Resistant Bacterium Surfaces in Alabama

A few posts ago I wrote about the emergence at Methodist Hospital in Houston TX of the truly antibiotic treatment-resistant Klebsiella bacterial strain. The infectious disease and internal medicine clinician researchers had been following the presence and prevalence in patients in the ER and hospital wards since 2011 through 2015. They had recently published their results in the prestigious journal Nature.

Methodist Hospital had been tracking this dangerous bug since it was noticed in patients in that hospital in 2011 or slightly before. The Methodist Hospital clinical researchers had tracked large numbers of patients both at risk and not at risk for harboring “bad” germs such as the better known MRSA [methcillin resistant Staph Aureus bug] as all hospitals have done for over a decade or more as standard procedure upon any admission to a hospital. They were taken aback and I dare say, medically frightened by their findings that larger than expected numbers of patients had this resistant Klebsiella.

Well, now it turns out that an equally antibiotic-resistant bug, a variant of our old Gram-negative E. Coli bug has turned up in Alabama centers in an alarming incidence that cannot be ignored either. This I fear really fear is the start of what all of us in public health, medical epidemiology, infectious disease and internal medicine have anticipated for years, the start of the antibiotic resistant age with multiple bacteria being antibiotic resistant.

For several years, the strategy in treating moderately resistant bacteria has been to employ typically dual or triple antibiotics to treat infections and this has until recently been quite successful. But the thinkers and ponderers in medicine, even in psychiatry such as those who practice in large hospitals and see patients in growing numbers with medical conditions that predispose to resistant ‘bugs,’ such as modern immunocompromised patients engendered by our novel non-chemotherapeutic anti-cancer drug regimens that do not utilize ‘cell poisons’ as in the beginning days of oncology and HIV patients who are immunocompromised out of hand because of the way the HIV virus operates and its routine effects on suppressing the immune systems of the body. I myself am partially immunocompromised by the treatment I do daily for multiple myeloma and have had a few episodes of serious body-wide infections or sepsis and face with some degree of trepidation this new issue of antibiotic resistant bacteria. But a number of other populations fall into these vulnerable categories, such as infants, children, the elderly, persons on the new drugs for rheumatoid arthritis and psoriasis. These are not small elements of our populations worldwide by any means.

So without really any or too many new wonder antibiotics on the horizon to save us all, the researchers are scramblers as fast as possible in another direction that likely is better. The development of vaccines bears promise and bacteria do not change and morph and trades parts of DNA in their annual changes such as in the various flu strains and so present hopefully, slower moving targets for vaccines. It appears we will enter into a new era of vaccine research and development since the days of the polio vaccines and childhood disease vaccines.

I also would throw down the gauntlet to the anti-vaccine movement parties in this country, for whom I have a great deal of antipathy for generating in my view truly ‘fake news and information’ about the supposed harm of vaccines and causing such alarm among the relatively less educated and even well-educated parents of the last 20 years or so  to let their children go unvaccinated. Because of this, we are having more and more outbreaks among the much larger cohorts of the unvaccinated of measles, mumps, whooping cough and even diphtheria as the collective “herd Immunity” is diluted by the larger numbers of unvaccinated children at the mercy of their misinformed parents. And yes as a physician I am well aware of the tragedies caused by the RARE cases of PANDA syndrome, catastrophic CNS cases of brain damage due to encephalitis which things like measles cause in large numbers in severe cases in the unvaccinated in addition to deafness and other tragic consequences. One could hope that the anti-vaccine ill-informed and just plain dead wrong movement in this country and others would wake up when the realities of the antibiotic resistant bacteria start causing widespread deaths and the only defense against them on the horizon or on the pharmacy shelves is bacterium-specific vaccines. Then when they, their elders, and their children are threatened in very real stark life and death terms, I would hope to God that they come to their rational modern day senses.

 

Worldwide Homogenization of Young Adult Consumerism

Converging consumer values in China and the U.S. are creating millennials without borders

Credit: Tech Crunch; July 10, 2017

I just read this weekend a telling article in Tech Crunch of the “homogenization” [my term] of modern fashion, gadgets, and consumerism in the modern, present world. I thought it was worth commenting which I will proceed to in my combined semi-historical personal way and lead up to some telling observations if not conclusions. The article is entitled, “Converging consumer values in China and the U.S. are creating millennials without borders.” by Hans Tung.

Consumerism and its ever present ‘sidekick’ marketing/advertising has fascinated me even from my earliest childhood. I grew up with stories of my father “painting his way across Texas” when he drove to El Paso from Huntsville to El Paso in a beat up old car in 1937 or so along with three equally poor friends to enroll at and attend Texas School of Mines as it was known then. They all had the idea that they wanted to be “engineers.” My father had gotten enamored of mining engineering by reading a pulp paper published penny dreadful adventure comic about a mining engineer that he kept a copy of and showed to me when I was about five or six. He had worked in high school as a billboard sign painter to earn money and help his family get by during the Great Depression. Billboards in those days were not printed and glued on in sections or electronically programmed LED light affairs as they are now. they were hand painted. My father was proud of his work and without biased exaggeration, he was very good at it. He painted billboards for just about every business in the Huntsville, New Waverly, Conroe Texas area. Once he misspelled a word and initially did not realize it and his buddies teased him mercilessly about it. He quietly and quickly set about to repaint the word hoping his customer had not noticed it but he had. The purchaser of his services thought it was hilarious and were gratified as locals told him of the mistake and it had the unique small town effect of bringing in more customers who laughingly told the proprietor of the said business of the mistake and of course bought more goods. The proprietor almost stopped my father from correcting it. So I had an early family based to local, small town advertising. By the time our family bought a television set in the 1950’s were avalanched by the big time national Madison Avenue advertising for cigarettes [back when it was legal and routine for tobacco products to be so advertised on tv, for the young reader who may not know that actually occurred once upon a time]. Detergents, washers, car tires, gasoline and motor oil brands, and my favorite Falstaff beer pitched by the famous Dizzy Dean on Saturday afternoon baseball was my favorite since Dizzy Dean almost always comically ad-libbed some hilarious backwoods homily or addition to the advertising script. His most famous that got him in temporary hot water was “But we ain’t got no gallons.”

Then a little later I happened to run across Vance Packard’s books on advertising, its power, and sort of subliminal evil influences. That caught my eye and reading mind. I mulled those concepts over endlessly. It helped me among really many,, many other concepts that economics were a very powerful influence throughout history and especially modern life.

 

Decades ago I somehow realized, likely through my travels with my family growing up all over the world, that elements of American culture were permeating [sometimes I felt it was a process almost akin to the inadvertent introduction/invasion of kudzu into the South] the rest of the world starting with the more affluent countries, McDonalds, Coke and Pepsi led the way. As the years rolled on and I became inducted into the world of medicine, I began to realize we were infecting the world with harmful American products. The American diet exemplified by Mickey D’s, soft sugary drinks, candies and more. And tobacco was the worst though I think it sprang up into parts of the world autonomous in regions where tobacco was also native and grown such as Turkey etc. But in recent decades as tobacco has become more and more unwelcome in the US, the companies are migrating in an organized and hurried manner to the Far East expanding into markets with far more customers in India, China, and the Far East. And very little regulations like we have had in the US since the initial warnings of packs of cigarettes decades ago. And the rates of breathing and lung disorders, and especially LUNG CANCER have increased in those countries like a reverse ski slope in predictably horrendously rapid rates.

The other side of the coin of American invasion, leaving out American music from rock and roll to jazz, the most American and more popular of American genres [sorry, I have not forgotten such other genres such as American Bluegrass and four or five person American Christian Gospel “Quartet” music which even as a Jew I do love, but those genres are not as popular overseas], is the dreadful American Diet.. And I must echo Oprah’s correct indictment of fat laden American steak and beef as bad or at least not good for us. fatty french fries and all the rest of it, even my wife’s Cherokee fry bread which is good if an acquired taste but full of grease and fat and not good for anyone but a traditional food nonetheless. So America’s obesity epidemic has grown overseas and the evidence of it is there for all to see when we view television scenes of other countries overseas where America’s “foodie” exports have taken hold in a big way. This is not to say the American diet is not the only culprit. The German diet from personal experience is full of fattening favorites, large amounts of beer per capita, and all those fatty meaty wursts of all flavors that I cannot keep straight and other fatty but oh so tasty goodies. And even my other main cultural heritage of Latino food has its unwise but centuries old emphasis on fatty beans, greasy carbohydrates foods that I restrict myself painfully to on a once a month basis or so…

Now we have a new phenomenon in this world of mega companies exporting their not so good products to the rest of the world. Worldwide advertising through television American style has invaded the rest of the world like the “fungus among-us” that can’t be stopped. It is visual, it gets you hyped up and craving-desiring whatever product is being hawked from cereals to iPods. It is a truly essential tool of business large and small and will never go away. But American television somehow apparently got a head start on local programming in other countries and set the tone and paradigms for shows in other countries. I remember once when I turned on the tv in a Latino country where we were living at the time during one of my father’s international consulting mining engineering contracts, re-opening a mine that had an explosion and closed, or sinking a deep shaft through dangerous formations and saw American like programs in Spanish, complete with Let’s Make A Deal like shows, breaks for the usual advertising commercials, all modelled after “Amerikanski” tv as my father used to call it. And the soap operas were just as bad as American ones with every other minute bouts of scripted hysterical crises in all the relationships of actors. I was aghast and fascinated.

In the last two decades, the American invasion has increased. Everybody races their Honda two-door Civics modified to dangerous levels in streets or parking garages in Japan like American teens did with their souped up pre-dragster jalopies in the 1950’s. Clothes are American like. We had the Japanese invasion of little transistor radios briefly in the 1960’s but then American boomboxes [though made in Japan] took over and held sway especially when the hippest of all American teens, the black teens, and gangstas came to the cultural foreground. What capped it off for me has been the recent appearance of Apple’s advertisement for a pair of teens obviously in love and the male is taking adoring pictures of his girlfriend in breathtaking big city settings with the coming iPhone which is supposedly now even better for portraits. And then you realize that it is some Chinese big city and the two Millenials, the young couple are indeed Chinese. It is a good commercial and romantic on a soft, pleasant plane that is nice to watch.

And there we have it. I think it is a culmination of all this American cultural spread/plague/internationally bourne cross-pollination homogenizing many cultures. These cultures were incredibly insular and very very proudly different just decades ago. And now look at them; at times you have to look closely to see their unique differences. No wonder some countries, even with their science and modernization phobias are trying to shut out the Internet. Once you enter into the world of the Internet, you change.

 

Attachment, Childhood Development and Refugees

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Trumpism Now Appearing in Legal Circles, i.e., in Defendants

Gosh, even the famous NY mobsters appearing long ago in the 1950’s before the brave and superb dogged Senatorial investigator, the Honorable and too much forgotten Senator Estes Kefauver of Tennessee, knew to keep their big yaps shut and take the fifth amendment under Kefauver’s relentless pointed grilling about their criminal activities.

Taking the Fifth has come to occupy a  hallowed and familiar place in American popular, media and legal culture. Everyone has accepted the right of the poor wretch under the microscope of such investigative grueling questioning to protect themselves with its constitutional protection, though it would often do little to convince most observers of that person’s innocence. Still it showed at least some prudent judgement on the part of the person in the Hot Seat.

Our Dear Leader, I think I will call our nation’s leader, our President, has set a new tone whether he realizes it or not in approaching such trials and tribulations [pun intended]. Rather than invoke the fifth whether in actuality which he has not been placed in the position of having to consider its use, or indirectly, he certainly has invoked lots of probably unwise defensive maneuvers, threatening he had tapes to try to intimate James Comey [which proved to another of his untrue made up on the spot dumb and untrue deflections], praising to the hilltops his dubious henchmen right up until he canned them abruptly, manufacturing his ‘maybe’ stories  that have to run down and checked out no matter how absurb they appear to a sensible non-blinded to the ideology fanboys he surrounds himself [they used to be called sycophants or in the 1950’s “yes men”].

But in a present day [today] post derived from the AP, entitled, “Pharma Bro: Martin Skreli Refuses Attorney’s Advice to Stay Low and Keep Quiet,” [URL: https://wordpress.com/read/feeds/1235237/posts/1507667218] (Sorry, for some glitchy reason I could not get the usual  link paste in mechanism to work…so you will have to manually copy and paste in another browser window’s search URL bar this URL to access the original article–again my apologies)

Photo: From AP/Seth Wenig

Mr. Shkreli made headlines last year  after being grilled by members of Congress on his blatant price gouging of the drug Daraprim used to treat the not very frequent fungus infection often of lungs, which can be life threatening if not treated. Its previous price had been $13.50 per dose and was raised to $750.00 per dose. This disease is endemic to the Southwest where it can be caught by workers who stir up the dusty soil in which it resides ordinarily [like heavy machine operators preparing sites for building of all kinds], or in other desert climes, i.,e. the Middle East. Mr. Shkreli called members of Congress “imbeciles” on Twitter and regaled his opposition royally, not in the regal sense, but in the slanderous meaning of the word left and right. He impugned the legal process.

His lawyers and handlers rightly feared he has poisoned his own prospective jury pool and may have even impressed his judge given the wide spread local coverage by the press of his impulsive shoot his mouth off shenanigans.

All the brings to mind Our Own Dear Leader who could easily be viewed as [gasp] a role model for this pharmaceutical _ _ _ _ _ _ _ _ [fill in the blanks with your own epithets that you are think are appropriate to your private heart’s content as I do wish to be sued…

Our Dear Leader has done all this and more. He can not stop insulting and slandering persons he does not like or by whom he feels legally threatened. He keeps tweeting to his own detriment almost nightly. He has millions of “followers,” half of whom I suspect actually adore and love his wild alternative fact universe 140 character assertions, and the other half who see them as their daily “unbelievable” modern day political theater of the Absurd. “Honey read what he said today. You’re not going to believe this one!!!” must be heard in millions of households ‘who want to know.’

This leads me as a psychiatrist to add to the popular list of definitions of a certain personality disorder that has been hinted at being relevant since the Presidential election and that is the inability for this kind of personality style not to be able to follow the then seemingly abusive verbal harassing of his wife, the now sage advice of the infamous Phineas T. Bluster puppet character of long ago Howdy Doody fame, our late Archie Bunker who would tell his hapless wife to “Stifle It.” This character trait I think now could be regarded as part and parcel of the blowhard subcategory of this personality style and type. We have already seen the constant impulsiveness, personal insecurity when not be adored by the audience, the recurring near weekly to go campaign some more, even though the Election is long over, and to be cheered by hundreds and thousands of fans, the constant tearing down of the usual checks and balances of the other branches of government especially the Intelligence Community and press, the pathetic demands for loyalty, the reported rages and off again, on again anger at his staffers, reminiscient of the Kremlin Watching of the Cold War, trying to keep track of who is in favor of Khrushchev or Breslin, who’s up and who’s down, etc.At least we are not having heads chopped off like in North Korea where a fall from political grace is a death sentence.

But the worrisome thing is that the new environment of BLOWHARDISM as I think I will lable it from now on, is setting a new low in national discourse. It encourages other and likely much less well controlled extremist home grown blowhards to feel emboldened to sounnd of in hateful ways, incite themselves and others to hateful and perhaps even violent acts in numbers we have never seen before in this country. And Radical Islam may very well not be blamed in the rise of our own homegrown blowhardist terrorism, who will be just be following the examples of what they see portrayed all around them in far more concentrated and frequent doses than ever before without the maturity to see any of it.

 

 

Even before his federal securities fraud trial began Monday, Martin Shkreli blatantly defied his attorneys’ advice to lay low. The former pharmaceutical CEO, who became a pariah after raising the cost of a life-saving drug 5,000 percent, has been preening for cameras and trolling on social media, potentially complicating his defense.

“I’m excited,” Shkreli said of the trial in a brief phone call last week to The Associated Press. “I can’t wait.”

Jury selection got underway Monday, and opening statements could occur as early as Tuesday.

Since his high-profile arrest in late 2015 when he was led into court in a gray hoodie, Shkreli has been free on bail and free to speak his mind. He went on Twitter to label members of Congress “imbeciles” for demanding to know why his company, Turing Pharmaceuticals, raised the price of Daraprim, a drug used to treat toxoplasmosis and HIV, from $13.50 to $750 per pill.

He took to YouTube for a series of lessons on chemistry and stock market analysis. His Twitter posts mocking a freelance journalist turned so creepy – one showed a fake photo of him canoodling with her – that his account was shut down. And on Facebook, he mused about the possibility of being “unjustly imprisoned.”

The 34-year-old Shkreli “travels to the beat of a very unique drummer,” exasperated-sounding defense attorney Benjamin Brafman said at a pretrial hearing this month.

Legal experts say there are obvious reasons lawyers want clients facing serious criminal charges to keep quiet.

“It’s twofold: You don’t want to antagonize the judge and you don’t want to get the attention of the jury in a way that hurts your case,” said veteran New York City defense attorney Gerald Lefcourt.

Columbia law professor John Coffee compared the situation to President Donald Trump’s unruly tweeting habits. “A lawyer can caution him,” he said. “But just like Trump, he doesn’t have to listen.”

Though Shkreli’s notoriety came from Daraprim, the federal securities fraud case is unrelated. Prosecutors say that after Shkreli lost millions of dollars through bad trades through his side business hedge fund, he looted a second pharmaceutical company for $11 million to pay them back. The defense has argued that he had good intentions.

“Everybody got paid back in this case,” his lawyer said. “Whatever else he did wrong, he ultimately made them whole.”

The defense has floated the possibility that it would put Shkreli on the witness stand to try to highlight how he grew up in a working-class Albanian family in Brooklyn, taught himself chemistry, interned at a financial firm founded by CNBC’s Jim Cramer and struck out on his own to become a rising star in biotechnology startups. He wanted to develop new life-saving drugs after seeing “several classmates and other children he knew struck down by debilitating disease,” court papers say.

Prosecutors call it a ploy to portray the boyish-looking Shkreli as “a Horatio Alger-like figure who, through hard work and intelligence, is in a position to do great things if only the jury would ignore the evidence and base its verdict on sympathy.” The real Shkreli was a con man often undone by his own mouth, they say.

The government has cited claims by one of Shkreli’s former employees that Shkreli harassed his family in a dispute over shares of stock.

“I hope to see you and your four children homeless and will do whatever I can to assure this,” Shkreli wrote the employee’s wife, according to court filings.

Prosecutors also used his boasts about some of his purchases of eccentric collectibles to undermine efforts to reduce his bail from $5 million to $2 million. If he needed to raise cash to pay legal fees and back taxes, they argued, why not sell the one-of-a-kind Wu-Tang Clan album that he brought for $2 million or his Nazi-era Engima code-breaking machine?

Also cited were his offers to pay a $100,000 bounty for finding the killer of a Democratic National Committee staffer and $40,000 in tuition for a Princeton student who solved a math problem he posed during a guest lecture at the school earlier this year.

Shkreli “is not the demon he’s been made out to be,” the student, Yuan Wang, told the AP.

Still, he added, “I haven’t received the money yet.”

Source: Associated Press

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Drones, Modern Warfare and Amazon

The CNAS website, which stands for the Center for New American Security, has its own podcast site, “Drones Podcast Series,” hosted on Soundcloud, It affords a fascinating independent porthole of information and discussion into the still little-known world of drones.

These days all most of us know about drones are twofold: Amazon and other companies are trying to perfect drones in similar private research efforts akin to the current race developing auto driving cars, and, the use of weaponized drones by the US in the War on Terror in the far Middle East, mostly in Afghanistan and Iraq, although recently, apparently a Russian drone was fired by the Syrians or Russian advisors or somebody against ISIS.

The world of drones evolving into weapons of modern warfare is fascinating. Many boys, myself included, loved to buy those cheap balsa wood glider planes, and see who could launch theirs the furthest and achieve the longest flight times. Little did I know that even in the years of my childhood, now quite distant indeed, gliders of the World War II era hauling “commandoes” as they were called then to behind enemy lines, towed by larger transport planes, were beginning to evolve in fits and starts over the coming forty years or so into instruments of novel warfare by the late 1980’s, all in relative obscurity from the mass public awareness.

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