Leprosy in the U.S.

 Having recently read Abraham Verghese’s A Covenant of Water—part of which takes place in a leper colony—I was drawn to an article about leprosy in The New York Times.  According to the article, 159 new cases in the U.S. were reported in 2020, the most recent year for which national data are available. Apparently, the disease pops up regularly in Florida, especially the central part. New cases are also reported in California, Louisiana, Hawaii, New York, and Texas.

Leprosy, also known as Hansen’s disease, is caused by slow-growing bacteria called Mycobacterium leprae. Happily, most of us are resistant to the bacteria, which are transmitted by droplets from the nose and mouth of an infected patient, but only after close, sustained contact. Caught early enough, leprosy can be cured with standard antibiotic drugs.

Left untreated, the disease may damage skin, peripheral nerves, the upper respiratory tract and the eyes. By slowly destroying muscles, it leads to deformities in the hands and feet. It starts with either discolored, numb patches on the skin or with tiny nodules under it. Early symptoms can be mistaken for other skin conditions such as psoriasis or eczema.

While the disease is rare in the U.S., roughly 200,000 cases crop up all over the world each year, mostly in Southeast Asia and India. In the U.S., new cases are often found in people who have traveled to other parts of the world. But since 2015, more than a third of the cases in the U.S. have been locally acquired. Interestingly, Armadillos carry the bacteria.

Because leprosy is rare in the U.S, and because most of us are immune to the disease, you don’t need to worry about it! Just try to stay clear of Armadillos.

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Anxiety and Xanax

The other day I stumbled on a Netflix documentary about Xanax (“Take Your Pills: Xanax”). It features psychiatrists as well as Xanax users. Here’s what I learned:

The use of Xanax has skyrocketed in the last twenty years: roughly one in eight adults take the pills for anxiety, panic disorder, and insomnia. Xanax is in the class of drugs called benzodiazepines, which also includes Librium, Valium, Klonopin, and Ativan.  They work by enhancing a neurotransmitter in the brain that reduces communication from one brain cell to another.

As the users in the program say, “It takes the edge off'"; “All the weight that’s on you is gone"; “It made me feel like a better version of myself"; and “I need to numb myself to be able to sleep.” But also this: “Knowing what I know now, I would never have taken that first prescription. Never.”

 Anxiety is complicated. It seems that both nature and nurture may be involved. For some, anxiety may be part of their baseline temperament, as seems to be the case for Scott Stossel, author of My Age of Anxiety and editor of The Atlantic magazine. “I was a nervous kid. I’d get panic attacks.” Other people mentioned the long-term effects of bullying, parental expectations, and sexual assault.

The psychiatrists viewed Xanax as a useful tool to use occasionally for acute anxiety. But if you take them every day, multiple times a day, abruptly discontinuing them can have serious consequences, including severe anxiety and insomnia. Some patients have no problems reducing their dosages and some are sensitive to even the smallest dose reductions. Stossel, whose anxiety is debilitating, tries not to take Xanax, but he does take Lexapro, an antidepressant.

The man who was sorry he had ever started on Xanax had been taking three milligrams a day for 15 years. When he decided to quit by tapering off, he lowered his dosage from three milligrams to two and a half. He was soon extremely ill: fatigue; heart palpitations; burning skin; muscle twitching; brain fog, etc. Not realizing his symptoms were those of withdrawal, he consulted 35 specialists including some at the Mayo Clinic. None concluded his symptoms resulted from Xanax withdrawal. They were wrong. More than a year later, he was still tapering off, using titration techniques to reduce his dosage by tiny fractions. This takes years. A memoir, called Blood Orange Night: My Journey to the Edge of Madness by Melissa Bond, chronicles a similar experience. Both people finally found the information they needed in the highly regarded The Ashton Manual.

As one of the psychiatrists noted, “I think benzos erode the resilience that we must rely upon at some point in our lives. If you’re mediating your anxiety through a Xanax, you’re not really confronting it. What’s going to get you on the other side of anxiety is to go through it and experience it and understand it and make some sort of peace with it.” For many, I’m guessing, this is easier said than done.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

For improved health, eat ice cream

Extensive research has shown that, among diabetics, eating half a cup of ice cream a day was associated with a lower risk of heart problems. As reported in the May, 2023 issue of The Atlantic magazine, numerous studies, beginning 20 years ago, kept coming up with similar benefits of eating ice cream. Of course, the researchers didn’t like the finding. Data was double-checked. No errors could be found. Nutritionists tried to make it go away, but their debunking efforts have been largely futile.

Medical data collected by Harvard since the 1980s found that men who consumed two or more servings of skim or low-fat milk a day had a 22 percent lower risk of diabetes. But so did men who ate two or more servings of ice cream every week. Of course, no one wanted to talk about this finding.

Mark A. Pereira, an epidemiologist at the University of Minnesota, had stumbled on a similar association more than 20 years earlier. He found that, for overweight people, “dairy-based dessert” (ice cream) was associated with dramatically reduced odds of developing insulin resistance syndrome, a precursor to diabetes. Oddly, the effect of ice cream was 2.5 times the size of what they’d found for milk. “We analyzed the heck out of the data.…This study surprised the heck out of me.”

Ice cream’s glycemic index, which measures how rapidly a food raises blood sugar, is lower than that of brown rice. One scientist mentioned that ice cream is better for you than bread. “It’s got fat, it’s got protein, it’s got vitamins.” One man ate 2,000 calories a day of ice cream plus 500 calories of protein supplements, plus liquor (Irish whiskey milkshakes). After 100 days, he’d lost 32 pounds and had better blood work than before he’d started this regimen.

Of course, I love this sort of thing. As The Atlantic article mentioned, “Once you start contemplating all the ways that cultural biases can seep into science, it doesn’t stop at dairy-based desserts.”

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Moral injury in the medical profession

 In the world of medicine, moral injury refers to an emotional wound sustained when the demands of administrators, hospital executives, and insurers force practitioners to stray from their ethical principles. Seventy percent of doctors work as salaried employees of large hospital systems or corporate entities, taking orders from administrators and executives who do not always share their values or priorities. (Note: A new study finds that private equity firms own more than half of all specialists in certain U.S. markets, a situation associated with higher prices.)

Medical personnel are pressured to make decisions based on financial considerations. The emphasis is on speed, efficiency, and relative value units (R.V.U.), a metric that rewards doctors for doing tests and procedures and discourages them from spending too much time on less remunerative functions, such as listening and talking to patients. Making matters worse, in the eyes of their patients, doctors become the scapegoats, the instruments of betrayal by the health care system.

This situation has been taking a toll for years. The suicide rate among doctors is higher than the rate among active military members; one in five health care workers has quit his or her job since the start of the pandemic, and an additional 31 percent have considered leaving. In the remarks of some doctors: “Every day, you’re reminded how savage the system is;” “It’s turned us into a widget factory of just throughput, getting people in, getting people transferred onto money-making specialties, without really addressing their health care needs. And it’s demoralizing and it’s not good care.”

To address the problem, some doctors join unions, such as The Valley Physicians Group of Santa Clara County, California, not to increase their pay but to improve working conditions. Others have opened direct-care practices in which patients pay a monthly fee. Such solutions don’t eliminate all the problems, such as fighting with insurers, but at least they reduce moral injury.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.