Maggie's Farm

The Heimlich Maneuver and CPR should be known by every responsible citizen. As I regularly remind readers, the CPR procedure has been revised and simplified.

The difficult thing about CPR is knowing who needs it. I have heard stories of people doing CPR on people who were choking, and on people who simply fainted.

The study of how gene expression can contribute to adaptation is a hot topic in biology these days.

Asperger's Syndrome has been removed from the DSM and folded into Autism Spectrum. I'm not convinced that people with Asperger's-like symptoms have anything in common with what was traditionally termed Autism, and my suspicion is that Asperger's is just a normal human variation which, a while ago, might have been termed "slightly eccentric."

The comments here are interesting: Convergence in the meaning of "autism"

From Dr. Dalrymple's Everyone on the Couch - Today’s psychiatry undermines self-reliance and morality:

     The DSM is ultimately an instrument for weakening human resilience, self-reliance, fortitude, and resolve. It turns human beings into mechanisms, deprives their conduct of meaning, and makes them prey to entrepreneurs of human misery. The authors, one could say, suffer from PNOD—psychiatric nosology overvaluation disorder—the criteria for which are as follows:

        A: The grandiose belief that all human weakness can and should be divided into valid diagnostic categories.

        B: At least two of the following: a firm and unshakable belief that all human distress arises from malfunctioning serotonin metabolism; a firm and unshakable belief that functional MRI scans will soon teach humans how to live; a firm and unshakable belief that the seven deadly sins have been scientifically superseded by psychiatric diagnoses.

A colleague highly recommends the 1971 black humor The Hospital (George C. Scott, Diana Rigg)

The government thinks they know how to practice medicine better than we docs in the trenches do. They have no clue.

I'll admit that some of what doctors do, many expensive things, are purely defensive medicine. Lawsuits are inconvenient and no fun, but we all get sued. Most of the time, we either win or our insurers pay them to go away, but it's a major interference with our work and our mental bandwidth.

Each and every medical decision can be questioned, because it's all an individualized art requiring individualized judgements.

Here's this: An attempt to alter Medicare may let Washington dictate how doctors treat patients.

Physicians take a solemn oath to do what they believe is best for their patient. It's always a complex dance, of course, with the doctor recommending and the patient thinking about what they want.

We accommodate patients' desires all the time, even when we believe that they are wrong. It's a free country, is it not? We work for, and with, the patient. Nobody else.

I am 100% out of government medical care.

People joke about how bitchy and cranky, if not downright hostile, many women become around menopause. Bitchy, cranky, and raging may drive family members and friends away, but are not depression in themselves. On the plus side, sometimes, women become much more horny as their estrogen lowers in proportion to their testosterone (yes, women's bodies do produce some of that).

However, menopause-related clinical depression happens, not uncommonly.

Fortunately, we have ways to quiet these demons nowadays. Hormone replacement, antidepressants, or both.

What qualities do people look for in elected (or unelected) leaders? The question applies to all areas of life, not just politics.

What qualities stimulate people to "follow," or choose, a leader? Among others, physical presence, ability to speak, self-confidence, and reliable decision-making play important parts, but some of it is difficult to express. This post stimulates the discussion:  What is the "Presidential Presence"?

One component of it, perhaps not a large one, is a person's aptitude for being a target of positive transferences. That, plus the power, is what transforms an employee of the citizens (ie a politician)  into something that seems special, probably too special. After Washington, my favorite President was Coolidge.

When it comes to politics in the modern era, one part of it is simply celebrity. "Charisma." TV, video, and film create celebrity, as in "famous for being famous." What qualities support that? Why does anybody listen to, or pay attention to, celebs?

CDC Report Finds ADHD Diagnosis, Treatment in Children and Adolescents Continue
to Rise

It's just a matter of degree. Shouldn't the government simply put Prozac and amphetamines into the water supplies? Historically, one of the selling points of Coke was the coke in the mix.

The latest very large study says it's not really possible: Fat and healthy is a myth, new study says.

Medical risks associated with being overweight include breast cancer and several other cancers, cardiovascular disease, arthritis (esp. knee), diabetes (obviously) along with other insulin-resistance-related metabolic syndromes and carbohydrate-craving, non-alcoholic liver disease, pancreatitis, stroke, hypertension, gall bladder disease, sleep apnea, and many more fun problems.

Yes, Obamacare's insurance standards cover quackery: Obamacare and the New Age quacks

In a short piece discussing shyness vs. Social Anxiety Disorder, Dr. Kristy Dalrymple has this to say (my bolds):

A “disorder” is a socially constructed label that describes a set of symptoms occurring together and its associated behaviors, not a real entity with etiological homogeneity.  Labeling emotional problems “disordered” assumes that happiness is the natural homeostatic state, and distressing emotional states are abnormal and need to be changed.  A diagnostic label can help improve communication and understand maladaptive behaviors; if that label is reified, however, it can lead to assumptions that the etiology, course, and treatment response are known. Proponents of the diagnostic psychiatric nomenclature have acknowledged the dangers of over-pathologizing normal experiences of living (such as fear) by way of diagnostic labeling.

That's what I've been saying for years, but she says it better.

Ethical Questions Science Can’t Answer

I am not sure what science has to do with ethics, or what they mean by science. Everything is called "science" now - political science, social science, etc.

Also interesting:  Male And Female Brains Have Different Gene Expression

Sex 'Addiction' Isn't Just a Guy Thing

Well, for starters there is no such thing; just people with varying degrees of self-respect, dignity, and self-control. Humans are apes, after all.

Via Instapundit, an Antioch student who does whoredom on the side

A sex object, and proud of it

Girl-on-girl catfights

It's not exactly news.

It depends. As Freud knew, memory is distorted by our choice of defensive narrative of the moment. One of the many fascinating things about Psychoanalysis is to see how memories change over time.

How Many of Your Memories Are Fake?

In Psychiatry, rightly or wrongly, we are able to work in the world of psychic reality rather than courtroom facts 99.9% of the time.

It has become a big business: Addiction Treatment With a Dark Side - In Demand in Clinics and on the Street, ‘Bupe’ Can Be a Savior or a Menace

It's an opiate agonist/antagonist. Apparently it's a mild high. I know a doc who prescribes it. He is all about $.

My bias tends to be in favor of sobriety and standing up and facing life and oneself directly, but those things are difficult for everybody. In the UK, however, certified addicts can pick up their heroin etc at the docs' office on the way to work. The NHS figures it's cheaper than rehab. Of course, the NHS also considers death cheaper than cancer treatments.

This article explains nothing: Why Teenagers Are So Impulsive, but it's a good example of the nonsense that is coming from brain imaging.

The article spins the imaging data to be about crime. It's not about crime, it's just about the young male brain as compared to the female. It's not a bug, it's a feature. Young male humans are designed to defend the tribe, to kill food, and to be willing to die doing those things, but no brain scan can explain that.  Vive la difference.

His first death, third year of medical school

I recall my first deaths in medical school, in the ER. Two ambulances, family of four after a parking lot accident. The cool efficiency of the ER senior resident doing five-second triage: the 7 year -old - "Dead."  The ten year-old - "Dead."  The Mom - "Dead." The dad, blue but not grey like the others - "Breathing. Get him in a room and let's work on him. Tube here now, chest tube, EKG, crash cart, IV. Get a surgeon down here. Let's go, team."

In just a couple of minutes the unconscious Dad was intubated, had an emergency chest tube, IV, monitor, etc., survived.

People ask me, as a Physician, whether or how I would reform healthcare. (What they mean, it turns out, is not to reform medical care but to change how medical insurance works. Nobody really wants medical care in the US to change because it is the best and most caring in the world, by far, thanks to our free choices, national prosperity, brains, and freedom in general.)

It's become clear to me that people are divided into two basic camps on medical insurance: those who want to insure cheaply against major expense and those who want what amounts to pre-paid medical care. In any event, it is stunning to me that 85% of Americans were content with their medical care situation pre-Obamacare so I'm not sure that represented any crisis requiring massive Federal intervention and control.

As someone whose bias is against government getting involved further in our lives, if I were King here's what I would do about medical insurance - free it up:

1. I'd permit medical insurors to create national markets for insurance, like MLS does with real estate. They would be happy to do so were they free to do that.

2. I'd make medical insurance portable across state lines, and detach it from employment. If any employer wants to chip in, or if a union contract requires a business to chip in, fine. They could offer vouchers as a benefit, if they want to.

3. I'd demand that insurors insure everybody who wants to buy some, creating high-risk pools just as they do for auto insurance if needed.

4. I would permit the freedom to sell any kind or style of medical insurance people might want with whatever sort of coverage they want to buy. Or not to buy, if they want. It's a free country, and people are free to be foolish or to trust in the benevolence of others.

5. Regarding Medicare and Medicaid, I would fold them together somehow as means-tested charities for the poor, run by states or municipalities.

(As an off-topic aside, let me tell you the problems with many government-paid Medicaid patients and charity patients: they miss appointments, they are not appreciative and treat you like a servant, they will not make morning appointments, they resist advice, their fees do not pay the rent so docs have to limit their numbers - and they are prone to lawsuits against you. I know about this, because I do around 10-15% charity work in my office as my form of tithing, volunteer one day/week in a charity clinic, and teach for free 1/2 day/week. Just another greedy doc. )

Addendum: A reader asks about tort reform. Good question. God knows how much of medical expenses are CYA by docs and hospitals. The reality is that medical care is an art, and that any medical decision can be challenged or questioned if somebody wants to sue their doc.

What would you do if you ran the world?

In the Western world, the things that Public Health was invented to address are basically complete. From The disease of ‘public health’ - We are in the midst of an epidemic of lifestyle moralism:

Since the 1970s, however, the World Health Organisation has defined health as ‘a state of complete physical, mental and social well-being’ and demands ‘Health for All’.

Good grief. I suppose that will ensure steady work for the public health people forever.

In a related piece, The Radical Case for Bloomberg's 'Nanny' State

Not especially, unless you are calorie-deprived in the Third World. Definitely not "good for you" if you're on a diet, and fruit juices and dried fruits are the worst:

"Eat more fruits and vegetables.”

If I had a dime for every time I heard that recommendation, I’d be a rich man today.

The 1 Boring Old Man mentioned the book Big Data.

A review of the book comments:

Academic Mayer-Schönberger and editor Cukier consider big data the new ability to crunch vast collections of information, analyze it instantly, and draw conclusions from it. Big data is about predictions: math applied to large quantities of data in order to infer probabilities. Because big data allows us to analyze far more data, we will move beyond expecting exactness and can no longer be fixated on causation. The authors state, The correlations may not tell us precisely why something is happening, but they alert us that it is happening.

Data is not knowledge.

Just for starters, eggs are good for you. More at that link.

It's wonderful that Americans have the luxury of getting neurotic about what to buy at the supermarket and about what to eat. As I do, they advocate low-to-no-carb diets for weight control. It's Physiology 101.

An author at Slate thinks Americans should consider imitating the Dutch approach - or non-approach - to marriage. Of course, our lower classes already have, but I don't know how you run a complicated and nurturing family life that way, to imbue a family heritage and family values.

I mean, who hands out the candy while hubbie is taking the kids out trick or treating?

The Dutch Don’t Care About Marriage -Americans can learn a lot from their indifference:

As a popular view, this laissez-faire approach accommodates the vicissitudes of the heart, the changing nature of love, the great variety of forms attachments take in real life. It acknowledges that things change, and to exit a relationship with kids is less violent somehow, less publicly absolute, than to exit a marriage. A bit of tolerance, of bemusement, of compassion or imagination is built into the system.

Very bemusing indeed. The "vicissitudes of the heart"? Are we in high school?  Why grow up, if you don't have to? The government will raise your kids, Julia.

So some Dutch women just want to "follow their hearts." I'll assume that means plenty of romance and sex with lots of guys, like monkeys. But are Dutch men real men?  Is life a serious enterprise, or just a lark before your well-deserved and government-paid euthanasia?

For difficult patients who need more than outpatient treatment or short-stay stabilization. Over the years, I have found Gould Farm to be very helpful to patients: Gould Farm.

Good, highly-dedicated people work there.