From NY Times: Here’s the Biggest Thing to Worry About With Coronavirus
“We don’t have enough ventilators and I.C.U. beds if there’s a significant surge of new cases. As with Italy, the health system could become overwhelmed.”
From Atul Gawande’s twitter feed 3/12/20
When I hear people say that the changes in climate are ‘just another weather cycle,’ I wonder if they understand the reasons why scientists are so worried. It is not simply the historic increases in temperature. The bigger concerns are the permanent changes in the environment that foster ongoing and worsening problems. The atmosphere now has greenhouse gases that could take a 1000 years to dissipate even without further pollution (Related blog post: The Health Consequences of Climate Change). This is akin to sleeping under more blankets except that in the middle of the night, when you are sweating, there is not a simple fix –no easy way to remove the greenhouse gases in the atmosphere.
A recent commentary (RN Salas. NEJM 2020; 382: 589-91) details the myriad ways that the climate crisis will affect clinical practice.
The climate crisis is a threat multiplier; key points:
My take (borrowed from commentary): “Despite the irony, I often describe our current knowledge of the health effects of climate crisis as an iceberg. Though we see a peak above the water’s surface, there is much to fear from the larger mass beneath –the effects that we haven’t yet identified.”
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Garden at UNC Chapel Hill Campus
This is a link to a 20 minute video regarding “The Truth About Allergies and Food Sensitivity Tests” with Dr. Dave Stutkus and Dr. Mike Varshavski. (If trouble with link, then can find with quick search on YouTube.)
A couple of clarifications:
The video (~at the 3 minute mark) does not provide much nuance on “non-celiac gluten sensitivity” (see related blog posts below)
Some other points:
Dr. Stutkus decided to undergone ‘food sensitivity’ tests and was reportedly sensitive to nearly 80 foods.
Related blog posts:
Disclaimer: This blog, gutsandgrowth, assumes no responsibility for any use or operation of any method, product, instruction, concept or idea contained in the material herein or for any injury or damage to persons or property (whether products liability, negligence or otherwise) resulting from such use or operation. These blog posts are for educational purposes only. Specific dosing of medications (along with potential adverse effects) should be confirmed by prescribing physician. Because of rapid advances in the medical sciences, the gutsandgrowth blog cautions that independent verification should be made of diagnosis and drug dosages. The reader is solely responsible for the conduct of any suggested test or procedure. This content is not a substitute for medical advice, diagnosis or treatment provided by a qualified healthcare provider. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a condition
NY Times: Nonprofit Hospitals Are Too Profitable
An excerpt:
Seven of the 10 most profitable hospitals in America are nonprofit hospitals…
It’s time to rethink the concept of nonprofit hospitals. Tax exemption is a gift provided by the community and should be treated as such. Hospitals’ community benefit should be defined more explicitly in terms of tangible medical benefits for local residents…
The average chief executive’s package at nonprofit hospitals is worth $3.5 million annually. (According to I.R.S. regulations, “No part of their net earnings is allowed to inure to the benefit of any private shareholder or individual.”) From 2005 to 2015, average chief executive compensation in nonprofit hospitals increased by 93 percent. Over that same period, pediatricians saw a 15 percent salary increase. Nurses got 3 percent…
Additionally, hospitals should not be allowed to declare Medicaid “losses” as a community benefit. While it’s true that Medicaid typically pays less than private insurance companies, Medicaid plays a crucial role for private insurance markets by acting as a high-risk pool for patients with severe illness and disability…These large medical centers also enthusiastically accept taxpayer money for research…
Particularly in communities with a shortage of health care resources, tax exemption can make sense. In medically saturated areas, where profits and executive compensation approach Wall Street levels, tax exemption should raise eyebrows.
My take: This opinion piece makes a strong argument that many nonprofit hospitals do not deserve to be exempt from taxes. At a minimum, more transparency regarding tangible benefits is needed to assure that hospitals earn this exemption.
AJC: Georgia hospital disclosures show disparities, seven-figure salaries According to the AJC, the Children’s Healthcare of Atlanta’s CEO made 1.9 million last year. By comparison, the Northside CEO made 4.9 million. Other tidbits: Piedmont’s chief philanthropy officer was compensated 1.2 million.
Related blog posts:
“The problem with internet quotes is that you can’t always depend on their accuracy” ~Abraham Lincoln, 1864.
From Coronavirus Disease 2019 and Influenza
From CDC -2020 Immunization schedules (lots more details for healthcare providers and families on CDC website): Immunization Schedules
Perhaps in 2021, there will be a spot for COVID19.
This article is from 2018 and still relevant:
Full Text Link: NEJM 2018; 379: 1193-6: How to Stop Mass Shootings
Figure shows Age-Adjusted Rates of Death (per 100,000) from Firearms in 2016 (All Intents). Data are from the Centers for Disease Control and Prevention.
Climate change:
Related blog posts:
Sugary beverage Law:
Related blog posts –Sugary Beverages/Diet:
Related blog posts –Health Insurance:
A retrospective recent study (PL Watkins et al. J Pediatr 2020; 217: 52-8) provides data that suggests that preterm infants at 22-23 weeks gestation can have good outcomes.
Cohort:
Key findings:
These survival and neurodevelopmental outcomes far exceed previous reports. The study and the associated editorial (pg 9) identify several treatment characteristics that could have helped optimize outcomes: antenatal steroids, high-frequency ventilation, and a specialized environment. Also, the authors did not include infants who were outborn, stillborn or died in the delivery room.
My take: This article’s data needs to be replicated elsewhere; in the meanwhile, it is going to challenge the notion of nihilism for infants born at 22-23 weeks gestation.
Related article: AH Jobe. J Pediatr 2020; 217: 184-8. This commentary discusses the potential lifetime consequences of antenatal steroids, which may affect neurodevelopment and cardiovascular outcomes. “Antenatal corticosteroids are frequently used to disrupt normal development in rodent models”
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St Thomas Harbor
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Dr. Dave Stutkus shared some slides (on twitter) recently based on a lecture at Nationwide Children’s. Since I see children everyday who are undergoing poorly-conceived allergy testing, I wanted to share some of them.
Also, link to AAP guidelines on breastfeeding & eczema and introduction of foods to minimize development of allergies: The Effects of Early Nutritional Interventions on the Development of Atopic Disease in Infants and Children: The Role of Maternal Dietary
Restriction, Breastfeeding, Hydrolyzed Formulas, and Timing of Introduction of Allergenic Complementary Foods
Related blog posts:
Disclaimer: This blog, gutsandgrowth, assumes no responsibility for any use or operation of any method, product, instruction, concept or idea contained in the material herein or for any injury or damage to persons or property (whether products liability, negligence or otherwise) resulting from such use or operation. These blog posts are for educational purposes only. Specific dosing of medications (along with potential adverse effects) should be confirmed by prescribing physician. Because of rapid advances in the medical sciences, the gutsandgrowth blog cautions that independent verification should be made of diagnosis and drug dosages. The reader is solely responsible for the conduct of any suggested test or procedure. This content is not a substitute for medical advice, diagnosis or treatment provided by a qualified healthcare provider. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a condition
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