Thursday, December 28, 2006

Getting my butt kicked by a *shrub*??!

So they call it Cedar Fever here in Texas.

It's actually a phenomenon reserved mostly for Central Texas, specifically for the areas surrounding the Edwards Plateau (between Austin and San Antonio) where the cursed Mountain Cedar grows in abundance. It's been referred to by Texas Monthly magazine as hazing ritual for new Texans. And it's caused not by Cedar trees, the kind used to make cedar chests, closets, etc, but mountain cedar, which is really juniper. Basically, you're being bested not by some stately tree, but rather a bunch of scrub brush. Comforting, no?

Now as a person with entirely too many allergies, I feel like I can talk about allergic reactions with a decent understanding of scale, avoidability and seriousness of reaction with a certain amount of objectivity and expert knowledge.

Cedar Fever just sucks.

I am currently doped up on decongestants ~ I'm actually using MS Outlook Calendar to remind myself to re-dose every four hours so I can be sure not to miss a single moment of medicated assistance ~ and yet, my ears are still popping, my head feels like it's about 30 feet under water, and my sinuses are experiencing a whole new level of pressure. I'm thinking guy-who-knocked-up-a-17-year-old-girl-and-is-now-at-the-business-end-of-her-father's-shotgun-in-rural-Louisiana pressure? But I could be off. Maybe it's a cousin in West Virginia... Okay, so maybe I've spent too much time in Virginia...

Regardless, I'm told this first year is the worst. My sister seems to have developed immunity after five years. Gee. That's promising. Now I have something to look forward to besides not having to file state income tax returns. Oh, life is good.

If only I could get the stuff out of my ears....

Wednesday, December 27, 2006

Fixing the system

As we get to the end of the year and thoughts turn to income tax returns and getting in those last minute deductions or credits and whatnot, one can't help but reflect upon how hopelessly broken the American system is.

Paul Krugman wrote an Op-Ed in the New York Times on Christmas day (link above)about how the British have handled the same issues of poverty and income disparities, much by using the American model, and have been far more successful at it than we have.

Part of the problem is we don't really want to be successful. We don't care that much. We could raise the Earned Income Credit. We could raise the child/dependent deduction. But we don't. Would it really hurt American businesses? Seriously. Everyone knows that the quickest way to burn money is to have a child. They are ridiculously expensive. Kids just don't have lobbyists. Maybe it's their lack of income ~ they can't afford them.

Another recent NYT op-ed pointed to budget shortfalls for SCHIP (State Children's Health Insurance Program) which could be remedied by rolling back or even just halting the Bush tax cuts for the richest 1% (Those earning over $1 million ~ and that would probably be after adjusting for all their charitable donations and deductions, etc. So, the folks just barely making 7 digits are probably not included...) And seriously, which is more important? Having the rich get tax refunds or the poor children get health insurance??? (Hint: it's the latter)

Which brings me to my own favorite topic of holiday cheer. Healthcare. Apparently one of the leading causes of bankruptcy in America. Nice, huh? And they are ruthless. My own little tale: two and a half years ago I took a fall outside my office and somehow was completely unable to get my hands or arms down in front of me. My face took most of the impact, along with one knee and lower leg. Anyway, a coworker brought me to the ER since I was in shock. (There was all sorts of blood and I was clinging to pieces of my front teeth that had broken off.) So, examined for a concussion, x-rayed for a broken nose and broken leg, cleaned up and treated for abrasions and referred to a dentist, I was released a few hours later. I'm still getting bills from that afternoon.

Here's what really pisses me off ~ more even than my insurance company's refusal to pay a claim that clearly should be covered ~ the ease with which the hospital turns the bill over to a collection agency which then pursues legal action against you, or me in this case. It's textbook extortion. Pay this hospital bill or I'll F-up your credit rating. And I have to wonder, why am I even involved in this conversation? I paid my portion of my health insurance premium. I gave the hospital my insurance information. The bill clearly should be paid by the insurance company ~ why aren't they going after them? Wait. They are much harder to extort. They don't need a mortgage. And they most likely wouldn't fall for "If your insurance company does pay, we'll send you a refund check." Of course ya will. That's why you're call a "collection" agency.

Friday, December 22, 2006

Bow to the POWER!!

Truly. Unbelievable.

I blog about someone. Someone I don't even know. And within days, he's dead.

That whole President-For-Life thing just got a whole lot short than our old friend, Turkmenbashi, had anticipated. Oops. My bad.

Am I suggesting that my blog somehow brought about his death? Am I even suggesting that anyone actually READS my blog?

I would never do such a thing!!!

Trust me, even my family doesn't read this.

Although, I'm not opposed to testing this theory that my blog can bring about death. There's a certain narcissistic ex-boyfriend who could be a topic or perhaps a bear killing former supervisor. I could try and do a good deed and blog about a certain world leader who will also be spending the holidays in Texas, but would we really be better off with Cheney at the wheel? That actually scares me at this point.

I'll have to give it some thought. And in the mean time, not blog about anyone I like. At least not by name.

Monday, December 18, 2006

God loves Wikipedia

Okay, so I couldn't let it go.

I needed to know more.

Yes, there are statues everywhere of the infamous Saparmurat Atayevich Niyazov and apparently also his mother. (Now there's a bit of psychological profiling you just don't want to touch...) Included among the statues is the one in the photo which rotates to always be facing the sun. He's renamed airports, schools, towns and even a meteorite after himself. But not to worry, he's still the same humble guy we've always known. "I'm personally against seeing my pictures and statues in the streets - but it's what the people want," Niyazov has said.

But what about the clocks? Still nothing about the clocks.

Here's the cheery one. He's rewritten the history of the Turkmens in a book called Ruhnama (or Book of the Soul). It is used extensively in the Turkmen educational system, replacing the Koran at least one day a week. He's also written another book of lyrical poetry and short stories.. One can only imagine.

The story about renaming the days of the week may have been overstated. It appears he has only renamed the months of the year. January is after himself and April is after his mother.

Alright, not so impressed anymore. Revisionist history, renaming everything after yourself, statues, reforming religion to make oneself a central figure ~ it's all right out of the dictator's playbook.

Forget my earlier statements. He's nothing special.

Things that never would have occurred to me if I was a totalitarian ruler

Okay, so I'm linking you to an article about iodization of salt. Yeah, yeah, yeah, we all the the public health implications. (Step off if you're still concerned that thermisol causes autism or that the U.S. government set off charges in the World Trade Center to make sure the buildings collapsed on 9/11.) The little girl with the umbrella has been delivering all the healthy American children a safe dose of Iodine for decades, protecting them from stunted growth and diminished itellect. (Kind of makes you wonder whose mother kept them on a low salt diet as a child, huh?)

But that's not what this entry is about. Oh, no! I found something far more interesting in that article. And in case you're not interested enough in iodized salt to read to the second page or if you just don't want to click on the link, I've quoted the paragraph of interest below.

In neighboring Turkmenistan, President Saparmurat Niyazov — a despot who requires all clocks to bear his likeness and renamed the days of the week after his family — solved the problem by simply declaring plain salt illegal in 1996 and ordering shops to give each citizen 11 pounds of iodized salt a year at state expense.

Now this guy is not just your average narcissistic dictator. He can't be placated with portraits of himself on the side of buildings and larger than life statues. Not even of portrait of himself in every home will do! He wants his constituents to see his face every time they check the time!! How this works in digital, I'm honestly not sure... But I may feel the need to investigate....

But seriously, Mao, Hitler, Stalin, Sadam, Castro, Noriega ~ none of them had the creativity, nay, the ingenuity, to place themselves on timepieces. (This is obviously a man who was raised with iodized salt!)

And the days of the week thing, well that's just icing on the cake. How much you want to bet that Monday is named after his mother-in-law???

Wednesday, December 06, 2006

I'm at a loss

I think I've mentioned before on this blog how highly skeptical I am of the antidepressants/suicide link in adolescents. No one would ever suggest an insulin/foot amputation link or an antihypertensive/stroke link because both are know adverse outcomes of the disease that those drugs treat. Why is depression different from diabetes or heart disease? I mean, for everyone other than Tom Cruise? (Who, let's face it, is in SERIOUS need of some psychiatric care...)

Anyway, the above linked article was published in today's NYT ~ something that would almost make you believe that it was recent information, not something released by the FDA nearly 6 months ago to support recommendations that were issued two years ago. WHATEVER. Maybe this news wasn't "fit to print" until now.

This is what has me thinking. In the article, Dr. Nierenberg from Harvard Medical School points out that not only is all this data based on clinical trials (which I'll get to in just a minute), but individuals with suicidal ideations were excluded from the trial.

This is where I'm at a loss. How would excluding those who were previously suicidal effect the outcome? First of all, it would make it impossible to tell if the drugs reduced suicidal ideation. Second, since being suicidal kept one out of the drug trial, we can't assume that everyone who entered the trial was honest about whether or not they were suicidal. They claimed not to be in order to get medication; an act of desperation no one could blame them for, but if they then "became" suicidal it would have nothing to do with the drug. It would just be honesty. But if we do assume that everyone was honest at the entry into the clinical trial, they were medicated for 4 to 16 weeks at a standardized dose, not necessarily a therapeutic one. Now, the placebo would assumably have no side effects, but the antidepressants would immediately start wrecking havoc on their patients ~ dry mouth, constipation, nausea, diarrhea, excessive sweating, tremor, head ache, orthostatic hypertension, syncope, urinary retention, weight gain ~ a real boatload of fun for someone who is already hating life. Now keep in mind that most antidepressants take 8 to 12 weeks to treat depression, and then only if at a therapeutic dose. Most of these folks weren't even on the drugs long enough to get any positive effects, just all the negative stuff. Meanwhile, everyone in placebo-land is hanging out, side effect free, waiting for their drugs to kick in. No one is actually getting "treated", but at least the placebo crowd isn't getting put through the side effect ringer for their efforts. Just thinking about that kind of makes me want to kill myself.

But back to the clinical trial issue. Clinical trials are not real life. They don't account for any type of non-compliance. They exclude anyone who steps outside their very strict parameters. They avoid comorbidities, they avoid difficult cases, they use small samples and they're a self selected group of people who are then cherry picked by the drug companies. Not real life. You ever wonder why we don't find out about some of the really troubling side effects until a drug has been on the market and out in the general public for a few years? Because clinical trials in no way resemble real life!!

So then what's the answer? Probably registries. Controlled data collection of real world patients that are being voluntarily treated by doctors with specific drugs. Their history, treatment and outcomes are recorded into a database along with a control group, say of adolescents being treated with only talk therapy, and after a period of time, when enough data has been collected, it can be analyzed to see if the hypothesis holds in the real world or if the anecdotal reports of treating physicians who have successfully used these medications are really the norm. Registries are the only way to identify the tetragenic properties of drugs since doing anything but observational research on pregnant women is ethically out of the question. Since there are women who need certain drugs to survive their pregnancy (and let's face it, survival of the mother through the pregnancy is crucial to survival of the baby!) there experience is invaluable for women who may have a choice or at least want to see if they do.

Am I suggesting that clinical trials are worthless? No, but I'm at a loss for a reason at the moment. I'm sure one will come to me sooner or later. They play an important role in monitoring and controlling the safety of U.S. pharmaceuticals. (That was a statement of fact, still don't have a reason....)

Perhaps I'll find one and get back to you...