Emergency Pain Management

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A newly reported study from Australia finds that

  1. Acupuncture is a viable alternative to drugs such as opioids for pain management for patients coming into ERs in severe pain. The researchers believe that ER personnel should be trained in acupuncture and have this available as a resource.
  2. However, the authors report that neither drugs nor acupuncture provide immediate, adequate pain relief. They urge the need for research into development of tools for immediate pain management.

In a previous post, I talked about tai chi as a recommended treatment for depression for individuals resistant to Western psychotherapy. Now we have a recommendation for incorporating  acupuncture with Western medicine. Taking the best elements from different traditions seems to make sense.

Marc M Cohen, De Villiers Smit, Nick Andrianopoulos, Michael Ben-Meir, David McD Taylor, Shefton J Parker, Chalie C Xue, Peter A Cameron. Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non-inferiority trial. The Medical Journal of Australia, 2017; 206 (11): 494 DOI: 10.5694/mja16.00771

Immigration and the New American Reality

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“I don’t want my child to grow up in the US.”

That’s a simple and direct statement from a financial professional who moved to Europe earlier this year. Her child will grow up learning between four and six languages and without the attitude/belligerence she sees in US schools. Plus college and healthcare are free.

Europeans pay high taxes. However, because so many expenses are included in those taxes, they have more money available to spend than most Americans do. That’s driving a faster economic recover in Europe than the US is seeing.

That prompted me to look at the data on migration. What are the trends? You might be surprised.

  1. Both legal and illegal immigration peaked prior to the recession in late 2008. The trends since are downward. The declines started during the Obama administration.
    • The illegal immigrant population peaked at 12.2 million in 2007.(2)
  2. Most illegal immigrants living in the US have been in the US for more than ten years. They are homeowners and taxpayers.
  3. Mexico no longer accounts for a majority of illegal immigrants. The majority now from from a combination of Central America and Asia.
  4. Mexico provides the largest number of LEGAL immigrants to the US. (1) Most Hispanic residents in the US are legal residents. (3)
  5. Recent immigrants from Mexico tend to work in the US for a few years and then return to Mexico. Pew reported in 2012 that net immigration from Mexico was zero, with the number of people leaving the US matching the number entering.
    • This “breakeven” has little to do with US immigration enforcement. People are leaving for a lower cost of living and better social services.

FT_17.04.17_unauthorized_update_2015-1The State Department estimates that 9 million US (non-military) citizens are now residents of other countries. That’s up from 4 million in 1999. However, the government has no formal mechanism for tracking citizens who move overseas. The actual number could be lower or much higher.

  • Seniors are part of the out-migration. Financial advisors recommend considering moves to places like Costa Rica in order to be able to maintain a reasonable standard of living on Medicare. (5)

The US is changing relative to other countries. There are a growing number of valid reasons for not wanting to live here, and that will have an impact on the economy and employment in the future — probably driving more jobs and business investment offshore. Don’t expect driving people and money out of the US to improve job prospects and the economy here. That’s naive in the extreme.

Sources:

  1. Homeland Security, “Yearbook of Immigration Statistics 2015.” https://www.dhs.gov/immigration-statistics/yearbook/2015/
  2. Jeffrey Passel and D’Vera Cohn, “As Mexican share declined, U.S. unauthorized immigrant population fell in 2015 below recession level,” Pew Research Center, 25 April 2017. http://www.pewresearch.org/fact-tank/2017/04/25/as-mexican-share-declined-u-s-unauthorized-immigrant-population-fell-in-2015-below-recession-level/
  3. Jie Zong and Jeanne Batalova, “Frequently Requested Statistics on Immigrants and Immigration in the United States,” Migration Policy Institute, 8 March 2017. http://www.migrationpolicy.org/article/frequently-requested-statistics-immigrants-and-immigration-united-states
  4. US State Department, “CA by the Numbers,” updated June 2016.  https://travel.state.gov/content/dam/travel/CA_By_the_Numbers.pdf
  5. “Retire Overseas . . . and Live Better for Less . . . ” International Living, undated.  https://www.internationalliving-magazine.com/?gclid=COyAv7-tytQCFYWNswodZNkMcw

Autism and Eye Contact

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In theory, autistic individuals shun eye contact with others.

According to a new study, that’s not a voluntary or learned behavior. Eye contact can cause excessive stimulation of a section of the brain, and that in turn can be felt as pain by the individual.

That makes sense. If something causes pain, you usually try to avoid doing it.

Unfortunately, lack of eye contact is also interpreted by some as a sign of dishonesty. With the autistic person, that interpretation simply doesn’t apply.

Bottom line: you have to get to know someone in order to understand what their physical cues mean.

Sources:

  1. Nouchine Hadjikhani, Jakob Åsberg Johnels, Nicole R. Zürcher, Amandine Lassalle, Quentin Guillon, Loyse Hippolyte, Eva Billstedt, Noreen Ward, Eric Lemonnier, Christopher Gillberg. Look me in the eyes: constraining gaze in the eye-region provokes abnormally high subcortical activation in autism. Scientific Reports, 2017; 7 (1) DOI: 10.1038/s41598-017-03378-5

Raising Bizarre to an Art Form

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This surfaced from an independent, nonpartisan news service in NJ this afternoon.

President Trump has picked his son’s wedding planner to run federal housing programs in N.J. and N.Y.

The details are actually worse than this statement indicates.

I’m speechless.

Sources: https://patch.com/new-jersey/hoboken/trump-picks-sons-wedding-planner-run-housing-programs-n-j

The Mechanics of Concussion

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A new study from a research team at Ohio State University provides insight into how concussions work. The research is based on a laboratory experiment with mouse tissue, but the effects are quite similar to what is seen with human patients with neurological disorders.

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Source: Washington Univ.

Cells contain axons, which transmit signals (messages) to other parts of the body and brain through the nerve system.

Concussions activate a protein “called TRPV4, which causes a chain reaction that prompts a pause in content exchange along the axon.” (1) When the pause occurs, the axon swells, which is the physical sign of the problem. Similar swelling occurs in patients with Alzheimer’s and Parkinson’s.

This research also indicates that the swelling can be reversed with prompt reduction of stress to the brain. Further, if the protein is suppressed, the swelling does not occur. However, we don’t know exactly what that means for humans, at least not yet.

Knowing how something works is key to developing fixes for problems.

Sources:

  1. Yuanzheng Gu, Peter Jukkola, Qian Wang, Thomas Esparza, Yi Zhao, David Brody, Chen Gu. Polarity of varicosity initiation in central neuron mechanosensation. The Journal of Cell Biology, 2017; jcb.201606065 DOI: 10.1083/jcb.201606065
  2. Picture source: https://faculty.washington.edu/chudler/cells.html

The [State] Politics of Health Insurance

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In the rush to repeal the Affordable Care Act, the Trump Administration has been repeating the mantra that the individual insurance marketplaces are “failing.” Like most statements made by politicians these days, the facts seem to be a little different.

Clearly, Iowa is in crisis. With the withdrawal of Aetna from the individual marketplace, there is a real risk they may have no insurers offering individual coverage through the marketplace in 2018.

My suspicion is that Aetna’s withdrawal has more to do with its stock price and financial liabilities after a failed merger attempt than with the ACA itself. Aetna has also stopped writing small group insurance in some states.

However, Pennsylvania has six carriers committed to the marketplace for 2018. The only concern is what the Trump administration might do the mess things up.

Further, another insurer, Centene, has announced that it is expanding individual marketplace coverage into three new states — Kansas, Missouri and Nevada.

So what’s the real story with Iowa? If the fault were with ACA, it would be impacting every state and every carrier, and that’s not the case. What have state officials done to mess things up?

If you know the story, please reply. I’d like to know, both about Iowa and about other states where local officials are whining about Obamacare. Let’s get the full story out into the open.