--- Ronn! Blankenship <[EMAIL PROTECTED]>
wrote:
> Deborah Harrell wrote:
> > >- Ronn! Blankenship wrote:
> > > Is it your opinion, then, that all cancers are
> > > caused by exposure to
> > > toxins, and could be avoided if the toxins were
> > > removed from the environment?
<snip>
> >Nooo, many are unfortunate genetic changes, in
> either the parent's genes (ie congenital) or in the
> >individual cell during division (ie spontaneous)...
> ...others are from some
> >non-chemical insult, like a virus or radiation.
> >However, many chemicals *are* known carcinogens (eg
> >benzene, asbestos); I was pointing out that
> research into health effects of industrial
chemicals,
> although
> >not cheap, is ultimately more cost-effective than
> >poisoning large populations and then having to deal
> >with the aftermath.
>
> Though many of those chemicals were not found to be
> carcinogenic until
> after they had been in use for many years.
True. You can never anticipate all possible bad
outcomes. But some chemicals (frex vinyl chloride,
tobacco) were strongly suspected by researchers in the
industry to have serious health consequences years
before it was brought to general attention. We can
make an educated guess that a chemical which has
hormone-like properties, or is highly fat-soluble and
not easily biodegraded, may have real health
consequences if it is released without
modification/treatment into the environment.
> ><snip>
> Maybe the doctor needed to get to his bank before it
> closed . . . ;-b
<curls lip and snarls> Yank. License. Permanently.
> > > >As Evil Overlady, I would institute local
> programs
> > > >(tailored to the community/culture) to work
> > > >intensively with folks and their particular
> > > >addictions, be they food, nicotine or whatever;
> but after a specified time (to be
> > > researched/negotiated),
> > > >if the person returned to the deadly behavior,
> care for that aspect of their health would be
> > > eliminated.
>
> So when a person who couldn't quit smoking shows up
> at the ER with a heart
> attack or cancer, they are just sent home to die (if
> they make it that far)?
Maybe just palliative care. That's why early
education would be so important ("fear and guilt are
not all bad!"). This sort of a program clearly could
not be implemented full-blown.
If I choose to drink past the point of intoxication,
and run my car over a cliff, why should anyone risk
their life to save mine, since I have such little
regard for it?
> > > Okay, so we outlaw alcohol, tobacco, and all
> other "recreational" drugs
> > > (including coffee and tea?), as well as
> > > unhealthy/excessive food.
> >
> >No no no!!! Where is the personal responsibility
> in *that*?! How does 'educating and providing an
> >intensive treatment program' morph into
> 'outlawing'?!
> >As Evil Overlady I have no intention of engaging in
> >foolishly dangerous actions, remember? <VBG> I
> would *not* want to promote a black market in these
> things!
>
> That is of course why I said we'd have to wipe out
> those crops.
I really don't think that would be possible. I used
to be vehemently against any program to provide drugs
to (registered?) addicts, but what we're doing now
sure isn't working. :(
<snipped discussion of food police>
> In the article in the Jan 2003 _Scientific
> American_, the authors are
> saying that the current food pyramid is too
> simplistic because it seems to
> say "all fats are bad" and "all complex
> carbohydrates are good", when the
> truth is that "some types of fat, in moderation, are
> good" and "some types
> of carbohydrates are not very good."
I'd agree with that; the general impression that
'whole grains' are good and 'refined carbohydrates'
are not-so-good has been around for a number of years.
I actually don't recall when fish-oil fatty acids
were first thought to be of potential benefit; fats in
nuts as 'probably good' is fairly recent, more so than
"trans-fats bad," IIRC.
> >and it's wise to consider even "known facts"
> >with a critical eye (was it one this list we
> discussed
> >how the "drink 8 glasses of water a day" was
> recently found to be based on a *misreading* of a
> >~1947 paper?).
>
> Sure it wasn't an ad for American-Standard products?
> ;-)
<LOL> No - but I guess it was a different group.
> > > And what do we do about AIDS and other STDs?
> Leper colonies on isolated islands, perhaps?
> >
> >Once again: educate, treat if needed (frex, it's
> very cheap to treat some STDs...
>
> So far, though, not AIDS. And how about the other
> diseases which are
> spreading along with it, such as drug-resistant TB?
>
> And speaking of treatable STDs, TB, etc., how do we
> insure that those who
> may be at risk for those diseases get tested, and if
> they are infected,
> that they follow through with the treatment? (More
> of a problem with
> things like TB which can be transmitted to
> "innocents" by relatively casual
> contact. Frex, some of the school districts around
> here still require
> anyone who applies to teach or do other work where
> they might come in
> contact with students to first get a TB test from
> the county health department.)
(And I _was_ thinking of TB when the drunk man snoring
in the row ahead of us started hacking...we moved. So
I'll have to go see _Nemesis_ again.)
I think there are already programs that link 'observed
therapy' (where the infected person is directly seen
to take the anti-TB pills that the observer handed
them) to food vouchers or some such. And AFAIK most
schools and hospitals do require periodic TB testing
of staff; clinicians must ask about patients' origins
at first encounter, and keep it in mind if the person
develops suspicious symptoms (not just TB either).
Have they stopped premarital testing for STDs? And
while it isn't 'romantic' or 'spontaneous,' I've
advised patients and their SOs to get pre-intimate
tests (HIV status) even if they do plan to use
condoms.
[Aside: but we have to be careful about what we put in
patient's records, especially with the Eye looming;
I've seen people get in trouble for a stupid teenage
act being recorded, even though it was decades ago.]
> >and since cost was the
> >bugaboo that opened this up, has to factor in) and
> >allow people to make their own choices. But AIDS
> is as much a social as medical problem (one frex: a
> woman gets it from her cheating husband - or in some
> >societies, it is not even considered wrong for a
> man to go elsewhere for 'bodily needs' if his wife
is
> >ill, cycling, or pregnant. Even an _Evil_ Overlady
> >can't fault the innocent spouse in such a case
> >And I use M->F transmission b/c it's technically
> >more likely, not trying to be sexist).
>
> An even worse case scenario is when a man gets it,
> gives it to his wife,
> who passes it along to their children, all before
> they know any of them is
> infected. And the husband need not be a philanderer
> or drug addict: maybe
> he is a medical worker who got exposed to the virus
> in the course of his work . . .
Saddest case I saw as a resident was a grandmother
whose husband had recently died of a rare lymphoma -
he'd gotten a blood transfusion back in the 80's - she
did indeed have full AIDS.
> Again, what can we do to protect the innocent
> victims of such
> diseases? Preferably from getting such a disease in
> the first place?
While the window of undetectable HIV virus in the
blood is less now than it was, we still have some
slipping through (recent FL case, I think). But once
someone has it, frex a child, I see nothing to do but
treat as best as we know how.
<grimace> Primary prevention in the West usually
involves personal choice; I think far too many are
ready to roll the bones with someone they barely know.
> > > To open another COW, what do we do about
> conditions which have genetic causes?
> > > If a young person tests positive for
> > > Huntingdon's disease, do we
> > > sterilize that person before puberty so they
> won't pass along the bad genes
> > > and then offer them euthanasia when the symptoms
> > > start in their 40s?...
<snip>
> >Now you're talking social engineering (if I
> understand the term correctly), which is quite
>beyond 'trying to reduce medical costs.'
>
> Although one can justify intervention in at least
> some of those cases on
> the basis of the expected cost of lifetime health
> care for a child born
> with certain genetic diseases.
And if there was a way to treat these 'in utero' (gene
therapy, frex), that would be a reasonable
intervention. I _really_ wouldn't want to make policy
for such cases now, though - but I suspect such things
will come. Probationer indeed...
> > [Aside: How much has the
> >missile defense program cost thus far?]
>
> And is the possibility that the mere fact that such
> a thing was talked
> about back in the 80s might have contributed to the
> fall of the Soviet Union perhaps worth the cost?
I've heard this before; do you know of a good article
that is more than speculation? [although I was
actually thinking of the current program, not Reagan's
'Star Wars' - b/c from what I've heard about today's
situation, it appears to be more likely that a bomb
would be brought in, not lobbed in]
<snip>
> >In the not-to-distant future, we will be able to
> >prevent or treat many if not all of the diseases
> you mentioned.
>
> At present, though, we can detect them but not treat
> them. What choices do
> we give parents who have a child with such a disease
> and no way to cover
> the costs of treatment to keep the child alive?
<sigh>
This is the thorniest of issues, because my desire for
'personal responsibility' cannot apply to a child.
And I am unwilling to impose my own choice on another.
So, in cases where the state does not provide
(Medicare or Medicaid), currently such parents have
ugly options: go bankrupt in an attempt to treat
(refering to your premise that they are unable to pay
for such care themselves), give the child up to the
state, or if an early pre-natal diagnosis is made,
abort. Not very appealing alternatives.
> >...I do not like the idea of
> >"custom-designing" a child to be a blue-eyed,
> >red-headed 6' 7" basketball player who paints and
> >likes pythons.
>
> Or has too much taste to like Monty Python . . .
Wot's wrong with likin' conversations about swallows
and coconuts!? Or deceased, defunct and former
parrots?! Or - shrubbery? ;)
Debbi
Blue? Maru
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