

In other Ebola news, the WHO is now saying that the Ebola outbreak in the affected areas of Africa, is much larger than they first thought. As I wrote in an earlier article,  doctors who had been on the ground in the area, and infectious disease specialists, were saying that the outbreak was probably much larger than the numbers released based on those seeking treatment. They predicted that as high as 75% of cases were not diagnosed, as they didn’t present for treatment. They may have just stayed home, fled or died. Also, Doctors Without Borders said weeks ago that they were overwhelmed by just the number of reported cases of Ebola.

Guinea has declared a public health emergency over Ebola. It joins Nigeria, Liberia and Sierra Leone who had all previously done the same.

The government there says that its Ebola outbreak is “under control” and numbers of cases inside its borders are decreasing. Whether that is true or not is a matter of debate for two reasons. First, sometimes the local governments are somewhat less than honest about reporting information such as this. The Ebola outbreak is costing the area’s economies millions of dollars that they cannot afford to lose. They certainly want to do as much damage control as possible. Additionally, the press in those areas tends to be somewhat less than factual, at times. So the reporting from the area may be suspect. Also, a few months ago, the number of Ebola cases in the area actually were falling, but then they began to spike again. This seems to be the pattern with Ebola. Appear, infect, spread, wane, disappear. When the incidence of cases declined, people thought that the outbreak was over.

More airlines are suspending flights to the affected countries and neighboring countries. Meetings and conferences in the area are being canceled. The Youth Olympic Games is banning some West African athletes from competing because, the IOC feels, that there is a risk of transmitting the virus if infected athletes participate in swimming events. West Africans will also be banned from a few other sports at the Games in China.

US patient Kent Brantly is looking forward to getting discharged. SIM, a Christian Missionary group, says that he’s feeling much better, but a discharge date has not been set.

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Liberian Ebola clinic attacked by mob, 29 patients have fled http://americablog.com/2014/08/liberian-ebola-clinic-attacked-mob-29-patients-fled.html http://americablog.com/2014/08/liberian-ebola-clinic-attacked-mob-29-patients-fled.html#comments Sun, 17 Aug 2014 20:54:37 +0000 http://americablog.com/?p=122188 An armed gang of men attacked an Ebola isolation center.

They are angry that the government opened the quarantine center in their neighborhood. Some refuse to believe that there is an Ebola outbreak or that the virus is a threat to residents.

The news came as Kenya closed its borders to travelers from the west African countries affected by the recent Ebola outbreak.

At the same time, the World Health Organization says that “staff at the outbreak sites see evidence that the numbers of reported cases and deaths vastly underestimate the magnitude of the outbreak.”

Symptoms of Ebola, by Mikael Häggström.

Symptoms of Ebola, by Mikael Häggström.

The group of men was armed with clubs, some are reported to have had guns. They broke into the clinic and trashed it. Some of them reportedly stole supplies and equipment.

Among the stolen items were blood-stained mattresses and sheets. Officials are afraid that these items could spread Ebola. Several of the clinic patients fled the clinic during the attack and have not been found.

Also, during the attack, some relatives of a few of the quarantined patients stormed in and abducted their family members. Police were called to chase off the gang. About 29 patients who may be infected with Ebola are unaccounted for and have presumably fled.

Previous to this attack, another group had attacked a party of men who were out to bury Ebola victims. Police arrived and shots were fired to disburse the group interfering with the burial team.

These aren’t the first incidents in the area. Over the past few weeks there have been protests and shouting matches, and rocks have been thrown at healthcare workers. A group of rioters were chased away from a hospital. Some clinics were also attacked.

Some residents in the area do not want Ebola patients or corpses anywhere in their vicinity. While others think that healthcare workers are deliberately spreading Ebola among those that they are treating.

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Women call 911 after “Cuppy” the kitty holds them hostage in bedroom http://americablog.com/2014/08/people-call-911-cuppy-cat-traps-bedroom.html http://americablog.com/2014/08/people-call-911-cuppy-cat-traps-bedroom.html#comments Fri, 15 Aug 2014 11:23:45 +0000 http://americablog.com/?p=122158 It’s all fun and games until someone gets a cat.

My love-hate relationship with members of the feline race is well-known in these parts.

Don’t get me wrong, I do love animals. But I have a simple rule about pets, and it’s the same I have for people — I stop loving them when they try to kill me.

And even then, I still show mercy.

The time demon-cat got awfully close to becoming a permanent part of the freezer.

The time my nephew’s demon-cat got awfully close to becoming a permanent part of the freezer.

I’m currently staying in Paris with two cats. One old and lovable, who throws up a lot. And the second, young and precocious (and in heat), who has a thing for jumping up on your shoulders, unannounced, when she’s not screaming her lungs out at 4am in search of a mate.

Demon-cat decided that Sasha would not enter mom's kitchen. Sasha complied.

Nephew’s demon-cat decided that Sasha would not enter mom’s kitchen. Sasha complied, looking to me for help.

But what particularly caught my eye with the story below, about the people who had to call 911 to rescue them from their cat that had trapped them in their bedroom, was that the same thing happened to me.

No I didn’t call 911 when my nephew’s demon-cat decided I was never to leave my mom’s bathroom again, but I did call upon friends on Facebook and Twitter, who suggested I was being silly, and told me to simply walk on by, she’d be fine.

The time demon-cat trapped me in my mom's bathroom.

The time demon-cat trapped me in my mom’s bathroom.

That’s when she ripped into my leg and drew blood.

So I’m sympathetic to the women in the story below. Hell hath no fury like a cat who doesn’t like Mondays.

The reporting in the video is pretty hysterical.

cuppy-and-cops

PS It’s a holiday here in France, and I’m busy cleaning the apartment, preparing to move somewhere else. So this may or may not be my last post today.  Enjoy.

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The Eiffel Tower is pretty fetching after cataract surgery http://americablog.com/2014/08/eiffel-tower-pretty-fetching-cataract-surgery.html http://americablog.com/2014/08/eiffel-tower-pretty-fetching-cataract-surgery.html#comments Thu, 14 Aug 2014 20:03:46 +0000 http://americablog.com/?p=122146 I’ve written before about the (sometimes brutal) epiphany I had after getting (rather unexpected) cataract surgery a few years ago.

You see, unless you’re 5 years old, or 90, the world simply doesn’t look like what you think it looks like. And that can be a bit existentially disconcerting.

For example, take grass. With lenses colored by age, grass is pretty hot stuff. It’s so bright green, it practically screams at you on a summer’s day. Not so much after you get cataract surgery. Grass, alas, is a post-cataract bummer.

But sunsets. Don’t even get me started on sunsets. Forget the main event, the sun itself. That’s for amateurs. Those of us with artificial lenses in our eyes, rather than those pale yellow things the rest of you put up with, see the world (other than grass) in technicolor. During sunsets — often, but not always — I see the entire sky light up with a beautiful bright burgundy, pink, neon-y glow. It’s pretty amazing. (And I tested it after I’d only had cataract surgery in one eye, and had my sister test it too – as she’s only had one done — both confirmed I wasn’t (or rather, was) seeing things.)

Of course, it does take a few months — it took me at least — to get over the concern that perhaps you were living a color-lie your entire life (or perhaps you’re living one now). When I post photos on the blog, or blow them up for my apartment, will other people not see what I’m seeing?  And is what I’m seeing even real? Or is it like those cameras over the past decade that had the saturation amped up because people liked their photos to look more real than the real thing? Did the doctor amp-up my eye so that things are so pretty they’re fake?

And neon. Ooh, neon. Paris is filled with neon. And it’s pretty cool post-cataract surgery. You’ll just have to trust me on this.

And finally, the Eiffel Tower. I went to dinner last night with a friend who’s a reporter in Paris. We went to some little bistro near the Eiffel Tower, and he suggested we take a walk after dinner.

I’ve seen the Eiffel Tower, a lot, over the years. I had the good fortune to study abroad in Paris, then worked here for a summer, and have come back many of the past several years for my medical tourism (and for work), the savings of which gladly (and sadly) ended up paying for my entire trip.

But nothing prepared me for last night’s post-cataract Eiffel Tower sparklefest. We happened on it around 10pm, right when the light show begins.  Basically, the whole thing glitters.  It was far more glittery, and just simply stunning, than I remembered. Yep, the cataracts struck again.

The video is only one second long, because I thought the camera wasn’t capturing the true majesty of the moment — but in retrospect, it’s not so bad. But you have to watch fast!

I took some photos too, once we got right in front of the Tower. How could you not?

©John Aravosis, 2014

©John Aravosis, 2014

©John Aravosis, 2014

©John Aravosis, 2014

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Chicago Catholics fire church choir director for being gay http://americablog.com/2014/08/chicago-catholics-fire-church-choir-director-gay.html http://americablog.com/2014/08/chicago-catholics-fire-church-choir-director-gay.html#comments Thu, 14 Aug 2014 12:00:29 +0000 http://americablog.com/?p=122142 Colin Collette, who served 17 years as the music director of Holy Family Catholic Church in suburban Chicago, was fired from his job in July after announcing on Facebook that he was engaged to a — dum dum DUM — man.

Interestingly, the priest who leads the church in the town of Inverness says that the problem was that Kenned “has publicly endorsed a position in conflict with Church teachings.”

In other words, you can’t play the organ at a Catholic church unless you’re opposed to gays getting married.

The American gay publication, the Advocate, named Pope Francis their 2013 person of the year.

The American gay publication, the Advocate, named Pope Francis their 2013 person of the year.

It’s an interesting irony that the Catholic church thinks it’s ecclesiastically better for gay men to hook up with strangers in private than get married in public.

The religious right, and the Catholics, have for years railed about how dangerous all those “promiscuous” gay relationships are. Yet now that gays finally want to settle down, suddenly settling down is the real problem.

Here’s more from the priest of the church:

Through the use of social media, the Archdiocese of Chicago has become aware that Colin has publicly endorsed a position in conflict with Church teachings,” Keehan wrote. “Employees who make such choices cannot remain employed by the Archdiocese.”

Note that the church didn’t fall back on its usual argument, that you can be gay, you just can’t do anything gay. Apparently, you now can’t even Tweet gay.

Of course, the Catholic Church’s position on having gay choir directors shouldn’t really surprise.  After all, this is a church that tolerates its cardinals calling gays “f*ggots.”

Then there’s Catholic Charities’ penchant for taking at-risk kids as political hostages.

In view of all that, what’s a choir director?

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Medical roundup: Aspirin and cancer prevention; Diabetes on the rise http://americablog.com/2014/08/medical-roundup-aspirin-cancer-prevention-diabetes-rise.html http://americablog.com/2014/08/medical-roundup-aspirin-cancer-prevention-diabetes-rise.html#comments Wed, 13 Aug 2014 22:18:32 +0000 http://americablog.com/?p=122137 Aspirin as a cancer preventative

Studies have shown that aspirin is useful in the prevention of heart attacks. But some research demonstrates that it may also be useful to help prevent, or control, some forms of cancer.

Investigators have found aspirin can inhibit the spread of some types of cancer (e.g., breast cancer) and/or decrease the risk of dying from some forms of cancer. The cancer types that seem to show this type of reaction to aspirin are breast, cancers of the GI tract, and prostate.

A recent study from Ireland looked at women who took aspirin regularly and those who didn’t take aspirin on a regular basis. Women who took aspirin had a lower risk of developing breast cancer, had less metastatic cancer, and fewer of them died from breast cancer than the group that didn’t use aspirin.

Of course, as with any drug, there are risks with taking aspirin. Some people are aspirin allergic, and aspirin can cause excessive bleeding. Before starting aspirin, discuss its advisability with your doctor.

Diabetes epidemic

A study shows that diabetes (type 2 diabetes, adult-onset diabetes) is increasing rapidly in the US, especially among minorities.

The researchers estimate that, of US citizens born between 2000 and 2011, about 40% will develop diabetes. That is almost double what the incidence was for US citizens born 10 years earlier than this group. Even before that, the incidence of type 2 diabetes was steadily increasing.

In minority groups the incidence can be as high as 50%. That’s a huge number of diabetic patients. Many of those patients will also suffer from the complications of diabetes: kidney problems, cardiovascular problems, blindness and others can put a tremendous burden on those affected and the healthcare system, as well.

Obesity and other factors can increase the risk of developing type 2 diabetes.

Preventing colon cancer

Sigmoidoscopy (similar to colonoscopy but only the left side of the bowel is viewed internally through a sigmoidoscope) is effective in decreasing the risk of dying from colon cancer.

A Scandanavian study showed that this test can cut people’s risk of developing and dying from colon cancer, just as colonoscopy does. Sigmoidoscopy is a little faster and the preparation may be easier. It can be done without sedation. But it is rarely done in the US. Most often a colonoscopy is preferred because the entire colon, not just the rectal area and left colon, can be seen during colonoscopy.

There are three different options recommended as screenings for colon cancer by the U.S. Preventive Services Task Force (USPSTF):

  • an annual stool test
  • sigmoidoscopy every five years, along with stool testing every three years
  • or colonoscopy every 10 years (John wrote about his experience a few months back)

For most people, screening for colon cancer should begin at age 50. Discuss your options with your doctor.

Beware of downloadable medical apps

Downloadable medical applications can be quite useful in managing people’s medical needs.

Some help users keep track of calories, carbohydrates, fats. Others record blood sugar readings. Some store the patient’s medical history, allergies, medications, etc. and can be given t o a doctor to keep him up to date with the patient’s medical background. There are literally thousands of apps available.

However, a word of caution. Neither the FDA, nor other governing bodies, regulates medical apps.

For example, an app that someone is using may claim to list the number of calories in a serving of a particular food. That number may be accurate – or not. It’s best to randomly check your apps to make sure that they’re doing what they’re supposed to be doing. Verify how well it works by comparing it with a data set from a different source. Verify that the 80 calories that your app says are in that apple are really there.

Similarly, if you’re using an app to track your blood glucose readings, keep a check on how well the app is recording and storing those numbers. The same holds for other apps. Make sure that they work properly before you trust them.

Recently, there have been a few ape published that claim to measure blood pressure and/or pulse by using a smartphone. Yet the authors of these apps have not explained just how a smartphone is capable of measuring or recording these parameters. Until they do, you can’t be sure that the “blood pressure” and “pulse” readings are accurate.

Chikungunya virus in Florida

A while ago I did a post on Chikungunya virus (CHIKV).  This is a virus that was endemic in Africa and has spread to the Caribbean.

It starts with a fever and then joint pain begins. The joint pain can be moderately painful to severe and incapacitating. It is spread by mosquitoes. The mosquito types that spread it in the Caribbean are also found in the US. Most cases in the US have been seen in patients who got infected in the Caribbean. A few weeks ago, there were two documented cases of Chikungunya that had been contracted in Florida.

Doc via Shutterstock

Doc via Shutterstock

Public health officials are now feel that the number of cases of CHIKV will begin to increase. Theoretically, the disease can be spread in any area where these mosquitoes live. That would include most of the continental US. Officials don’t think that it will be anywhere near as much of a problem in the US as it is in Africa and the Caribbean. Mosquito populations are higher in those areas, most people are outdoors more often, few have screens on windows or doors and are not in enclosed air conditioned buildings.

To help prevent infection it is suggested that people wear long sleeves and long pants and use mosquito repellant in areas where mosquitoes are present. Stay indoors when possible, behind intact screens or with doors and windows closed and using air conditioning. Since, to date, CHIKV is little known in the US, if you develop flu-like symptoms, fever, joint pain and/or joint swelling you may want to tell your doctor about CHIKV. While health departments, the CDC, medical societies and other organizations are putting out information on CHIKV, until the medical community gets saturated, some doctors who haven’t seen a case may not consider it as a possible diagnosis.

There is no vaccine or specific medications to prevent or cure Chikungunya. Care is supportive to lower fever and control pain.

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The difficulty of treating, and containing, Ebola locally http://americablog.com/2014/08/difficulty-treating-containing-ebola-locally.html http://americablog.com/2014/08/difficulty-treating-containing-ebola-locally.html#comments Wed, 13 Aug 2014 12:00:07 +0000 http://americablog.com/?p=122134 Some people have questions about the Ebola outbreak in West Africa. Questions like: Why can’t patients be treated there vs. transporting them to other countries? Why is the outbreak so difficult to control? Those are reasonable questions. Here is some additional information that may help to answer them to a degree.

I’m in contact with a few physicians who have been on the ground in Liberia treating patients there. One returned as recently as 6 weeks ago. Others have been in the area sporadically over the years volunteering to treat patients, teach local doctors, help with organizing clinics, etc. I’ve gotten an idea of what they, and the population, are facing there. Let me try to make a comparison between what things are like here and there.

Let’s take a look at a typical US patient. When someone in the US isn’t feeling well, in many cases, he has several options. He drives, is driven or takes an ambulance to a medical provider or clinical site. He can see his PCP or another doctor in that doctor’s office. He can go to a medical clinic. Or an urgent care. He might go to an emergency room. In some cases, depending on the problem, he might be able to go to his local public health department. He gets seen by the doctor who may give him a prescription(s), order blood tests, medical imaging, cardiac testing, send him to a hospital for more advanced treatment, send him for surgery, etc. He’ll get his prescriptions, tests, referrals and recover.

The Ebola virus, courtesy of Shutterstock

The Ebola virus, courtesy of Shutterstock

Now, let’s make this patient a Liberian in a village outside of Monrovia. He gets sick. If he can escape his family responsibilities (working at his job, getting food for the family) he might be able to walk several miles to the clinic, if there is a clinic in the area. He may get there only to find that it’s closed or that the doctor is away. He has no access to a phone to call the clinic in advance. That’s assuming that the clinic itself has a phone for him to call.

But let’s say that he gets there and there is someone to examine him. In this area, doctors are scarce, so he may be examined by a nurse. If the diagnosis is malaria, he can get some anti-malarial medications, if the clinic has any. If not, he might be told to come back in a week to see if the medicine is available then. Blood test? Maybe he can get it drawn at the clinic. Some of the larger clinics can do very limited, simple testing. Most can’t But the clinic has no electricity so the blood can’t be refrigerated till it gets picked up to be taken off for testing at the hospital. If there is a courier available to transport it. Medical imaging? No. Cardiology services? No. Perhaps, if he’s seriously ill, transport to the local hospital can be arranged. Maybe that day or in a day or two.

Now, imagine how difficult it would be to adequately treat a seriously ill Ebola patient in that setting. No electricity, no running water, no reliable communications or transport, no plumbing, no isolation ward, healthcare workers with minimal training, limited protective gear, no facilities to incinerate contaminated equipment/fluids/supplies. Little clinics like these can even be out of aspirin for weeks at a time. No, or limited equipment to start an IV. No IV fluids (Ebola patients can go into shock. Shock can require a lot of IV fluids. And, since the Ebola patients bleed, they need transfused with blood and blood products. Those aren’t available at the clinic.) IV medications may be needed to help support blood pressure, too. Not available in this setting. Healthcare personnel are afraid of taking care of Ebola patients since they are working under primitive conditions and constrained by lack of facilities and equipment.

Add to that scene, the steady influx of other patients to the clinic. The patients with malaria, gastroenteritis, typhoid, other infections, wounds, broken bones, trauma, surgical conditions, ill children and babies and the occasional Ebola patient. Trying to take adequate care of an Ebola (or other seriously ill) patient under those circumstances? Virtually impossible.

What about containing Ebola in Africa? How difficult might that be? Here are a few glimpses of some of the possibilities.

A mother’s baby has Ebola. The baby has diarrhea and is vomiting. He’s feverish, too. Mom needs to wash her clothes and the cloths she’s clean the baby with. She also wants to bathe the baby and try to cool him off with a bath. She fills a large basin and washes the Ebola-infected clothes exposing herself to the virus. She throws the water outside of the door. It forms a puddle that the other children play in. Or, she takes the clothes and baby to a nearby stream or river to wash. Just out of sight, downstream, children are playing in, and drinking, the water.

The Mother becomes infected and subsequently dies. The mourning relatives wash and prepare her body and kiss her goodbye. In the process becoming infected with Ebola themselves.

Fruit bats (carriers of Ebola) often nest in the ceilings of houses and huts. Their excrement falls on the floor. The babies and toddlers get the bat feces on themselves and transfer virus to their mouths and eyes. Or children playing in a local cave where fruit bats roost, floor covered with bat guano.

To supplement their diets, the people often eat “bush meat.” That’s a generic term for pretty much any animal that they can trap and kill. This can include fruit bats, pigs, antelope, various species of monkey and other animals that can be infected with Ebola. Skinning and cleaning these animals can expose people to the virus. Also, if the meat is undercooked they can be exposed, as well. Remember that there is no running water in much of this area. So, after skinning the animals, there may be no place to wash off the animal’s blood.

Similarly, with no waste treatment facilities, people with diarrhea from Ebola nay be squatting urgently wherever they can. They can contaminate their hands and then greet others, handle food, pick up children, etc. and spread the virus along that way.

When dealing with an outbreak in somewhat more advanced countries allows for better communication and education options. Here we can reach out to people via TV, radio, social media, newspapers and other print media, videos and by other means. In these areas of Africa, the people are mostly poor and uneducated or under educated. Some are illiterate. They don’t have access to television, radio, social media, smart phones. The local governments have to try to do teach and spread information virtually on foot, visiting people in markets, in their homes and other places. It has to be done individually or in small groups because, in many areas, large group meetings have been banned. Liberia has about 4,000,000 citizens scattered over about 40,000 square miles. Additionally, English is the predominant language. But there are dozens of other tribal languages spoken there. Not everyone has a good grasp of English. Just putting up posters in English would still leave some people uninformed about the nature of Ebola.

Now visualize the difference if we needed to limit an outbreak in a country with a better infrastructure. That country would have the physical facilities that Liberia (or Sierra Leone or Guinea) lacks. Electricity, tap water, waste disposal/sanitation, transport, supplies, trained staff, medications, support services, advanced medical devices, etc. It would be easier to communicate with large numbers of people quickly via social media and other routes. A better educated population that is more literate would be easier to educate about the hazards of Ebola. The country would have many more doctors and healthcare personnel on site. More clinics and hospitals to diagnose, admit, isolate and treat patients adequately. A better economy to help deal with the costs of an outbreak. Having those factors in place, would make quarantine and treatment much easier than it is in a third-world country.

So when people demand that Ebola patients be treated where they are infected, they may not realize the problems and complexities of doing so where they lie ill. Similarly, when they are puzzled why the spread is so difficult to control, they may not realize many of the underlying reasons for it.

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Ebola Update: Situation worsens in Africa, untested drug out of stock http://americablog.com/2014/08/ebola-update-situation-worsens-africa-experimental-drug-stock.html http://americablog.com/2014/08/ebola-update-situation-worsens-africa-experimental-drug-stock.html#comments Tue, 12 Aug 2014 18:43:24 +0000 http://americablog.com/?p=122127 The priest evacuated to Spain for medical treatment, Fr. Parajes, died of Ebola in a Madrid hospital.

He had been infected with Ebola while ministering in Liberia. He was supposed to have been given the experimental treatment, ZMapp at some point before he died, but there is some controversy as to whether he did. His body will be cremated tomorrow.

Several missionaries from SIM, who were in Liberia, have returned to the US. None has Ebola, but they will remain in quarantine at a location in North Carolina for 21 days. Their temperatures will be monitored 4 times/day. If anyone develops a fever, he will be removed to a hospital for isolation and treatment.

Kent Brantly and Nancy Writebol continue to improve in Emory Hospital’s isolation unit.

The number of Ebola patients in Nigeria varies, depending on the source. There may be 10 or 13. They are quarantined and being treated in Nigeria. So far, all of them have had direct contact with the Nigeria’s index case, Patrick Sawyer. They were healthcare professionals involved in his treatment.

A sign warns visitors that area is a Ebola infected. Signage informing visitors that it is a ebola infected area. September 27, 2013, Congo, Africa. Sergey Uryadnikov / Shutterstock.com

A sign warns visitors that area is a Ebola infected. Signage informing visitors that it is a ebola infected area. September 27, 2013, Congo, Africa. Sergey Uryadnikov / Shutterstock.com

The World Health Organization has approved the use of ZMapp, the monoclonal antibody drug that is currently untested in humans, for treatment of Ebola patients. Use of untested therapies can pose a risk to patients. Any patient who gets ZMapp will have to be informed of possible complications and other consequences of trying an unproven therapy. There has been an ethical debate about using the drug under these circumstances. In addition to the question of “should it be used,” bioethicists were also looking at which people should get it. Should it be only used for patients near death? Should it be used earlier, before the patient was in extremis? Should it be used only in the country (-ies) where it had been developed? Could it be given to pregnant women, knowing that there might be a risk to the fetus? These and other questions were considered. Some are still under study.

Unfortunately, the bioethicists will have some time to consider them because the manufacturer of ZMapp has exhausted its supply. Two doses of ZMapp have been sent to the affected area to treat two African physicians infected with Ebola. The company says that it will now take several months to produce even a small amount of additional drug.

One trial of an anti-Ebola vaccine may begin as early as next month. Other vaccines are in the drug development pipeline and could begin testing as early as next year. But even if drug tests go very well, it will still take some time for the vaccine to be produced in large quantities and made available for use.

The situation in the three most affected countries, Sierra Leone, Liberia and Guinea, continues to worsen. Some religious charities, like SIM, are evacuating most of their medical personnel. With the number of cases of Ebola increasing, decreasing medical personnel, the rainy season beginning, unwillingness of some healthcare personnel to treat patients, lack of funds and supplies, conditions will continue to get worse. These areas have very few of their own Western-trained physicians. Even at the best of times, without an outbreak such as this, medical care is stretched thin. In many cases it is totally unavailable.

Some physician-members or the nationwide medical organization on strike in Nigeria, voted to end the strike and return to work. Others refused stating that the Nigerian government is not even considering their demands. So the physicians’ strike in Nigeria continues.

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The roosters of the Square du Temple http://americablog.com/2014/08/roosters-square-du-temple.html http://americablog.com/2014/08/roosters-square-du-temple.html#comments Tue, 12 Aug 2014 16:00:15 +0000 http://americablog.com/?p=122102 Walking through Paris with my friend Régis the other day, we came upon a beautiful park right across from the local city hall in the 3rd arrondissement (Paris has a city hall and a mayor for each neighborhood).

I’d stumbled on this park before, it’s called the Square du Temple, and it’s just lovely.

Huge gorgeous trees, kids playing, even a little pond in the middle — just great.

square-du-temple-parisWhat we didn’t expect to find in the park were two rather happy roosters.

There they were, just clucking away in the flowerbeds.

roostersI kept looking around, expecting to see someone claiming the birds. And finally another woman walked by and explained.

It seems the first bird appeared about a month ago.  A man from the countryside had come to town and dropped it off.  Reason unknown.  Then, a few days ago, a second man came by and dropped off his rooster as well. So now there were two.

I think we have a budding tradition.

square-du-temple-map

It’s unclear how the birds will handle the winter. Paris winters are usually a bit better, or sometimes a bit worse, than the typical Washington, DC winter. And in addition to the cold, which I’ve read the birds can handle pretty well, there’s the question of what they’ll eat in the winter.  But I suspect if the city lets them hang out that long, someone will come by and throw them bird food (or whatever chickens eat).

It will be interesting to see if the city in fact lets them stay.

Here’s a quick video I shot of the roosters, with a quick cameo by Régis.

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French refuse to change name of town called “Death to Jews” http://americablog.com/2014/08/french-refuse-change-name-town-called-death-jews.html http://americablog.com/2014/08/french-refuse-change-name-town-called-death-jews.html#comments Tue, 12 Aug 2014 13:33:48 +0000 http://americablog.com/?p=122109 Less than 100 miles from an exhibition in Paris about the city’s liberation from the Nazis, there’s a small French town called “Death to Jews.”

The town, “La Mort aux Juifs” in French, is about 116km (72 miles) south of the French capital.

mort-aux-juifs

“Death to Jews” is a small town, made up of only a couple of houses and a farm. Searching around on Google Earth, I found that one of the houses is (or was) for sale:

death-to-jews-house

The old real estate adage of “location, location, location” comes to mind. Because let’s face it, advocating genocide just doesn’t do for property values what it used to.

Here’s the entirety of the hamlet of “La Mort aux Juifs.”

Screen-Shot-2014-08-12-at-2.48.01-PM death-to-jews-france

The Simon Wiesenthal Center has understandably demanded that the French change the name of the Jew-hating town.

The deputy mayor of “Death to Jews,” while explaining that “no one has anything against the Jews,” called the demand to change the town’s genocidal name “ridiculous.”

From AFP:

“This name has always existed,” [deputy mayor] Marie-Elizabeth Secretand told AFP.”No one has anything against the Jews, of course. It doesn’t surprise me that this is coming up again,” she added.

“Why change a name that goes back to the Middle Ages or even further? We should respect these old names.”

Sometimes you show respect by not respecting tradition at all.

Interestingly, the city of Paris is currently running an exhibit honoring the 70th anniversary of the Liberation of Paris from Nazi occupation. As I wrote yesterday, the exhibit, titled “Paris liberé, Paris photographié, Paris exposé” (i.e., “Paris freed, Paris photographed, Paris exhibited”), devotes a single panel in a single room to the role of American troops in liberating the French capital. And that panel is devoted entirely to a discussion of how the American liberators were a bunch of racist criminals.

The museum, which is run by the city of Paris, found it “ironic” that a bunch of racist American servicemen would fight a war to stop “racist” Nazis.

Yes, well, irony is a bitch, mon amie.  Just ask the deputy mayor of  “Death to Jews.”

On a side note, France does have a few other “death to” towns, including (and I’m not making this up):

“Death to Hares”

“Death to Lice”

And my personal favorite:

“The Path of Death to Donkeys” (it’s sounds cuter in French)

Screen-Shot-2014-08-12-at-3.04.51-PM

When all is said and done, the deputy mayor does have a point.

After all, you don’t hear the donkeys complaining.

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How learning computer code made him a better writer http://americablog.com/2014/08/learning-write-computer-code-improved-writing.html http://americablog.com/2014/08/learning-write-computer-code-improved-writing.html#comments Tue, 12 Aug 2014 12:00:25 +0000 http://americablog.com/?p=122022 This past year, my last as a college student, I went down two wildly different academic tracks.

The first was my honors thesis in political cognition, a book-length project that served as a fitting culmination of what can only be described as a liberal education. Starting with the question, “What’s going on in our heads when we talk politics?” I wound up using Ron Paul, evolutionary biology, molecular genetics, fMRIs, Deal or No Deal, chemicals related to those found in cilantro, community organizing, Thucydides, early childhood education, David Foster Wallace and Porto Alegre, Brazil, among other things, to argue that ideological disagreement is both inevitable and necessary in successful democratic societies.

With a lot of different pieces to tie together, the hard part wasn’t getting words on pages or getting large numbers of pages written. The hard part was getting those words and pages organized into something that made a reasonable amount of sense.

Old (new at the time) IRS computers in the early 1960s.

Old (new at the time) IRS computers in the early 1960s.

Which is where the second track, learning the basics of how to write computer code, came in handy.

I had gotten conversationally literate in SQL (pronounced “sequel”), and had learned the equivalent of how to ask where the bathroom was in R the previous summer; I enrolled in Intro to C++ because I wanted to get my brain out of its constant reading/writing mode. However, while I thought programming was a change of pace that had nothing to do with writing, my writing improved dramatically.

Why?

There’s a reason they’re called programming “languages”

The best computer scientists spend less than half of their time actually writing code.

The majority of their time is spent deciding what they want to code, outlining what elements of the program will go where, defining their classes and commenting out (aka writing little notes in the computer code) what each part of their code will do so that it will make sense to anyone else who looks at it if and when something breaks. Once that’s all done, the actual programming is easy.

Paper tape relay operation at US FAA's Honolulu flight service station in 1964 (via the FAA).

Paper tape relay operation at US FAA’s Honolulu flight service station in 1964 (via the FAA).

That should sound awfully familiar to the writers among us, but the truth is that I didn’t get serious about planning and outlining the things I wrote until I learned how to code. The first chapter of my thesis went from zero to 45 pages in about a week. However, sitting behind that week of writing was about a year of reading, six months of arguing and two weeks of outlining. I made sure I knew exactly what I wanted to say and how to say it so that the chapter would “compile,” and only then did I say it.

In this sense, coding is nothing more than a stripped down, abstract form of writing.

And this abstract writing comes with immediate, concrete feedback. It’s often difficult to be honest with oneself as to whether or not what they’ve written is coherent or internally consistent, but the compiler is brutally honest: If you make an error as small as leaving a semicolon off of your last line of code, your program won’t run; mess up your logic in a for loop, and you’ll get an infinite loop and your program will run forever. When someone criticizes your writing, you can tell yourself that they simply missed your point, and you may be correct, but if your code doesn’t produce the output you want you have no one to blame but yourself. It’s akin to one typographical error bringing down your entire essay.

// //

//

Having my code taken literally by a computer, over and over again, forced me to stop thinking of my words as simply what I meant them to mean. I had to consider as well how people would interpret what I wrote — would they understand what I really meant? This changed the way I structured my sentences, paragraphs and chapters; making my writing clearer. When your audience is a computer, you’re forced to think as systematically as it does. Irrelevant or inconsistent claims are called out, while concise, well-organized structure is rewarded. Plus, the feedback is immediate.

They say that a liberal education is supposed to “teach you how to think.” The manner of thinking that is rewarded when you learn a programming language overlaps immensely with the manner of thinking that a liberal education seeks to foster: abstract, yet rigorously logical.

So while I will likely never program for a living, learning some coding basics made me better at what I will do from now on.

Which brings me to my next point:

Coding should be mainstream, for two different reasons

As I wrote last week, computer science is currently a privileged field. There are clearly-defined social expectations as to who would probably make a good programmer, which, combined with the fact that practically no K-12 school systems teach computer science, means that very few Americans take programming seriously as a viable or socially acceptable career pathway. It should be noted that I stumbled on programming in an unpaid internship, itself an opportunity defined by inequality.

It’s in everyone’s interest to dismantle these social expectations and access asymmetries, as we are all increasingly reliant on the information sector of our economy. To this point, 1.4 million new jobs in computer science will be created between 2010 and 2020 with only 400,000 new computer scientists to fill them, according to the Bureau of Labor Statistics. If you’re looking for a reason why a cursory knowledge of Ruby on Rails is worth six figures, there it is. Our daily lives are increasingly supported by Java, HTML and Ruby. They are stored in SQL servers and optimized in Python. Our market has identified a need for people who are fluent in these languages; whether or not those people are predominantly white and Asian men depends on whether or not we change our social and educational standards accordingly. Of course, increasing the labor supply of programmers will lower the value of each programmer, but demand would have to fall quite a bit before anything I’ve just written is invalidated.

If we’re serious when we say that we need to modernize our education system for the 21st Century, and if we’re serious when we say that economic inequality is a problem, then one of the first things we should do is add computer science classes to our public K-12 curricula. Making basic programming literacy part of an American education is an inexpensive, easy way to both fill a market gap and expand economic opportunity. Between CodeHS and Girls Who Code, among a growing number of other programs designed to expand access to computer science education, the resources are readily available. We really have no excuse.

home computer future

However, only about 30 percent of students exposed to computer science classes go on to pursue careers in the field, a number that would certainly drop if such classes became a part of basic public school education. While that speaks to the number of students we need to be exposed to computer science in order to fill the gap projected by the BLS, it also raises the question of whether there’s value added for the millions of students who would take programming classes and not pursue a computer science degree or career, if we were to modify our education system accordingly.

But if my experience in writing my thesis is any indication, learning to code is useful even for those who have no intention of writing Python scripts on a regular basis. It has made me a better writer, a more systematic thinker and a more competent employee. Independent of those things, though, it has also made me a more socially literate citizen.

As I mentioned above, an increasingly large amount of our lives – including your ability to read, share and comment on articles like these – are backed by code. We take civics in 8th grade because everyone who participates in society interacts with the government, so we feel as though everyone should have a basic understanding of how government works (whether or not they actually do is, of course, a different question). We should be taking programming at a similar time for the same reason: Whether or not you do it for a living, if you want to participate in society in the 21st Century you are going to be interacting with a lot of computer programs. As cyberspace gets bigger and bigger, “I don’t care how it works so long as it does” is becoming less and less tenable of a position for the majority of us to take.

On my first day of Intro to C++, my professor – in quintessentially Kenyon College fashion – said that “coding is a liberal art.” As both a method of thinking and avenue for social participation, I couldn’t agree more. Setting aside for the moment that it is one of our biggest untapped resources for expanding economic opportunity, exposure to programming languages has something to offer everyone.

system “PAUSE”;

return 0;

};

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Robin Williams just died http://americablog.com/2014/08/robin-williams-just-died.html http://americablog.com/2014/08/robin-williams-just-died.html#comments Mon, 11 Aug 2014 23:34:26 +0000 http://americablog.com/?p=122088 Comedian Robin Williams has died.

Wow, that’s really sad. What a brilliant and unique talent.

robin-williams

The LA Times says that it was an apparent suicide. Williams has long suffered from depression.

Williams “has been battling severe depression of late,” his publicist Mara Buxbaum said. “This is a tragic and sudden loss. The family respectfully asks for their privacy as they grieve during this very difficult time.”

Williams was 63.

Here’s the press release from the Marin County Sheriff’s Office:

On August 11, 2014, at approximately 11:55 am, Marin County Communications received a 9-1-1 telephone call reporting a male adult had been located unconscious and not breathing inside his residence in unincorporated Tiburon, CA. The Sheriff’s Office, as well as the Tiburon Fire Department and Southern Marin Fire Protection District were dispatched to the incident with emergency personnel arriving on scene at 12:00 pm. The male subject, pronounced deceased at 12:02 pm has been identified as Robin McLaurin Williams, a 63 year old resident of unincorporated Tiburon, CA. An investigation into the cause, manner, and circumstances of the death is currently underway by the Investigations and Coroner Divisions of the Sheriff’s Office.

Preliminary information developed during the investigation indicates Mr. Williams was last seen alive at his residence, where he resides with his wife, at approximately 10:00 pm on August 10, 2014. Mr. Williams was located this morning shortly before the 9-1-1 call was placed to Marin County Communications. At this time, the Sheriff’s Office Coroner Division suspects the death to be a suicide due to asphyxia, but a comprehensive investigation must be completed before a final determination is made. A forensic examination is currently scheduled for August 12, 2014 with subsequent toxicology testing to be conducted.

Here’s is Robin William’s first appearance on the Tonight Show:

And how the Scottish invented golf:

And oh my god, check out the very young other actors in this Dead Poets Society trailer (it’s the guy from House, and Will from Good wife!)

And this: Robin Williams on Canada.

robin-williams-on-canada

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Join me on a walking tour of Paris (photos) http://americablog.com/2014/08/join-walking-tour-paris-photos.html http://americablog.com/2014/08/join-walking-tour-paris-photos.html#comments Mon, 11 Aug 2014 21:27:32 +0000 http://americablog.com/?p=122067 As a photographer, I always enjoy exploring Paris. In addition to the obvious things to ogle, like the Eiffel Tower in the distance, the city has a number of funny quirks that I enjoy capturing on film, or hard-drives, or something.

I think part of it for me is simply the fact of being in another country, so things are per se different. Graffiti is often different. Posters are different. Buildings and monuments and things in shop windows are different.

And I really enjoy different. My mind enjoys different.

So join me for a little walk (well, okay, it was actually more like a 9-hour outing) I took yesterday with my friend Régis, that we took from the Marais neighborhood, walking north on Rue St. Denis.

french-friend

This is Régis. I’d say he was looking particularly dapper at that moment, but honestly, he just looks like this all the time. Ah, French boys.

wigs-two

The window of a wig shop we passed walking north. The wigs had names. I love reflections in windows, when they do odd things and confuse. It’s fun capturing them in black and white.

wigs

A better view of some of the wigs, sans reflection.

Louis-arch

This is a fabulous arch, called Porte St-Denis (the door, or entryway, of St. Denis). It was built by King Louis XIV in 1672 as a way of awing visitors as they entered Paris. It still awes.

great-building

This was a stunning building we passed. I have no idea what it is. Look at that clock, and the design going from the clock all the way to the ground.

wall-thing

Just a fun poster on a wall.

regis

Régis in silhouette at a pizza place we found north of the arch. His name is far prettier in French ;-)

hotel-de-ville-bw-pano-volleyxxx

The Hotel de Ville — aka City Hall — with some people playing volleyball in front as part of the annual Paris Plages festivities.

paris-plage-hotel-de-ville

Similar shot, in color.

hillary-bookstore

The book store is closed for August, as is much of Paris, but Hillary’s book is front and center.

doorway-marais

Just look at this doorway to God-knows-where in the Marais.

paris-graffitti

Some really fun graffiti in the Marais.

waffle-paris

And finally, right before it started to pour, I got a waffle (goufre, I believe) at Amorino in the Marais. I can’t say it tasted like the insanely good waffle I had in Ghent, Belgium. It was more like an American waffle, but hey, with gelato and chocolate sauce on it, it worked :)  So, with it now pouring rain, Régis and I stood in a little doorway, me eating my waffle and he drinking his lemon granita, while I had one of those wonderful, but somewhat melancholy, “people actually live like this” moments.

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Ebola Update: The hysteria grows http://americablog.com/2014/08/ebola-update-hysteria-grows.html http://americablog.com/2014/08/ebola-update-hysteria-grows.html#comments Mon, 11 Aug 2014 14:00:39 +0000 http://americablog.com/?p=122016 Two possible cases of Ebola are in quarantine in Benin. Benin is a neighbor of Nigeria and there is a lot of commercial traffic between the two countries. It is not yet known if these cases are Ebola or something else, like Malaria.

The CDC and WHO have both labeled the outbreak a major public health emergency. The WHO wants to have all affected countries to declare a state of emergency. Some have, and already are using government troops to maintain quarantine and suppress demonstrations.

Thomas Frieden, of the CDC, says that while there is a possibility that a traveler who unknowingly had Ebola could arrive in the US, this would likely not lead to a large scale outbreak. The conditions and situations between West Africa and first-world healthcare are amazingly different and much better in more developed countries.

The Ebola virus, courtesy of Shutterstock

The Ebola virus, courtesy of Shutterstock

One major problem in both Africa and the US is the growing hysteria about Ebola. Some Africans believe that missionaries introduced it into Africa. That they are actively seeking body parts for transplant. That they need to hide family members with Ebola or else dump them at clinics and then flee. Some doctors are saying that Ebola is a hoax.

In the US, I’ve seen posts where the authors have confused Ebola with AIDS, made wild statements: Ebola is mutating to an airborne form. I IS already airborne. Ebola mutates faster that the flu. US government wants to decrease population. Almost none of this is supported by any evidence. Just fear, hostility, conservative talking points getting repeated, endlessly, without thinking. The government, CDC, NIH are all out to get us. They have drugs that will keep them safe while we’ll die. Then other posts obviously just made up from fear and trying to spread fear. It’s 90% fatal, it will kill all of us. It’s God’s punishment for “homosexism” in Liberia.

We need to combat this with facts from research, public information programs, sound information presented on news programs, etc. Public Health Departments need to get active and educate people about what Ebola is and what it isn’t. Now is the best time to do that while public interest is high and people are asking questions.

The CDC has some good educational material and several good links available here.

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