TOPIC: healthcare
Issue 15
February 17, 2019
Senior Syphilis

If the title of this article is meant to shock or be misconstrued, it is neither. This week’s topic of discussion is not about American youth and sexually transmitted diseases (STDs), rather we will delve into an unheeded demographic where STDs are becoming evermore prevalent: the elderly. Unfortunately, senior citizens in our society are too often overlooked and sometimes outright ignored. Nowhere might this be more apparent than in the lack of focus, education and care for the aged who are becoming infected with STDs at an alarming rate. This must change.

While older people tend to be mindful of their blood sugar, blood pressure, cardiac care and more; many are startlingly ignorant of the epidemic that’s taken hold of their communities. STDs? Why would those even apply to them if they are not of child rearing or producing age? One reason is the lack of basic education and effective communication by health care providers. Another impetus is societal neglect. Simply put, older people are marginalized when it comes to many relevant public service health campaigns. As a result, they do not consider themselves a high-risk group for STDs. This false sense of immunity coupled with the fact that older people tend to have more compromised immune systems, increases the probability that the elderly will acquire a sexually communicated disease.

Needn't we forget that many senior citizens are products of the Baby Boomer Generation. They came of age during the sexual revolution. Their attitudes towards sex combined with the use of drugs like Viagra & Cialis have made an the active sex life well into retirement all but commonplace.

In late 2018, the US News & World Report published an article that encompassed some sobering statistics: "A recent analysis of patients on Athenahealth's network found that patients over age 60 account for the biggest increase of in-office treatments for sexually transmitted infections. The report found that in adults over age 60, diagnosis rates for herpes simplex, gonorrhea, syphilis, hepatitis B, trichomoniasis and chlamydia rose 23 percent between 2014 and 2017.” In 2014, Psychology Today published a piece with the following lead in sentence: “According to the Center for Disease Control, among our senior citizen population sexually transmitted diseases (STDs) are spreading like wildfire. Since 2007, incidence of syphilis among seniors is up by 52 percent, with chlamydia up 32 percent." The examples above were published in the mainstream press. And while there has been much written on this particular phenomenon, the stories tend to be buried in the back pages of a newspaper or relegated to the preserve of medical journals.

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Issue 23
April 14, 2019
Anti-vaxxers

Ironic indeed that the very message Anti-vaxxers are conveying – not to vaccinate children – increases the probability of what are trying to prevent: their child being afflicted with a life-long disability or even death. - TQC

Below is a sampling of serious diseases coupled with some corresponding symptoms. All are preventable by vaccine.

Measles: Death, Pneumonia, Encephalitis (swelling of the brain).
Mumps: Deafness, Encephalitis, Meningitis (swelling of the spinal cord and brain).
Diphtheria: Death, Nerve Damage, Myocarditis (damage to the heart muscle).
Pertussis: Death, Coughing Fits.
Polio: Paralysis in the arms and or legs.

As a result of a herculean nationwide effort to inoculate children based on a scientifically managed, strict effective schedule, these and other debilitating illnesses were all but eradicated in the United States. Unfortunately, because of scaremongering and misinformation underpinned by pseudo-science spread by Anti-vaxxers, these and other serious but preventable diseases are making a comeback.

Anti-vaxxers have been particularly effective in communicating a falsehood, namely that vaccinations cause autism and other developmental problems in children. Ironic indeed that the very message Anti-vaxxers are conveying – not to vaccinate children – increases the probability of what are trying to prevent: their child being afflicted with life-long disability or even death. Despite misguided warnings, there is not a shred of credible, objective scientific evidence that depicts a causal link between vaccinating children and autism. On the flip side, however, there is exhaustive scientific evidence and hard data that demonstrate vaccines are a safe and effective means of preventing diseases that can cause permanent disabilities or even death.

Not only are anti-vaxxers being reckless with their children by not vaccinating them, they are putting entire communities at risk. Vaccinations are most effective when over 90% of people are vaccinated. “This type of protection is known as “community immunity” or “herd immunity.” When enough of the community is immunized against a contagious disease, most other members are protected from infection because there’s little opportunity for the disease to spread.” Once the number of inoculated individuals drops below 90%-95%, a vaccine becomes materially less effective. Thus, a small minority of parents are putting entire communities at risk, not just their own children. This is selfish, misguided and dangerous.

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Issue 35
July 21, 2019
Sacking the Sacklers

In November 2018, The Quintessential Centrist’s inaugural issue covered the opioid crisis and the efficacy of fast acting antidotes such as Narcan and Evzio to counter overdoses. At the time of publication, there had been plenty of ongoing media coverage as to the role of Purdue Pharma in perpetuating the opioid epidemic. Purdue’s legal troubles began in 2001 when the company was sued by the state of West Virginia, which was effectively ground zero for the opioid crisis. The state claimed that Purdue inappropriately marketed their drug, OxyContin, and hid “from doctors the extent to which OxyContin's morphinelike qualities could lead to addiction.”

At the Quintessential Centrist, we have sometimes been a vocal critic of the government for regulatory and judicial overreach, which, we believe can stifle economic growth, innovation and job creation. But with respect to Purdue Pharma and its role in propagating the opioid epedemic, both state and federal governments are right to prosecute the company to the full extent of the law.

According to the CDC, 400,000 people perished from opioid overdoses between 1999 and 2017. Beyond just the death toll, the economic and social costs have been stunning. An article penned in 2016 in The Science Daily approximated the economic cost of the opioid crisis at over $78 billion dollars. The numbers are certainly much higher today. The social costs have been equally if not more enormous as the nuclei of tens of thousands of families have been hallowed out, the fabric of entire communities shredded.

Purdue Pharma is certainly not the only company to produce opioids; publicly listed firms such as Johnson & Johnson (JNJ), Teva Pharmaceuticals and Allergan are involved in the space. Indeed, every pharmaceutical company found to be complicit in monetizing the opioid crisis should be held accountable. Recently, Teva quietly settled a related lawsuit while JNJ continues to fight in court; next month a ruling is expected. The outcome should be carefully watched as it will set precedent. But Purdue, a private company controlled by the prominent Sackler family, is disproportionately to blame for this societal disaster. From their unscrupulous marketing tactics, refusal to accept responsibility and then to plan to profit from the very crisis they spawned, their actions are reprehensible.

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Issue 36
July 28, 2019
4x3x2x1 Eat Right Live Well and Have Fun

Ever since high school, I have taken a keen interest in physical fitness, worked out consistently, read different books and periodicals and consulted with many fitness pros to broaden my knowledge base on the subject. I have logged thousands of hours in the gym testing out numerous weight lifting (anaerobic), aerobic, stretching and dieting routines, using myself as a human guinea pig. Since then, I have tailored many strength training and conditioning programs, stretching routines, and given copious amounts of nutritional advice to family, friends and fellow gym rats. When I was in my twenties and early thirties, a disproportionate amount of inquiries that came my way were about lifting weights and stretching. Once I turned 40, the majority of questions I received had more to do with diet and weight loss.

Mythos

Does a “diet” exist that people with an average amount of willpower can actually stick to over the long term, does not deprive them of their favorite foods and is well-balanced? The short answer is “no.” Indeed, the number of get slim quick gimmicks, get lean fast fads, and other enticing offers that conveniently find their way into our inboxes (talk about “junk” mail), mailboxes, across our computer screens or in books and magazines is mind boggling, can be overwhelming and most importantly, are of little long term practical value. The notion of the term “diet” is temporary, which is why they often fail; it inherently implies a short-term solution to eating and lifestyle choices that will revert to the mean. Below is a sampling of three of the most famous diets:

The South Beach Diet: In this diet, the subject must eliminate “bad carbs” derived in part from sodas, candy and cookies and eat protein, whole grains, fruits, vegetables, and “good carbs” derived in part from brown rice, corn and legumes.

The Paleo Diet: Commonly referred to as the “caveman diet.” Only foods that existed hundreds and thousands of years ago before the advent of modern food processing technology, are allowed to be consumed. Meat, fish, nuts and vegetables are permissible. All grains and processed foods are not.

The Atkins Diet: The most famous of all fads. The original Atkins Diet simply instructed its participants to avoid all carbohydrates; fried eggs and bacon where fine. The new Atkins Diet is “healthier.” It includes leaner protein and “good carbs.” However, whole grains are not allowed until later, once the dieter enters the “maintenance phase.”

All three of these diets are rigid, not particularly well balanced, and close to impossible to stick to over the long term. The primary reason is because they all deprive of us of some of our favorite foods. That is no fun and tends to put people in rotten moods.

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Issue 55
December 22, 2019
Circumcision & Jewish Tradition

In accordance with Jewish custom, when a newborn boy is 8 days old, he is circumcised. Traditionally, a mohel, a Jewish person trained in the practice of "brit milah,” or circumcision, performs this religious and cultural rite of passage. The procedure is typically done in the home, followed by a celebration over Jewish-style cuisine, drinks, and conversation. When asked why, many Jewish parents say they circumcise their sons simply because it is “tradition.” Specifically, the ritual of circumcision is a rite of passage, a symbol of “total obedience to God’s will.” At the ritual's onset, it was also believed that circumcision provided a way of distinguishing a Jewish boy or man from others, particularly those who might seek to inflict harm on, or "pose as Jews." Today, circumcision is widely practiced outside Judaism - for religious, cultural and health reasons.

Tradition or Barbarism, or Both?

Religious traditions can be wonderful in drawing communities and families closer; they create an innate bond and sense of identity. But when do we reach an inflection point where a cultural or religious ritual that’s historically been socially acceptable, is considered barbaric and generally looked upon by society with disdain? For an example, look no further than the brit milah itself. In accordance with Jewish law, a mohel “must draw blood from the circumcision wound.” Up until the 1800's, the “m’tzitzah” or removal of the blood, was effected by the mohel who would suck the blood off the newborns penis. Centuries ago most Jews were unmoved by the thought, let alone the act, of a grown man putting his lips on an 8-day old’s penis to “clean” the wound. Of course, today all but the most regressive people cringe when they learn about this part of a bris that was formally commonplace.

In the ultra-religious Haredi sect, a mohel still removes the blood using his mouth. Regrettably, this abhorrent “custom” which most people would (now) argue is analogous to sexual assault, has resulted in multiple cases of an incurable sexually transmitted disease (genital HSV-1 or herpes) being communicated from mohel to baby. A newborn’s immune system is not fully developed. The herpes virus is usually an unpleasant annoyance for an adult; it can kill an infant. The Centers for Disease Control and Prevention (CDC) has documented cases of death resulting from herpes acquired via transmission from mohel to newborn.

Fortunately, today almost all mohels remove the blood with a suction device. But 100 years from now, might our descendants reflect back upon the present-day customs of the brit milah and cringe in a similar way to us when we learned about the related practices of the past?

Personal Experience

I am Jewish. I have attended a few brit miloht (plural for brit milah) in years past. While I remain malleable and welcome a respectful debate, my current position is that I will not attend any more of these "celebrations." I cannot in good faith – excuse the pun – take part in any social, cultural or religious gathering consuming Jewish fare, drinking wine and conversing, to celebrate a newborn boy’s religious rite of passage that involves his penis being handled by a grown stranger. In my view, doing so would be perverted and tantamount to child abuse.

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Issue 60
February 2, 2020
The Wuhan Coronavirus

The 2019-nCoV, known as the Wuhan Virus is a coronavirus, one of a group of viruses that originate in animals. Coronaviruses are not typically passed from animals to humans but occasionally the virus mutates and humans can become susceptible. An infected human can communicate the virus to other people.

There are seven (known) human coronaviruses. Four strains: HCoV-229E, -eL63, -OC43, and -HKU1 are always percolating among us. These typically cause common colds. Sometimes, a more severe coronavirus can cause pneumonia and on rare instances, can prove deadly.

The Wuhan coronavirus is the third known strain of human coronavirus that can cause acute symptoms. The other two are SARS-Cov better known as SARS (severe acute respiratory syndrome) and MERS-Cov better known as MERS, (Middle East respiratory syndrome, or camel flu).

SARS:

The SARS virus originated in Yunnan province, in Southern China. The initial outbreak occurred in late 2002 / early 2003. Most likely, SARS was initially communicated from a bat to a wild animal, possibly a civet. The virus then mutated and humans became vulnerable. Although Chinese authorities at first covered up the SARS outbreak, which of course contributed it to spreading, in total only ~8,000 people became infected. The vast majority of cases were contained to China and Hong Kong. Of those, ~10% succumbed to the disease. There were 27 reported SARS cases in the United States; nobody perished.

MERS:

Bats are believed to be carriers of the MERS virus but camels are suspected as being the agent that passes this particular coronavirus on to humans. While MERS is rare - only ~2,000 people worldwide are known to have contracted it - it is particularly lethal. ~40% of people who acquire it, die. Most MERS cases have been concentrated in Saudi Arabia and South Korea. There have been two reported cases of MERS in the US, both patients survived.

The Wuhan Coronavirus:

The Wuhan coronavirus originated in the Chinese city of Wuhan, in Hubei province, located between Chengdu to the west and Shanghai to the east. Specifically, the virus has been traced to a (since closed) wild animal market in Wuhan. Most likely, an infected civet hosting the disease passed it on to a human who in turn infected other unsuspecting peoples. Thus far, the vast majority of Wuhan virus patients are concentrated in mainland China.

The timing of the Wuhan outbreak is particularly suboptimal, the dangers magnified by the lunar New Year, a time period in which many rural migrants travel on the nation's network of bullet trains and buses to reunite with family; each passenger a potential host of, and agent to pass on, the Wuhan virus.

The Wuhan coronavirus is contagious when an infected person is symptomatic. Many new patients are healthcare workers who treated the initial batch of infected people without donning proper protective gear. Asymptomatic transmission (people who are infected but do not have noticeable symptoms) might be possible during the incubation period (~2 weeks). Travelers deemed high risk are being quarantined to help mitigate that threat. What is not yet clear is if Wuhan is transmitted via casual contact or from close or more intimate interaction. Furthermore, “Both SARS and MERS had ‘superspreaders’-patients with unusually high viral loads, who are exceptionally infectious. In South Korea in 2015 a patient with MERS infected 81 people during a 58-hour stay at a hospital emergency room.” It is unknown if any Wuhan patients share similar properties.

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