Wednesday, December 31

The Benghazi Mess and Washington's Blowhards

In a report today for the Daily Signal, Emmy award-winning investigative journalist Sharyl Attkisson and author of Stonewalled lists 26 Ways the Media Botched Their Reporting on the Latest Benghazi Report.  The list is  a helpful summary of a complete mess.  But it's not only the media that can be faulted. Taken together the items on Attkisson's list point to a tangle of CYA actions on the part of officials in Congress, the White House and at an alphabet soup of Washington agencies.  

As to whether the tangle points to an actual conspiracy in the mode of Iran-Contra, it looks to me as if the same situation is at the bottom of both:  Washington officials and their policy advisers strategizing on the strength of a delusion that the world is a chessboard.  When reality impinges on the delusion, the one predictable outcome is that things have a way of falling apart. 

In the case of Benghazi, before and during the attack on the U.S. mission the State Department couldn't very well press for more security for their personnel in Libya because they were involved in a clandestine operation -- an operation that seemed to be directed at Syria.  

At any rate, an ongoing U.S. 'defense' involvement in Libya was more than the American voters wanted; they hadn't even wanted the Obama administration to be involved in air strikes on Libya, period.  Much less fooling around in Syria with an ill-defined gaggle of fighters bent on taking down Assad.  

But the Obama administration was trying to please the Pussyfooting War Hawk contingent in Congress plus Qatar's fat emir and the Saudi monarch.  (I think it's the fat emir who runs Qatar; no matter, it's one of those Middle Eastern gas or oil banana republics.)  Plus trying to keep NATO and the EU happy about Syria and placate the French or was it the Italians about Libya.  

The point is that any chess master could have told them this ain't chess.  But no, no, if they made enough X, Q, A, and Z moves the Y situations would somehow work out.  It's just that they didn't factor in enough factors.

Can anything pry Washington away from its long-running idea that it can turn millions of  living, unpredictable humans -- foreign humans, at that -- into inanimate pieces on a chessboard?  Yeah. Oil at $5 a barrel and the U.S. dollar falling to a level that reflects its actual worth, both of which will put a crimp in the U.S. government's ability to kite checks to fund its harebrained geostrategizing.

On a related matter, did you know it's possible to exacerbate and even create a sinus infection, a chronic infection, in yourself by blowing your nose wrong?  Talk about blowback.   This ignorance has translated to endemic sinus infections in the USA to include Washington, DC.   

Here's the right way to blow your nose.  Number One rule:  don't blow hard.   By interesting coincidence that's what a pussyfooting war hawk actually is:  a blowhard.  A blowhard who can get a lot of people killed and maimed and never be held to account.   


Happy New Year, OPEC

Will OPEC nations including Saudi Arabia retaliate in any way they can to the latest turn of events?   Will they put inordinate pressure on their best friends in Congress to pressure the Obama administration to hold the line? It would be short-sighted to do so, which means they might try.  2015 could be a very interesting year.

Bloomberg/Business Week

U.S. Opening Door to More Oil Exports Seen Foiling OPEC Strategy

December 31, 2014

The Obama administration’s move to allow exports of ultralight crude without government approval may encourage shale drilling and thwart Saudi Arabia’s strategy to curb U.S. output, further weakening oil markets, according to Citigroup Inc.
A type of crude known as condensate can be exported if it is run through a distillation tower, which separates the hydrocarbons that make up the oil, according to U.S. government guidelines published yesterday. That may boost supplies ready to be sold overseas to as much as 1 million barrels a day by the end of 2015, Citigroup analysts led by Ed Morse in New York said in an e-mailed report.
Saudi Arabia led the Organization of Petroleum Exporting Countries to maintain its production quota at a meeting last month even as a shale boom boosted U.S. output to the highest in more than three decades. That prompted speculation OPEC was willing to let prices fall to force some companies with higher drilling costs to stop pumping.
“U.S. producers are under the gun to reduce capital expenditures given lower prices,” Citigroup said in the report. “Now an export route provides a new lease on life that can further weaken crude oil markets and throw a monkey wrench into recent Saudi plans to cripple U.S. production.”
While the guidelines on the website of the Commerce Department’s Bureau of Industry and Security are the first public explanation of steps companies can take to avoid violating export laws, they don’t mean an end to the ban on most crude exports, which Congress adopted in 1975 in response to the Arab oil embargo.
“While government officials have gone out of their way to indicate there is no change in policy, in practice this long-awaited move can open up the floodgates to substantial increases in exports by end-2015,” Citigroup said. The U.S. produces about 3.81 million barrels a day of light and ultralight crude, according to the bank.
[...]  [Lots more to the report]

Thursday, December 25

Christmas 1941: Yet in thy dark streets shineth ...

John Batchelor's wonderful introduction to Stanley Weintraub's 2011 book, Pearl Harbor Christmas: A World at War, December 1941 featured clips from two of President Franklin D. Roosevelt's most memorable talks to the American nation; one broadcast on the radio the day after the December 7 Japanese attack on Pearl Harbor, the other on the occasion of the President's lighting of the White House Christmas tree that year -- with Winston Churchill at his side  (photo above). During that second talk Roosevelt asked rhetorically how during this darkest hour Americans could celebrate Christmas -- and answered the question, in perhaps the most memorable speech given in modern times.   

John urged that people re-read the book once a year around Christmas time, to remember what a threat constitutes.  Well, the podcast of his discussion with the author is a great substitute if the holiday season leaves no time for reading.  

The world Stanley Weintraub describes for John's radio audience, the world as it was in 1941 as the Japanese triumphed, horribly, in region after region while the Germans pounded away at the Russian front, is indeed a good refresher on what evil in full battle regalia looks like.  

The more one knows about the era, the easier it is to understand why to this day it dominates the defense/foreign policy of the Western nations, and still influences the Chinese view of Japan.  In many instances this focus on what I've called the "Ghost of 1939" has had tragic consequences. And yet, listening to the discussion, it struck me that it's less a remembrance of World War Two and more a fogginess on the details of what actually happened that's caused American policymakers in post-war eras to blindly adhere to strategies that should be limited to responding to the kind of situations the Allies faced.

An example is that Roosevelt and Churchill knowingly made a deal with the devil, that being Josef Stalin.  It has been argued that they hadn't needed to give away so much to Stalin but I think this view ignores the time pressure under which the deal was struck.

No such pressure existed for post-war American (and British/European) leaders who made deals with Gulf Sunni leaders espousing a strict interpretation of Islam that is fully as dehumanizing as Nazism.   Yet Western leaders struck the deals on the rationale that harks to the fateful decision by Churchill and Roosevelt to treat Stalin as 'the enemy of my enemy.' 

This conversion into a long-term strategy of a tactic that should only be deployed in the most pressing of wartime circumstances has been disastrous. So perhaps it's Washington policymakers who most need to read Stanley Weintraub's book, or at least listen to his discussion with John Batchelor, to visit in their minds the way things actually were at Christmas, 73 years ago. 

But enough of giving advice that will surely fall on deaf ears.  A nifty companion volume to Weintraub's offering is historian David McCullough's 2010  In the Dark Streets Shineth: A 1941 Christmas Eve Story.  Only 40 pages long, the book is about Winston Churchill's wartime visit to Washington.   From Mark Tooley's review at the American Spectator, the book:
... focuses particularly on the British premier's first hearing of the hymn, O Little Town of Bethlehem, sung at a Christmas service to which FDR took him. The carol partly echoed some words in Churchill's first radio broadcast to the American people, referring to the "English-speaking world" at Christmas as a "brightly-lighted island of happiness and peace."
Churchill had steamed the Nazi submarine–infested Atlantic to appear in Washington, D.C. on December 22, just two weeks after Pearl Harbor had made Britain and America wartime allies.[...]  During the Christmas Eve tree lighting on the White House south lawn, the Marine Band had performed Joy to the World and the Hallelujah chorus from Handel's The Messiah
On Christmas Day, FDR took Churchill to Foundry Methodist Church, about a mile north of the White House. "I like to sing hymns with the Methodys," FDR had once chirpily explained of his sometime attendance at Foundry, despite his being Episcopalian. 
Various dignitaries joined them, including Army Chief of Staff General George Marshall and Vice President Henry Wallace. The minister prayed for "those who are dying on land and sea this Christmas morning." 
Churchill later remembered of the service: "Certainly there was much to fortify the faith of all who believe in the moral governance of the universe." 
Surprisingly, it was the first time Churchill ever heard O Little Town of Bethlehem, written 75 years earlier by a Philadelphia pastor while visiting the Holy Land during Christmas. 
Memorably, the hymn declares: "Yet in thy dark streets shineth the everlasting light; the hopes and fears of all the years are met in thee tonight." 
According to McCullough's book, both FDR and Churchill typically "sang lustily, if not exactly in tune."[...]

Sunday, December 21

Part 6, Shoot Yourself in the Foot health care: Death as an effective pain remedy

"It usually began with a back sprain."

This situation is horribly complex don't you dare laugh Pundita it's not a bit funny.  But from a long distance there is something funny -- not about the specifics but how democratic governments typically react to an outcry from the public that can be politically ruinous. The elected legislative body -- in this case, the U.S. Congress -- after being told by voters  to "do something" right away, turns to the federal bureaucracy and says "do something right away."  Then the frantic hunt launches for a government agency, any agency, that has a little budget and manpower to spare and can be hurled into doing something this minute. 

That's how the Secret Service, which is supposed to guard the U.S. President and other high-ranking government officials, got roped into helping the FBI chase down pyramid scheme scammers.  The flimflam artists proliferated like rabbits after 9/11, when the FBI got roped into fighting terrorism, leaving the agency few resources to go after pyramid schemes.  The upshot was that many Americans were being conned out of their life's savings, with the attendant hue and cry from the public to do something.

At least from what I saw of the Secret Service efforts, which were depicted in CNBC's documentary series Greed:  Scams, Scoundrels, and Suckers, the Service did a surprisingly good job at cooperating with the FBI and helped bring many pyramid schemers to justice, which is harder than it sounds. 

The government's duct tape approach to problem solving didn't work out as well when the U.S. Drug Enforcement Agency (DEA) was roped into doing something right away about misuse of opioid prescription painkillers. By the start of this decade the misuse was killing a surprising number of Americans. Perhaps not the "epidemic" as it was characterized in the press but the most alarming part is that many of the people who die in this way aren't knowingly abusing the drugs they're prescribed.
As an ER physician in Seattle noted to Dr Sanjay Gupta (CNN's Chief Medical Correspondent) for Gupta's 2012 CNN documentary, Deadly Dose:  Let's End the Prescription Drug Death Epidemic, " often it starts with a person being prescribed an opioid for severe pain due to a back sprain.  But because opiates depress the lung and heart functions, if taken with alcohol, which is also a depressant, death can easily result -- particularly if a person inadvertently takes a pill too soon after the previous dose.  

Take a pill, have a couple beers a few hours later, go to sleep and not wake up.  It can  happen.  But hurling the DEA into dealing with the problem just because it involves drugs was like sequestering  a logger to perform an emergency appendectomy. You cut down trees, right?  So you should have no problem cutting out appendix.  

The DEA typically deals with violent criminal drug cartels. When it turned its scorched-earth methods to legitimately prescribed opiates, by gum it quickly got a handle on the worst of the problem. And if I recall, put some of the illegal operators and counterfeit opioid pill manufacturers out of business 

But in the process the agency so greatly terrified respectable pharmacies, physicians, and law-abiding pill takers that for a time the prescribing of opiate painkillers ground to a virtual halt. Doctors who prescribed opiates and drug stores that filled the prescriptions were frightened that the DEA would descend on them in full body armor with automatic weapons drawn. And patients trying to get their legitimate prescriptions filled were treated by their local pharmacy like drug addicts or illegal pill dealers.

The upshot was that everyone involved in the muddle -- doctors, pharmacists, legal opiate manufacturers, pain-ridden patients. etc.  -- pointed fingers of blame at everyone else.  

All this greatly upset another U.S. agency, the Food and Drug Administration.  Hey the FDA also had "drug" in its name. So why was the DEA chosen to handle the opioid overdose problem?  (Maybe because the FDA never tires of complaining that it's grossly understaffed and under budgeted?)  

There's much more to the story, which as I noted is complex. If you're a sucker for jigsaw puzzles you can read a yeoman attempt by Reuters in 2012 to clearly explain all parts of the issue.  If you combine that report with the 2012 CNN transcript that discusses Dr Gupta's very dramatic and emotional documentary, you'll have a fairly clear picture.

What that picture is today, I don't know; I haven't followed up.  But it was in the course of my reading Radley Balko's 2012 discussion of the Reuters report, which while praising it cherry-picked a little too much for my taste, that I stumbled across a situation which is in some ways worse than the prescription opioid misuse, and which is colloquially known as drug bundling. 

The bundling was mentioned by a reader in the comment section on Balko's blog, more as a question to other readers about the practice than a comment.  The sum total of the replies, and their implications, dropped my jaw.
I didn't come across the discussion at Balko's blog until the other day. Until then I'd never known about drug bundling. This is despite the fact that I stared straight at an indication of bundling on the label of a prescription opioid I'd briefly taken same years ago for a bout of severe pain.  I just hadn't paid any attention to the verbiage on the prescription bottle label, didn't bother to read the warnings included with the bottle, and wouldn't have made anything out of it, if I had. 

And while I check the headlines at Google News at least three times a day, and until July 2013 kept close track of news on national TV stations, I'd never come across mention of bundling.  So to the extent it's been publicized in the USA I think only certain segments of the American population, such as physicians and the patients who routinely take painkillers, have paid attention. 

This ignorance works out to societies shooting themselves in the foot in the name of compassion. It seems one of the few comparable situations is the ongoing practice in several developing countries of injecting medications and vaccines with disease-contaminated hypodermic syringes. On the one hand the injections are saving lives, on the other the jabs are killing people or making them sick for life.  

But the bundling is mostly directed to pain management.  And right now it seems the only way to stop the severe medical consequences of bundling is by warning the public not to accept at least certain types of bundled medication prescriptions. And then informed individuals, on a case by case basis, refusing bundled medication.  

Granted, this can be hard when a person is in severe pain. One just wants the pain too stop by any means necessary. I've been in that situation once; if I ever went through it again I'd take any painkiller I'm handed by an ER nurse and without demanding to know the ingredients.  

And for emergency or short-term purposes, unless the person has a prior medical condition that could be affected I can't see great or lasting harm -- although whether bundling for painkiller pills is necessary is another question.

There is an element to this story that reminds me of sugar, which over time was added to more and more processed foods even when the recipe doesn't call  for it. I mean, who adds sugar to mayonnaise and ketchup?  But it seems that it's the routine, ongoing use of bundled prescription painkillers that becomes increasingly harmful to the pill taker's health. The effect seems to be cumulative. 

Without further introduction here are the relevant responses to the reader's query at Balko's blog, by comment number. They're certainly not a definitive analysis, and a caveat is that Balko's readers tend to be in the libertarian camp, which looks askance at government efforts to do just about anything, But the information and links provided by the commenters are enough to sound a clear warning and prompt further inquiries:

#4 |  C. S. P. Schofield |  
I have read the assertion that many of the overdoses associated with prescription pain meds are, in fact, kidney failure due to the DEA mandated inclusion of Acetominophen(sp?). While this sounds like the kind of bone-headed idiocy I expect from the government, the assertion was made in a comment on a Blog, and without reference. Does anybody here know anything about this? Is there any basis for it, or am I drifting into Area 51 territory?
  1. #11 |  David Jones |  
    As a physician, I can tell you I am pretty sure there is no mandate to include acetaminophen in these pain medications. While many narcotics are available in combination with acetaminophen, you can get the narcotic alone in most (perhaps all) cases. There is a real problem with prescription diversion, and it is amazing what lengths some people will go to as they try to get multiple prescriptions filled at different pharmacies, go by the emergency room and try to get meds, etc. This needs to be controlled, but we need to find a way to address this that doesn’t limit supplies to legitimate users.

  1. #13 |  el coronado |  
    #4 [Schofield], you’re right on about adding acetominophen & ibupfofen to high-powered pain drugs to “help them work better.” I’m a chronic pain guy, and have been aware that acet. isn’t the magic pill it’s made out to be ever since NFL stud Kenny Easley fried his kidney on them (and almost died) 20+ years ago. Adding ‘em to Lortab/Vicodin/Etc is like taping a BB gun on a 30.06 to “make it more effective”…..but that’s what they did. Why?
    Because that’s what the drug warriors DO. It goes back a long way: have read somewhere, maybe even on this blog, that back in Prohibition, the Booze Ninjas added (actual, for-real) *poison* to alcohol, and quite a few folks died from it. So y’all might wanna think about tossing your Tylenol and going back to aspirin. Just sayin’.
    Served ‘em right, really: they were breaking the *law*, you see. Promotions and commendations for everyone!!

  1. #19 |  Highway |  
    CSP Schofield: Regarding the issue of acetaminophen in painkillers – yes, it is a significant hazard. Here’s an article from the NY Times in 2009 describing some of the issues around acetaminophen poisoning:
    And it mentions that Vicodin and Percocet are both mixes with acetaminophen, and that Hydrocodone is not available by itself, and Oxycodone is, but is *much* harder to get. The government is far less restrictive (not unrestrictive, just less restrictive) regarding prescriptions of Vicodin and Percocet. So why the discrepancy? Because of the belief that the acetaminophen is a limiting factor in the dose, not because it ‘works better’. It’s bullshit to say it works better. If it did, then just prescribe Oxycodone and a Tylenol. But no, they want it together so that you can’t take more than a certain amount of the narcotic.
  2. #20 |  SJE |  
    CSP Schofield: acetominophen is seriously hepatotoxic (liver damage), responsible for 48% of acute liver failure in adults (FDA ref below). According to 2004 paper, acetiminophen and is the #1 cause of overdose (over 100,000 calls, 56,000 emergency room visits, 2,600 hospitalizations, and est 458 deaths:
    In 2011, the FDA asked manufacturers to limit acetominophen in combo products, including oxycontin, because of the dangers:
  3. #28 |  Pi Guy |  re: use of acetaminophen in conjunction with narcotic pain relievers  I’m pretty certain that part of the reason for adding acetaminophen to, say, oxycodone to make make percocet (percodan isn’t so common any more but is oxy + aspirin) is that it allows it to be scheduled differently on DEA’s list. For example, [marijuana] pot’s a Schedule I drug – no medicinal value (according to the DEA) but percs, I believe because of the combination of the two pain relievers, are Schedule II.
    1. #30 |  DoctorT |  
      “… From 1999 to 2009, the number of deaths from narcotic pain pills nearly quadrupled…”
      These are the usual bullshit statistics the government uses to justify its war on drugs. The CDC changed the way it classifies death reports from medical examiners and coroners. If a person dies of any cause and has detectable levels of opiates, cocaine, amphetamines, barbiturates, tranquilizers, alcohol, etc., then it now is classified as a drug-related death. That’s where the quadrupling comes from. (The CDC pulled the same stunt with obesity: change the criteria and suddenly we have an obesity epidemic.)
    2. #31 |  DoctorT |  
      @27: Adding acetaminophen or ibuprofen-like drugs to an opiate painkiller does NOT alter its classification or its DEA reporting requirements. The reason for combining the drugs is to reduce both pain and inflammation. If a patient has severe pain without inflammation, the use of an opiate alone is better. 
    3. I am unable to verify this but seem to think it made sense when I heard (read?) it.
      1. #32 |  Other Sean |  
        Of course patients could simply take two pills, if inflammation control is that important. Given the massively different rates of tolerance between APAP and opioids, you must admit it’s medically irrational to bind them together.
        I think the larger point is: if lots of people were spoiling their livers on a non-narcotic medicine that was unnecessarily bundled with APAP, there would be a massive outcry, denunciations of big pharma, 60 Minutes special reports, etc.
        One reason the public may tolerate such dangerous bundling here is because they have a moralistic reason to feel indifferent to the victims. [Pundita comment:  Again, I think the general public tolerates the bundling practice because it knows little or nothing about it.]  
      2. #34 |  Katie |  
        1. Dr T,
          Since acetaminophen is not an anti-inflamatory, I fail to see how it can be included. To the best of my knowledge, the principal effects of long-term acetaminophen use are kidney and/or liver damage, the pain of which often renders any minimal previous pain relief moot. It is, however, an excellent means of suicide – long slow and painful – but effective when taken with a glass of scotch. I watched a friend die that way and I won’t put acetaminophen in my ear, let alone my mouth.
          1. #59 |  Elaine |  
            @ Doc T. I never said it did. A schedule 1 narcotic is a schedule 1 narcotic no matter what you add to it. Oxycodone and hydrocodone are both schedule 1 with or without acetaminophen. The DEA will not specify how much of a schedule 1 drug qualifies as “potential dealer”. Therefore you can’t know if you are over their arbitrary number or not.

Saturday, December 20

Part 5 of Shoot Yourself in the Foot health care: It's 1 AM; time for a snack before bed

Guess which mouse gets to eat whenever it wants


The only difference between the two lab mice in the photograph above is that the one on the left is allowed to eat any time it pleases, whereas the slender mouse sticks to a sane eating schedule -- sane by the body's definition of sanity.  Otherwise, their diet and exercise routines are the same.  

There's a reason the first meal of the day was named "breakfast;" it referred to breaking a literal fast of roughly 12 hours. This fasting traditionally extended from the end of the evening meal to the next day's first meal; in other words, most of the fast is due to sleeping.  
Then came electric lights, indoor plumbing, and indoor ice boxes. Then TV and late night television shows.   And with this, the after-dinner snack and before-bedtime snack (or outright meal), followed six or eight hours later by a morning meal.  Somewhere in all this modernizing of meal scheduling the fast disappeared from breakfast.

Yet the experiment with mice suggests that their body clocks need roughly a 12 hour rest from noshing to keep their inner house in order.  If there's no order, then chrono-chaos (see the previous Pundita post) extends to the body's process of 'natural' weight management.  

The big question for Science is whether mankind and mouse are pretty much the same in this regard.  Researchers who experimented with the mice are now planning studies to test whether the human body's inner clocks are also thrown out of whack by abandoning the age-old 12 hour overnight fasting rule.

I think the most interesting finding to come from the mice study is how sensible the mammalian organism is, after spending millenniums breaking its own fasting rule. A couple times a week the slender mouse in the photo was allowed to eat whenever it wanted,and this cheatingi didn't derange its body clocks. 

If this sensible approach extends to humans, then it's not as if one can never eat a late-night meal.  It's just that most of the week the overnight fast would have to be observed to naturally manage weight.

Of course there's a way people could get the answer without waiting for the researchers, isn't there?  The natural weight loss is striking in fat mice when they're put on an eating schedule that for the most part honors the 12 hour overnight fasting period.  From a December 2 BBC report on the study (Why late night dining may encourage weight gain; Emma Wilkinson, reporter; the above photo is from the report.):
Even when given the same amount of calories overall, mice that ate around the clock put on more fat.
Fasting for at least 12 hours appears to switch on important fat burning pathways in the body. [...]
During the study around 400 mice were fed diets high in sugar or fat or both, or normal diets and over different time periods. 
Overall, mice that were only allowed to feed for nine or 12 hours gained less weight than mice that could eat the same amount food but at any time they wanted in a 24-hour period. [...]
Even when the restricted feed time mice were allowed a blow out at weekends and could eat when they liked, they still gained less weight, suggesting that the diet can withstand some temporary interruptions, the researchers said.
And when obese mice who had been eating freely were moved to a restricted schedule they lost 5% of their body weight even though they were eating the same number of calories as before.
The researchers believe a key to controlling weight gain could be sticking to a consistent 12-hour fast every 24 hours.
In the experiments, fasting at night had beneficial effects on blood sugar and cholesterol and reversed the effects of diabetes in the mice.
Study leader Dr Satchidananda Panda, an associate professor at the Salk Institute in California, said that brown fat, which burns energy at a much higher rate is also activated by this approach.[...]
Now you really want to let the ramifications sink in, if tests on humans comport with mice tests.  Think of the trillions of dollars poured into medical care and medications for illnesses created or exacerbated by obesity. Think of billions of lost work hours from these illnesses.  And think of the huge waste of resources in making large-size clothing for fat people, making larger plane seats for fat people, and so on.

Think also of the psychological trauma that fat people experience because they're fat, and God Only Knows the amount of money these people spend on diet books, special diets, medications for depression because they're fat, etc.

There would also be a tie-in with a factor that's not been very evident until the past few years.  The International Energy Agency felt its way to the realization that governments in 'developing' countries are shooting themselves in the foot, if they want to limit greenhouse gases, by providing endless fuel subsidies. Human nature being what it is, recipients tend to look at the subsidies as an invitation to expand their energy use to an outlandish degree.

That's how residents of Cairo, Egypt became all-night party hounds, with restaurants filling fast food orders called in all night from cell phones.  The nightlife society is made possible by wildly cheap electricity -- and gasoline, which of course powers the food delivery vehicles.  

Earlier this year the country's new government raised fuel prices in an attempt to put the lid on fuel subsidies, which eat up nearly a quarter of the state's budget. For details, see this richly ironic op-ed at Forbes, Hurrah!  Egypt's Reduction of Fuel Subsidies First Step To Climate Change Solution!  

The point for this writing is that one might be able to trace a line between the rise of subsidy-fueled nonstop nightlife in Cairo (and nightlife in other big 'second world' cities) and Western-style diseases rooted in, or exacerbated by, being seriously overweight.  And if the chrono-nutrition testing on humans pans out, it could be possible to trace another line -- one between between overweight people and their abandonment of the body's 12 hour overnight fast.

If these three lines actually intersect, we'd be looking at a chart depicting a kind of racial suicide -- and not so much from bad diet or over-eating but from eating at the wrong times.  The enjoyment of modern amenities and plentiful food wouldn't get much more counterproductive that.

As to how people who want to be their own test subjects can withdraw from late-night snacking without dying from hunger overnight  -- I'd say "very slowly and incrementally."

As to how Cairo residents can party all night and still show up at work in the morning -- it could be that the biggest reason so many Egyptians got behind booting the Muslim Brotherhood from power is that at least one high-ranking member of the organization loudly observed in 2011 that Egyptians in government had to stop sleepwalking through their jobs.  (A lot of Egyptians work in government.)   Screw the politics, just don't take my 3 AM pizza away from me.  


Thursday, December 18

Part 4 of Shoot Yourself in the Foot health care: Chrono-Chaos

If lately you've been getting the feeling there's an increasing number of crazy people in the world, this is probably not your imagination....  

It's been established at least since the early 1970s that frequent jet flights between very different time zones has severe negative physical and mental consequences for the frequent flier. The travel disrupts the body's roughly 24 hour cycle of rest and wakefulness (the Circadian Cycle).  It wasn't long after this momentous discovery that researchers realized that rotational night shift work had the same negative effect on the Circadian Cycle as routine time-zone hopping.  

This was bad news for society's critically important workers -- emergency room doctors, police, fire fighters,  and so on -- who must maintain a high degree of mental clarity for their jobs often under life-or-death circumstances allowing no time for hesitation or 're-do.'   

And of course, it was bad news for the societies that depend on such workers.  And while there are workarounds, there is no real solution to the problem.  Yet decade after decade, evidence keeps piling up about the cost of fooling around with the Circadian Cycle -- and that even night shift work, without the added strain of rotational shifts, was dangerous to mental and physical health. 

By 2011 an American physician, Jessica Freedman, was reporting on "The exhaustion of emergency physicians, and its toll on patients and family."  She noted in part:
[A] recent longitudinal study of EM physicians by the American Board of Emergency Physicians ... reports that one third of EM physicians report burnout. Other studies suggest an increased incidence of breast cancer, obesity and other comorbidities in night shift workers. One survey of EPs over 55 reported several “age related concerns”;  74% found it more difficult  to recover from night shifts, 44% reported a higher level of emotional exhaustion after shifts, 40% were less able to manage high patient volumes, and 36% reported less ability to manage the stress associated with EM practice. ...  Anecdotal evidence supports these findings ...
Then in January 2014 came a stunning revelation, as reported by the BBC:  It's not just one of the body's clocks that go haywire when the Circadian Cycle is disrupted; it's all of them.  

All?  Scientists are now understanding that there's an entire complex of body clocks, all working in synchronization. When the synchronization is thrown out of whack it results in "chrono-chaos," as the syndrome has been termed. The chaos goes all the way down to the molecular level: 
Doing the night shift throws the body "into chaos" and could cause long-term damage, warn researchers.
Shift work has been linked to higher rates of type 2 diabetes, heart attacks and cancer.
Now scientists at the Sleep Research Centre in Surrey have uncovered the disruption shift work causes at the deepest molecular level.
Experts said the scale, speed and severity of damage caused by being awake at night was a surprise. 
The human body has its own natural rhythm or body clock tuned to sleep at night and be active during the day. 
It has profound effects on the body, altering everything from hormones and body temperature to athletic ability, mood and brain function.
The study, published in Proceedings of the National Academy of Sciences, followed 22 people as their body was shifted from a normal pattern to that of a night-shift worker.
Blood tests showed that normally 6% of genes -- the instructions contained in DNA -- were precisely timed to be more or less active at specific times of the day.
Once the volunteers were working through the night, that genetic fine-tuning was lost.
Chrono-chaos"Over 97% of rhythmic genes become out of sync with mistimed sleep and this really explains why we feel so bad during jet lag, or if we have to work irregular shifts," said Dr Simon Archer, one of the researchers at the University of Surrey.
Fellow researcher Prof Derk-Jan Dijk said every tissue in the body had its own daily rhythm, but with shifts that was lost with the heart running to a different time to the kidneys running to a different time to the brain.
He told the BBC: "It's chrono-chaos. It's like living in a house. There's a clock in every room in the house and in all of those rooms those clocks are now disrupted, which of course leads to chaos in the household." [...]
As to what we're going to do about Chrono-Chaos -- well, a few things are getting clear:

Megacities have evolved large populations of critically important night shift workers, including people who can only work at night to maintain the cities' vast infrastructures.  But city life has also created a large population of residents who live as if they're critical night shift workers, when actually all they're doing is staying up at all hours because they want to. 

Then around 2 in the morning these groggy people attempt suicide, or suffer other mental emergencies, get into accidents, or have a heart attack or decide to shoot a neighbor for playing music too loud, etc., etc. 

Then they all dial 911 or show up in hospital emergency rooms and have to be taken care of by facilities that are often underbudgeted and understaffed and working their groggy employees on double night shifts.  

Then these patients threaten to sue the facilities if the care seems -- groggy.

In short, we've evolved a lifestyle that is absolutely guaranteed to increase and perpetuate a host of mental and physical disorders, and is it ever costing societies a bundle. Just one cost is that there are now an awful lot of people who've been driven quite mad by their deranged body clocks.  Many of these people vote.