Summary

Idaho entered a state wide crisis mode on Sept 16, 2021.  Alaska has since followed. Many other state are also being hit hard. In this podcast, I discuss crisis care, leadership, and how front line healthcare workers have lost complete control of the healthcare industry.

Morbidity and Mortality

In September of 2021, approximately 700,000 people have died from COVID19 in the United States. Worldwide at least 4.5 million have died (likely more). I am not sure how many front line healthcare workers have left the job or been pushed out, but it seems like a lot!

Key Points

1. In crisis standards of healthcare, the focus shifts from taking care of individual patients to prioritizing care for a population of patients due to scarce resources and the need to prevent as much morbidity and mortality as possible.

2. At first, this can be fun and exciting as red tape disappears. However, when decisions have to be made about who receives care and who does not, the fun quickly fades away.

3. During times of crisis, communications lines must be increased greatly to facilitate effective operations.

4. Crisis represents an opportunity to view things through a new light as it forces us to understand the most important parts of what we do.

5. Additionally, crisis represents an unprecedented opportunity for training

6. Front line healthcare workers have lost complete control of our industry and this has contributed significantly to an unhealthy and unhappy workforce.

References

-       Giroir and Kadlec. Rapid Expert Consultation on Crisis Standards of Care for the Covid19 Pandemic. The National Academies of Sciences, Engineering, and Medicine. 2020.

-       https://coronavirus.idaho.gov/wp-content/uploads/2020/10/Crisis-Standards-of-Care-Plan_Final_Posted_Signed.pdf

-       Personal Experience

Summary

Diversity in ecology and genetics appears to be a very good thing. The human species has a genetic pool (all the genes variants from all the humans alive) that is diverse and protective for our species. Human bodies and all other multi-cellular organisms host diverse arrays of micro-organisms that our essential to health. 

Morbidity and Mortality

Antibiotics, pesticide, cesarean sections, baby formula, monocrops, processed foods, disconnection with nature, other pharmaceuticals like proton-pump inhibitors, and other factors have all contributed to a mass extinction of the human gut microbiome. It is estimated that humans have lost 50% of our microbial diversity in the last few hundred years.

Story

Microbial fossils isolated from 1000 old poop shows 38% novel species (now extinct)

Key Points

1. Humans bodies are an ecosystem

2. A diverse ecosystem is associated with health. Dysbiosis is associated with numerous chronic diseases.

3. The food we eat and the way we live our lives has profound effects on our microbiotia and health.

References

- Tu P, Chi L, Bodnar W, et al. Gut Microbiome Toxicity: Connecting the Environment and Gut Microbiome-Associated Diseases. Toxics. 2020;8(1):19. Published 2020 Mar 12. doi:10.3390/toxics8010019

- Blaser MJ. The Past and Future Biology of the Human Microbiome in an Age of Extinctions. Cell. 2018 

- Manor O, Dai CL, Kornilov SA, Smith B, Price ND, Lovejoy JC, Gibbons SM, Magis AT. Health and disease markers correlate with gut microbiome composition across thousands of people. Nat Commun. 2020

- Chichlowski M, Shah N, Wampler JL, Wu SS, Vanderhoof JA. Bifidobacterium longum Subspecies infantis (B. infantis) in Pediatric Nutrition: Current State of Knowledge. Nutrients. 2020;12(6):1581. Published 2020 

- https://www.the-scientist.com/features/neanderthal-dna-in-modern-human-genomes-is-not-silent-66299

- https://www.genome.gov/about-genomics/fact-sheets/Genetics-vs-Genomics

- https://www.genome.gov/about-genomics/fact-sheets/Comparative-Genomics-Fact-Sheet

- https://academic.oup.com/jhered/article/108/6/671/3836924

- Satoh, M; Kuroiwa, T (September 1991). "Organization of multiple nucleoids and DNA molecules in mitochondria of a human cell". Experimental Cell Research. 196 (1): 137–140. 

- https://www.cancer.gov/news-events/cancer-currents-blog/2020/colorectal-cancer-rising-younger-adults

- Seneff, S. Toxic Legacy: Howe the Weedkiller Glyphosate is Destroying our Health and the Environment. 2021

Summary

We have been taught to not skip meals, make carbohydrates the most abundant macronutrient we consume, and to snack throughout the day. Sadly, this all appears to be wrong. Fasting exists in many forms and growing evidence suggests it is essential to health. We are all spending way too much time fed and not enough time fasting. Want to stimulate autophagy? Then eat less, exercise more, and feel better!

Morbidity and Mortality

Obesity rates have more than tripled worldwide since 1975. Over 50% of people in the United States are now obese and 30% or more have metabolic syndrome. Houston, we have a problem!

Story

Jesus fed for 40 days in the desert during what we now call Lent. Islamic peoples celebrate Ramadan, a remembrance of Mohamad’s 1st revelation. During this holy month, Islamic people do not eat during the daylight hours. Buddhist monks fast during religious retreats and the Buddha did not eat food after lunch. For a time fasting fell out of favor, but it is coming back, and just in time.

Key Points

1. Autophagy is biological process that allows cells to recycle nutrients and get rid of harmful waste. It is essential for health and best stimulated through fasting.

2. By fasting and/or limiting carbohydrate intake, mammals enter ketosis. Ketosis is marked by the mobilization of stored fat for nutrition, the synthesis of glucose from glycerol and amino acids, as well as the usage of ketones for nutrition. Maintaining the body in a state of ketosis is beneficial for the treatment of metabolic syndrome.

3. Metabolic syndrome is marked by obesity, hypertension, high bad cholesterols, low good cholesterols, high blood sugar, and high insulin levels. It predisposes individual to heart disease, cancer, and numerous other health problems. It is the great killer of our time.

4. Fasting and sleep are the best way to stimulate autophagy. Autophagy is essential to health, and we are increasingly understanding the link between autophagy and longevity.

References

-       Yoshinori Ohsumi. What is Autophagy. Lecture. Molecular Frontiers Symposium, Tokyo. 2017.

-       Chung KW, Chung HY. The Effects of Calorie Restriction on Autophagy: Role on Aging Intervention. Nutrients. 2019;

-       Hwangbo DS, Lee HY, Abozaid LS, Min KJ. Mechanisms of Lifespan Regulation by Calorie Restriction and Intermittent Fasting in Model Organisms. Nutrients. 2020

-       Ros M, Carrascosa JM. Current nutritional and pharmacological anti-aging interventions. Biochim Biophys Acta Mol Basis Dis. 2020

-       Wikipedia, Autophagy, Intermittant Fasting, ketosis

-       Colman RJ, Anderson RM. Nonhuman primate calorie restriction. Antioxid Redox Signal. 2011

-       Gershuni VM, Yan SL, Medici V. Nutritional Ketosis for Weight Management and Reversal of Metabolic Syndrome. Curr Nutr Rep. 2018

-       Moore JX, Chaudhary N, Akinyemiju T. Metabolic Syndrome Prevalence by Race/Ethnicity and Sex in the United States, National Health and Nutrition Examination Survey, 1988–2012. Prev Chronic Dis 2017

Summary

Planet earth is being destabilized as a result of human activity. Over half of the habitable land on earth is now used for human agriculture, 40% of our forests have been cut down, and humans now move more rock and sediment than any natural process. If we do not act quickly, it is likely that our planet will become unable to support human civilization as we know it. 

Morbidity and Mortality

70% of our crops rely on insect pollinators, but insect populations are collapsing. 40% of the human population live on the coast and could be underwater within 100 years. Deserts are expanding, forests are diminishing, wild fish stocks and wild animals have lost over 50% of their mass in just 40 years, and human health is at an all-time low.

Story

If humans act now and with great conviction, we can potentially avoid a catastrophe. But the window for action is closing rapidly.

Key Points

1. The earth is warming. In 50 years, the temperature has increased 1.1C, more than in the previous 10,000 years.

2. There is a mass extinction under way. The loss of species affects our own health. Even the micro-organisms that live on our body and promote health are becoming extinct.

3. New chemicals are hurting human health. Governments are all too willing to protect chemical companies over the health of people.

4. Eating healthy plant-based foods, supporting organic regenerative agriculture, protecting and expanding wild lands, planting trees and native plants, not using products that cannot be reused or recycled, and stopping all our carbon emissions by 2050 could save the planet. 

5. If we can do these things, our own health will improve, and we will assure a safe planet to live on for future generations.

References

-       Steffen et al. Planetary boundaries: Guiding human development on a changing planet. Science. 2015.

-       Rockstrom and Attenborough. Breaking Boundaries – The Science of Our Planet. 2021. Netflix

-       Chemicals in the Environment – Dehumanizing Humanity. 2017. Royal College of London. https://www.youtube.com/watch?v=oq2K1IvRf8M

-       Environmental Working Group. https://www.ewg.org/research/pollution-people

-       Meyer and Lemery. Health Implications of Environmental Change. Ch 121. Aurerbach’s Wilderness Medicine.

-       Experience as a medical doctor and naturalist

Summary

Planet earth is being destabilized as a result of human activity. Over half of the habitable land on earth is now used for human agriculture, 40% of our forests have been cut down, and humans now move more rock and sediment than any natural process. If we do not act quickly, it is likely that our planet will become unable to support human civilization as we know it. 

Morbidity and Mortality

70% of our crops rely on insect pollinators, but insect populations are collapsing. 40% of the human population live on the coast and could be underwater within 100 years. Deserts are expanding, forests are diminishing, wild fish stocks and wild animals have lost over 50% of their mass in just 40 years, and human health is at an all-time low.

Story

If humans act now and with great conviction, we can potentially avoid a catastrophe. But the window for action is closing rapidly.

Key Points

1. The earth is warming. In 50 years, the temperature has increased 1.1C, more than in the previous 10,000 years.

2. There is a mass extinction under way. The loss of species affects our own health. Even the micro-organisms that live on our body and promote health are becoming extinct.

3. New chemicals are hurting human health. Governments are all too willing to protect chemical companies over the health of people.

4. Eating healthy plant-based foods, supporting organic regenerative agriculture, protecting and expanding wild lands, planting trees and native plants, not using products that cannot be reused or recycled, and stopping all our carbon emissions by 2050 could save the planet. 

5. If we can do these things, our own health will improve, and we will assure a safe planet to live on for future generations.

References

-       Steffen et al. Planetary boundaries: Guiding human development on a changing planet. Science. 2015.

-       Rockstrom and Attenborough. Breaking Boundaries – The Science of Our Planet. 2021. Netflix

-       Chemicals in the Environment – Dehumanizing Humanity. 2017. Royal College of London. https://www.youtube.com/watch?v=oq2K1IvRf8M

-       Environmental Working Group. https://www.ewg.org/research/pollution-people

-       Meyer and Lemery. Health Implications of Environmental Change. Ch 121. Aurerbach’s Wilderness Medicine.

-       Experience as a medical doctor and naturalist

Summary

Planet earth is being destabilized as a result of human activity. Over half of the habitable land on earth is now used for human agriculture, 40% of our forests have been cut down, and humans now move more rock and sediment than any natural process. If we do not change our behavior quickly, it is likely that our planet will become unable to support human civilization as we know it. 

Morbidity and Mortality

70% of our crops rely on insect pollinators, but insect populations are collapsing. 40% of the human population live on the coast and could be underwater within  just 100 years. Deserts are expanding, forests are diminishing, wild fish stocks and wild animals have lost over 60% of their mass in just 40 years, and human health is at an all-time low.

Story

If humans act now and with great conviction, we can potentially avoid a catastrophe. But the window for action is closing rapidly.

Key Points

1. The earth is warming. In 50 years, the temperature has increased 1.1C, more than in the previous 10,000 years.

2. There is a mass extinction under way. The loss of species affects our own health. Even the micro-organisms that live on our body and promote health are becoming extinct.

3. New chemicals are hurting human health. Governments are all too willing to protect chemical companies over the health of people.

4. Eating healthy plant-based foods, supporting organic regenerative agriculture, protecting and expanding wild lands, planting trees and native plants, not using products that cannot be reused or recycled, and stopping all our carbon emissions by 2050 could save the planet. 

5. If we can do these things, our own health will improve, and we will assure a safe planet to live on for future generations.

References

-       Steffen et al. Planetary boundaries: Guiding human development on a changing planet. Science. 2015.

-       Rockstrom and Attenborough. Breaking Boundaries – The Science of Our Planet. 2021. Netflix

-       Chemicals in the Environment – Dehumanizing Humanity. 2017. Royal College of London. https://www.youtube.com/watch?v=oq2K1IvRf8M

-       Environmental Working Group. https://www.ewg.org/research/pollution-people

-       Meyer and Lemery. Health Implications of Environmental Change. Ch 121. Aurerbach’s Wilderness Medicine.

-       Experience as a medical doctor and naturalist

Summary

Exposure to warm environments can cause a number of heat-related illnesses including muscle cramps, heat rash, edema, syncope, heat exhaustion, and heat stroke. All of these issues are preventable. Early recognition of heat stroke is paramount for improving survival. Cool patients with cold water immersion.

Morbidity and Mortality

Approximately 600 deaths occur every year in the United States related to heat. It is a leading cause of death in high school athletes. Mortality from heat stroke approaches 10% even in modern times. 

Story

As many as 53 children die every year from heat related vehicle entrapment in the United States. Most of these cases are due to people forgetting the child was in the car. The second leading cause is children getting into unattended cars. Always know where your baby or child is and keep your unattended car locked.

A record-breaking heat wave in Europe in 2003 killed at least 30,000 people, mostly elderly. Taking cool baths throughout the day could have prevented many of these deaths.

Key Points

1. Risk factors for heat illness include older age, dehydration, impaired cooling capacity, lack of acclimatization, poor fitness, lack of sleep, chronic health issues, and obesity. 

2. Temperature, wind, humidity, and solar radiation all effect the thermal strain felt by any individual.

3. Heat exhaustion is common and characterized by fatigue, thirst, weakness, anxiety, and dizziness. Heat stroke is much more severe and can be distinguished from exhaustion by the presence of altered coordination, balance, and/or mentation. 

4. Rapid cooling is the most important treatment for heat stroke. Cold water emersion is the gold standard for lowering body temperature. 

References

-       Lipman et al. WMS Practice Guidelines for the Prevention and Treatment of Heat-Related Illness. Wild & Env Med. 2014.

-       O’Brien et al. Clinical Management of Heat-Related Illnesses. Ch. 13. Auerbachs, Wilderness Medicine. 

-       Gaudio FG, Grissom CK. Cooling Methods in Heat Stroke. J Emerg Med. 2016

-       Wikipedia – Heat Stroke

-       Personal experience as a physician and athlete

Summary

Radon is a radioactive element that accumulates in homes and buildings. It is the second leading cause of lung cancer worldwide. All homes should be tested for radon, and if above actions levels (US - 4 pCi/L), a radon mitigations strategy (getting rid of the radon) should be utilized.  

Morbidity and Mortality

Radon is often the largest contributor to an individual’s background radiation dose and is considered the leading environmental cause of cancer mortality. Worldwide, between 3 and 14% of lung cancers are due to radon in any giving country depending on smoking prevalence and background radon levels. In the United States approximately 21,000 lung cancer deaths are attributed to radon every year. 

Story

Before 1984 radon was only thought to be a risk in uranium mines. That year Stanley Watras, and engineer was starting a job at Limerick nuclear power plant in Pottstown, Pennsylvania. Prior to nuclear fuel being added to the plant, Watras began setting off radiation detectors meant to keep workers safe. Each day he was setting machines off in spite of decontamination. An investigation was undertaken and Watras’s home was found to have a huge amount of radiation, 2,700 pCi/L.  The source was determined to be radon. This amount of radon was the equivalent in lung cancer risk to smoking hundreds of packs of cigarettes a day. Watras’s family was moved out and the EPA began extensive testing. After this, the risk of radon in the home was recognized.

Key Points

1. Radon is chemical element 86. It is radioactive and gives off an ionizing alpha particle due to its inherent chemical instability.

2. This alpha particle is a helium atom with high energy and speed. If inhaled, ingested, or injected, alpha particles are harmful to human health.

3. Radon is colorless, odorless, and tasteless. All homes should be tested for is presence as it cannot be sensed.

4. There are several proven methods to reduce the level of radon in the home. As such, lung cancer due to radon inhalation is preventable.

References

-       Wikipedia – Radon, alpha decay

-       Field et al. Residential radon gas exposure and lung cancer: the Iowa Radon Lung Cancer Study. Am J Epidemiol. 2000

-       Hill et al. Radon in homes and risk of lung cancer: collaborative analysis of individual data from 13 European case-control studies. BMJ. 2005 Jan 29;330(7485)

-       Health Risk of Radon. EPA. https://www.epa.gov/radon/health-risk-radon

-       https://www.epa.gov/sites/production/files/2016-02/documents/2013_consumers_guide_to_radon_reduction.pdf

-       Radon and Health. https://www.epa.gov/sites/production/files/2016-02/documents/2013_consumers_guide_to_radon_reduction.pdf

-       Rella, Joseph. Ch. 128. Radiation. Goldfrank’s Toxicology. 2019.

Summary

Yellow Fever is a viral tropical disease. It is most prevalent in equatorial Africa (90%) and South America (10%). No specific treatments exist but it can be prevented with a highly affective vaccine. The disease is spread via mosquito vectors (arbovirus). Yellow refers to the jaundice that occurs in severe infection from liver damage. Bleeding (hemorrhagic fever) and kidney damage are other severe manifestations.

Morbidity and Mortality

About 5% of people infected with the Yellow Fever virus will die. Foreign visitors to endemic countries are at the higher risk of severe infection if exposed. Hemorrhagic fever, liver failure, and other organ failures can lead to shock and death. It is very difficult to know how many infections occur annually but the WHO estimates about 200,000 (likely many more). Epidemics periodically occur and usually have worse than normal case fatality rates.

Story

Yellow fever outbreaks plagued the America’s in the 18th and 19th centuries, having been introduced from Africa just few hundred years prior. The Yellow Fever Epidemic of 1793 killed 9% of the residents in Philadelphia. Many, including George Washington, fled the city. Yellow Fever has plagued the US military for years before the 17D vaccine was discovered in 1937 by Max Theiler (Noble Prize). 

Key Points

1.  Yellow fever is endemic to equatorial Africa and South America, but strangely not Asia.

2.  People living and traveling to these areas should be vaccinated with the 17D live attenuated yellow fever vaccine.

3.  Fever, chills, headache, and myalgias are common. A minority of cases progress to liver failure and hemorrhage.  About half of cases that progress will be fatal

4. Treatment is supportive. As such, prevention with vaccine, vector control, and avoiding mosquito bites is very important. Avoid blood thinners and anti-platelets.

References

-       Keystone et al. Travel Medicine, 4th Ed. Elsevier 2019. Ch. 12. Torresi and Kollaritsch. Recommended/Required Travel Vaccines.

-       Farrar et al. Manson’s Tropical Diseases, 23rd Ed. Elsevier 2014. Ch. 14. Young et al. Arbovirus Infection.

-       Wikipedia. Yellow Fever, Yellow Fever Vaccine

-       WHO, Yellow Fever. https://www.who.int/news-room/fact-sheets/detail/yellow-fever

-       Vaccine Information Statement. CDC. https://www.cdc.gov/vaccines/hcp/vis/vis-statements/yf.pdf.

-       Thomas R. E. (2016). Yellow fever vaccine-associated viscerotropic disease: current perspectives. Drug design, development and therapy, 10, 3345–335

Summary

Yellow Fever is a viral tropical disease. It is most prevalent in equatorial Africa (90%) and South America (10%). No specific treatments exist but it can be prevented with a highly affective vaccine. The disease is spread via mosquito vectors (arbovirus). Yellow refers to the jaundice that occurs in severe infection from liver damage. Bleeding (hemorrhagic fever) and kidney damage are other severe manifestations.

Morbidity and Mortality

About 5% of people infected with the Yellow Fever virus will die. Foreign visitors to endemic countries are at the higher risk of severe infection if exposed. Hemorrhagic fever, liver failure, and other organ failures can lead to shock and death. It is very difficult to know how many infections occur annually but the WHO estimates about 200,000 (likely many more). Epidemics periodically occur and usually have worse than normal case fatality rates.

Story

Yellow fever outbreaks plagued the America’s in the 18th and 19th centuries, having been introduced from Africa just few hundred years prior. The Yellow Fever Epidemic of 1793 killed 9% of the residents in Philadelphia. Many, including George Washington, fled the city. Yellow Fever has plagued the US military for years before the 17D vaccine was discovered in 1937 by Max Theiler (Noble Prize). 

Key Points

1.  Yellow fever is endemic to equatorial Africa and South America, but strangely not Asia.

2.  People living and traveling to these areas should be vaccinated with the 17D live attenuated yellow fever vaccine.

3.  Fever, chills, headache, and myalgias are common. A minority of cases progress to liver failure and hemorrhage.  About half of cases that progress will be fatal

4. Treatment is supportive. As such, prevention with vaccine, vector control, and avoiding mosquito bites is very important. Avoid blood thinners and anti-platelets.

References

-       Keystone et al. Travel Medicine, 4th Ed. Elsevier 2019. Ch. 12. Torresi and Kollaritsch. Recommended/Required Travel Vaccines.

-       Farrar et al. Manson’s Tropical Diseases, 23rd Ed. Elsevier 2014. Ch. 14. Young et al. Arbovirus Infection.

-       Wikipedia. Yellow Fever, Yellow Fever Vaccine

-       WHO, Yellow Fever. https://www.who.int/news-room/fact-sheets/detail/yellow-fever

-       Vaccine Information Statement. CDC. https://www.cdc.gov/vaccines/hcp/vis/vis-statements/yf.pdf.

-       Thomas R. E. (2016). Yellow fever vaccine-associated viscerotropic disease: current perspectives. Drug design, development and therapy, 10, 3345–335