Let’s Not Be Ridiculous

We are not losing the war on drugs, we have lost! In many jails, half of the inmates have been incarcerated after being found guilty of drug related crimes. Many of them have been found guilty for minor infractions- not large scale sales. There are lots of young adults who have been jailed for possession of marijuana or for having distributed some to friends and classmates. Our jails are overflowing and private companies are cleaning up by managing and/ or building new jails across the country under contract with state, federal or local governments. We, in the U.S. are the most jailed population in the world. At year-end 2009 it was 743 adults incarcerated per 100,000 population.

Accordinging to the U.S. Bureau of Justice Statistics (BJS) 2,266,800 adults were incarcerated in U.S. federal and state prisons, and county jails at year-end 2010 — about .7% of adults in the U.S. resident population. Additionally, 4,933,667 adults at year-end 2009 were on probation or on parole. In total, 7,225,800 adults were under correctional supervision (probation, parole, jail, or prison) in 2009 — about 3.1% of adults in the U.S. resident population. In addition, there were 86,927 juveniles in juvenile detention in 2007.

On January 1, 2008 more than 1 in 100 adults in the United States were in prison or jail. In 2008 approximately one in every 31 adults (7.3 million) in the United States was behind bars, or being monitored (probation and parole). In 2008 the breakdown for adults under correctional control was as follows: one out of 18 men, one in 89 women, one in 11 African-Americans (9.2 percent), one in 27 Latinos (3.7 percent), and one in 45 Caucasians (2.2 percent). Crime rates have declined by about 25 percent from 1988-2008. 70% of prisoners in the United States are non-whites. In recent decades the U.S. has experienced a surge in its prison population, quadrupling since 1980, partially as a result of mandatory sentencing that came about during the “war on drugs.” Violent crime and property crime have declined since the early 1990s.

In 2006, about $72 billion was spent on corrections. This went up to $74 billion in 2007. In 2005, it cost an average of $23,876 dollars per state prisoner. State prison spending varied widely, from $45,000 a year in Rhode Island to $13,000 in Louisiana. In California in 2009, it cost an average of $47,102 a year to incarcerate an inmate in state prison. From 2001 to 2009, the average annual cost increased by about $19,500.In 2001 among facilities operated by the Federal Bureau of Prisons, it cost $22,632 per inmate, or $62.01 per day.

Housing the approximately 500,000 people in jail in the USA awaiting trial who cannot afford bail costs $9 billion a year.Most jail inmates are petty, nonviolent offenders. Twenty years ago most nonviolent defendants were released on their own recognizance (trusted to show up at trial). Now most are given bail, and most pay a bail bondsman to afford it. 62% of local jail inmates are awaiting trial. To ease jail overcrowding over 10 counties every year consider building new jails. As an example Lubbock County, Texas has decided to build a $110 million mega jail to ease jail overcrowding. Jail costs an average of $60 a day nationally. In Broward County, Florida supervised pre-trial release costs about $7 a day per person while jail costs $115 a day. The jail system costs a quarter of every county tax dollar in Broward County, and is the single largest expense to the county taxpayer.

All of this would be acceptable I suppose except it has made not an iota of difference in the use of illegal drugs or the crime and health issues associated with their distribution and use. It has, in an economy that has failed, added an enormous expense to society with a very poor Return On Investment (ROI).

Estimate of the size of the international drug market range from $300-$500 billion dollars, making up approximately 8% of global trade. The United Nations Office on Drugs and Crime estimated that in 2010, the international drug market has a value of over $300 billion, making it larger than the gross national products of all but twenty-one nations. It is GROWING!!!!!!!

As a physician, I do not want to see kids who experimented in school end up with HIV or Hepatitis B and C as a result of the use of illegal drugs and dirty needles. An adolescent “experiment” could end up in a lifetime of pain and anguish. Likewise, it seems ridiculous to me to criminalize the use of marijuana. The laws have not changed anything! It is readily available across the country in schools, on the street, etc. The only thing is that the illegal marijuana may be laced with anything from cancer causing pesticides to cocaine or crystal meth. Oh yes, and the notion that marijuana is a drug that opens the door to other drugs (a “gateway drug) has never been proven. It is just another piece of worthless conjecture.

Now, I have heard all kinds of opinions about the horror that will occur if we were to decriminalize illegal drugs (including “weed”). These are all opinions and let us not forget that the companies that build and operate jails, those that illegally distribute large quantities of illicit drugs, and those that still are praying that God will perform a miracle and Rick Santorum will become President still hold sway with elected officials. But, let’s take this OUT of conjecture and into reality. Let’s look at Portugal:

The drug policy of Portugal was put in place in 2000, to be legally effective from July 2001. In 1999 Portugal had the highest rate of HIV amongst injecting drug users in the European Union. The number of newly diagnosed HIV cases among drug users has decreased to 13.4 per million population in 2009 but that is still high above the European average (2.85 cases per million). There were 2000 new cases a year, in a country of 10 million people. 45 % of reported AIDS cases recorded in 1997 originated among IV drug users, so targeting drug use was seen as an effective avenue of HIV prevention. The number of heroin users was estimated to between 50,000 and 100,000 in 2000. This led to the adoption of The National Strategy for the Fight Against Drugs in 1999. A vast expansion of harm reduction efforts, doubling the investment of public funds in drug treatment and drug prevention services, and changing the legal framework dealing with petty drug offences were the main elements of the policy thrust. In 2001, Portugal became the first European country to abolish all criminal penalties for personal drug possession. In addition, drug users were to be targeted with therapy rather than prison sentences. Drugs are STILL illegal and big time dealers and distributors are STILL prosecuted but the poor schnook in the street- your son or daughter perhaps?- is not prosecuted. Possession is a civil issue- perhaps they might be fined if anything at all. Individuals found in possession of small quantities of drugs are issued a summons. The drugs are confiscated, and the suspect is interviewed by a “Commission for the Dissuasion of Drug Addiction” (Comissõespara a Dissuasão da Toxicodependência – CDT). These commissions are made up of three people: A social worker, a psychiatrist, and an attorney. The dissuasion commission has powers comparable to an arbitration committee, but restricted to cases involving drug use or possession of small amounts of drugs. There is one CDT in each of Portugal’s 18 districts. Several options are available to the CDT when ruling on the drug use offence, including warnings, banning from certain places, banning from meeting certain people, obligation of periodic visits to a defined place, removal of professional or firearms license. Sanctioning by fine, which may vary by drug involved, is an available option. If the person is addicted to drugs, he or she may be admitted to a drug rehabilitation facility or be given community service, if the dissuasion committee finds that this better serves the purpose of keeping the offender out of trouble. If the offender is not addicted to drugs, or unwilling to submit to treatment or community service, he may be given a fine. Since the start of decriminalization, illegal drug use by teenagers has declined, the rate of HIV infections among drug users has dropped, deaths related to heroin and similar drugs has been cut by more than half, and the number of people seeking treatment for drug addiction has doubled. The number of drug related crimes has dropped as well.

 Let’s look at numbers in a time that we desperately need to cut costs in America:

A Harvard economist, Jeffery Miron, estimated that ending the war on drugs would inject 76.8 billion dollars into the US economy in 2010 alone. He estimates that the government would save $41.3 billion for law enforcement and the government would gain up to $46.7 billion in tax revenue. Since President Nixon began the war on drugs, the federal drug-fighting budget has increased for $100 million in 1970 to $15.1 billion in 2010, with a total cost estimated near 1 trillion dollars over 40 years. In the same time period and estimated 37 million nonviolent drug offenders have been incarcerated. $121 billion was spent to arrest these offenders and $450 billion to incarcerate them.

Holding on to some silly, costly and simply ineffective system of making criminals out of those who possess and use small amounts of illegal drugs is a battle lost with a high price. We cannot afford expensive inaction. It’s time to make a change and quadrupling our policing of drugs and making more jails is NOT the answer. Let’s not be ridiculous!

Magnesiums Affect on Insulin Sensitivity

Magnesium supplementation may help improve insulin sensitivity and lower the risk of diabetes in overweight patients, according to a recent study.

In the study, 52 overweight non-diabetic adults were randomly assigned to receive either 365 milligrams of magnesium-aspartate-hydrochloride or placebo daily for six months.

The researchers found that insulin resistance significantly improved in the magnesium group after six months of supplementation. Blood pressure and cholesterol levels were not significantly affected by supplementation.

The researchers evaluated magnesium intake, inflammatory markers and diabetes diagnoses in 4,497 adults who did not have diabetes. They found that that people who consumed the most magnesium were 47 percent less likely to develop diabetes than those who consumed the least amount. Additionally, higher magnesium levels were linked to lower inflammatory markers and improvements in insulin resistance.

While the results are promising, more research is needed to determine if magnesium has a protective effect against diabetes.However, when taken appropriately, magnesium is relatively benign and I see NO reason to wait for more definitive studies provided that you discuss what you are doing and why with your health care provider.

I ALWAYS check my diabetic patients for red blood cell magnesium which is an important marker. While most believe that magnesium should be taken in a 2:1 ratio ( calcium to magnesium), recent data suggesting that calcium MIGHT increase arterial calcifications is disconcerting. I am waiting to see more research in this regard. So, I advise my diabetic patients to take 100-250 mg of magnesium (preferably magnesium aspartate or citrate which are more absorbable forms). Remember, too much magnesium can cause diarrhea.

Really Treating and Diagnosing High Blood Pressure

Make no mistake about it, the dangers of high blood pressure (hypertension or HTN) have NOT been underestimated and unless you are one of those folks who “knows” when your blood pressure is too high (headache, feeling weird, etc.), most of us have no idea of what our blood pressure is. HTN increases one’s risk dramatically of cardiovascular and renal (kidney) disease. It contributes to sexual dysfunction; it adversely affects your vision; it contributes to bone loss and to insomnia (difficulty sleeping). It’s mostly silent and it is almost always deadly!

What is hypertension?

If your blood pressure is less than 120/80 you are normal (normotensive).

If your blood pressure is between 120/80 and 140/90-you are considered “prehypertensive” and are at risk for high blood pressure. Lifestyle modifications are important! Weight is a BIG factor.

If your blood pressure is 140/90 and above or 130/80 and above AND you have diabetes or chronic kidney disease then your blood pressure is high.

Often a high blood pressure reading is obtained in your doctor’s office and it is downplayed because you are anxious. However, could it also mean that whenever you are in an anxiety provoking state (like driving in city traffic or watching the end of a cliff hanger superbowl game), that you will be hypertensive as well? I see NO reason to underestimate the transcendence of a doctor’s office blood pressure reading! But perhaps of even greater significance is the routine circadian fluctuation in blood pressure and metabolism over a 24 hour period. Most people experience an increase in blood pressure during the day which peaks in the AM and then again in the evening but declines when they sleep in the evening- called dipping (typically a 10% drop in the systolic or top number blood pressure reading).If your blood pressure does not dip while asleep, your risk of cardiovascular disease (heart attacks, stokes, heart failure, etc.) is much greater.

So, what to do? First, I strongly suggest taking your blood pressure medications (except diuretics or water pills) at night. It seems fair to say that common sense as well as study data shows a decreased risk of hypertensive complications when dosing is done at night- in essence helping you “create” a dip if you do not have one normally due to metabolic issues. You might want to take a diuretic (typically just one of the antihypertensive drugs that people have been prescribed) in the day because otherwise you might spend a good part of the night awakening to urinate-creating a whole new set of problems.

Next, I would discuss with your health care provider whether it would behoove you to have a 24 hour blood pressure monitor study to assess whether you do or do not have a dip or if the night medication is addressing that issue. The monitor is not an invasive or particularly expensive procedure and your health care professional should be able to justify the procedure.  Here’s my thought – what’s the use of being diagnosed and treated for high blood pressure, if it is not treated at the right time?   

What We Need to Truly Reform Health Care

I would like to think that as much as we can disagree about politics, religion, economics, sex, and philosophies there are some points where there is common ground- where we can work together. When we work on one thing who knows, maybe it will lead to other arenas! (Am I Too optimistic)?  I KNOW that we will ALL agree on what follows:

If the Affordable Health care Act stays, is dismantled or if the model of health care is based solely on a free market concept, we will have a MUCH better system for most Americans. If members of the U.S. Congress, Executive Branch including the President and his staff, and employees of the Federal government ALL had health care programs that were EXACTLY the same as what is available to all the rest of us our health care system would be better. For example, did you know that Congressmen and women as soon as they are sworn in,  may participate in the Federal Employees Health Benefits Program (FEHBP). The program offers an assortment of health plans from which to choose, including fee-for-service, point-of-service, and health maintenance organizations (HMOs). In addition, Congress members can also insure their spouses and their dependents. Up and to this point you might say, well, that is OK. Here is the rub!!!!!! The government pays up to 75 percent of the premium! So, while deductibles are rising and employers contribute less to an employee’s health plan, YOU contribute 75% of the cost of premiums for health care insurance for members of the U.S. Congress. According to the St. Petersburg Times, “Members of Congress have their own pharmacy, right in the Capitol. They also have a team of doctors, technicians and nurses standing by in case something busts in a filibuster. They can get a physical exam, an X-ray or an electrocardiogram, without leaving work.” Is that in the Affordable Health Care Act for all of us? Do Tea Party Congressional members take advantage of this? Although members pay extra for these services – Representatives pay about $300 per month, and Senators about $600 – taxpayers end up kicking in another $2 million. That’s $2 million not being spent on those who need it. But, it is NOT just the $2 million which is a drop in the bucket with regard to money pissed off by our government. It is that these folks do not face the same pressures as the rest of us and do you REALLY think they can make decisions for the public if they do not “feel our pain”? By the way as best as I can figure it out, all of these benefits and Federal subsidy for premiums continue in retirement even after one term in office. Not bad!

Now the President:

The White House medical unit, with a staff of four doctors plus nurses and physicians’ assistants, is steps from his office. Treatment is free for Obama and his family which includes his mother-in law (as well as for the vice president and his family).Why his mother-in- law? She can make an appointment like the rest of us in the GW walk in clinic in DC!!!! Do they accept her Medicare?

During the president’s travels, a doctor and nurse ride in a limousine in his motorcade. An emergency medical technician comes too, with an ambulance.

Air Force One is stocked with equipment for an on-board operating room. On overseas trips, two medical teams usually travel with the president, one on the plane and one pre-positioned on the ground so the president will always have a rested doctor and nurse at the ready. The first family receives VIP treatment at military hospitals. And Obama has virtually instant access to medical specialists that few, if any, Americans could duplicate.

“If the president comes to us this morning with a mole on his cheek, a dermatologist will be seeing him today,” said Dr. Rob Darling, a retired Navy captain who was a White House physician for President Clinton. At military hospitals, the president typically is not charged for outpatient care, said a White House official who declined to be identified. The president’s insurance carrier is usually billed for inpatient care, but the hospital’s commander has authority to waive the fees if the administrative expense of applying for reimbursement would exceed the payment to the hospital, the official said. When the president’s insurance carrier is billed, he is responsible for copays and deductibles, the official said. Now this does make sense for many reasons- military and administrative. We should protect the President of the United States. But, after the presidency his benefits are at least comparable to a member of Congress if not MUCH better for him and his family. (I can’t find out all of the details yet. It could affect national security!)

IF members of Congress got the SAME care that we got (same doctors and facilities on call in Congress and NO pharmacy and a much smaller contribution to their health care benefits just like industry is cutting down, we sure as heck would get better thought out care for all- free market or federally based! If the President looked forward to getting what we all get AFTER the presidency (including his wife and kids) things would be different. My Lord the Congress and the President might actually start sweating it! Forgive my Bronxeze, it’s all bull, lies, deception! No? The President and First Lady encourage us all to support a public education! BUT, in do as I say, not as I do fashion, their kids go to PRIVATE school. Politician hypocrisy is not confined to a Populist US President. No sir! It’s the ruling class (right or left) vs. the rest of us dooffises. Ask Romney. Why his lovely wife explained recently that she and Mitt felt the pain of the cost of college education when they had to tap some of their reserves to pay for the kids! Tisk, Tisk.

Singularity

 

This is a long piece and many of you may not read it to its completion, but, it is in many ways the most important blog entry I have made thus far. Read it please. Share it with as many friends and acquaintances as you can. We desperately need a dialogue about SINGULARITY .

What I am about to discuss has transcendence through all of society, geographies, people, and philosophies. I want to head off at the pass an argument I have heard frequently when I introduce this topic at dinner discussion with friends and colleagues, namely, that SINGULARITY will only apply to industrialized society and would be meaningless to much of the world- still not that far upstream from the darkest of ages – primitive cultures and economies. What we are about to discuss will reach and is already reaching into the very fabric of humanity. Where you live, your education, whether you live in London, Shanghai, New York, are a cave dweller in Afghanistan, or an indian living as your forefathers have for thousands of years along the Amazon will not have any bearing on this issue or that it will change EVERYONE’S life. One other thing, this may be the FINAL FRONTIER for religion as we know it! Your deep convictions will be confronted in a sense- once and for all! What is the soul? Is there a soul? Are humans that special? Last, there can never again be an argument about evolution. We have created an evolutionary process by ourselves. A new species is most probably emerging before our eyes and share the planet and the universe with us. What will it mean? Where will it go? Seemingly disparate sciences are merging into a SINGULARITY. Your politicians either have no idea of what is happening around them (probably most) or they have no idea of what to do with this. Some just do not want to scare a global society focusing on economies, health care, political and power wars, religious wars, turf battles, etc. Perhaps, our “leaders” are themselves not ready to confront a true event horizon that is not long off.

I make NO pretentions about really understanding SINGULARITY and I plan to invite some experts to join me (us) on video and radio to discuss this term and what it means for you and certainly for your children. You WILL see very clearly the birth and rapid evolution of the new species in your lifetime. You ARE seeing it! Your children will live and possibly confront it. Can we direct the evolution? What will be the characteristics of the new species? Will we live side by side? Are we humans to be dispensed with or is it possible we will merge with the SINGULARITY- our humanity jumping evolutionary bridges- creating a new consciousness and a physiology?

This from Wikipedia:

“Technological singularity refers to the hypothetical future emergence of greater-than-human intelligence through technological means. Since the capabilities of such intelligence would be difficult for an unaided human mind to comprehend, the occurrence of a technological singularity is seen as an intellectual event horizon, beyond which events cannot be predicted or understood. Proponents of the singularity typically state that an “intelligence explosion” is a key factor of the Singularity where superintelligences design successive generations of increasingly powerful minds.”

This hypothesized process of intelligent self-modification might occur very quickly, and might not stop until the agent’s cognitive abilities greatly surpass that of any human. The term “intelligence explosion” is therefore sometimes used to refer to this scenario.

Let me lay down some facts for you.

1.Computer technology is advancing at lighting speed. The computer that I am writing this on right now is enough to power many of the functions of small cities just 5-10 years ago Within a short period of time (a few years) computers can and will start building themselves and modifying/improving their own software.

2.The silicon chip which has been a limiting factor in speeding up computer ability will soon be replaced by nanotechnology based chips such as those made of a new substance- graphene. This will expand computer speed and capacity well beyond anything we could have conceived of just years ago.

3.These computer advances are not just U.S. dominated. The process is global and the changes are unstoppable because if you wanted to control them where would you do so? The process is NOT centralized. The changes are happening all over the place in real hypertime.

4.Science had begun a push long ago toward computer driven artificial intelligence (AI). There is still a lot to develop on this front but it may not be unreasonable to assume that combined with the progress we are making in neuroscience (science of the nerves and brain) that we will be able to reverse engineer from the human brain what reasoning and intellect are and gift it to our powerful new species- the computer. The speed with which this is happening is faster and faster-thanks to the computer itself so do not lull your self into this silly notion that it is a hundred years away. I am talking decades for the pieces to start coming together.

5.We have developed synthetic DNA- the genetic essence or building block of life. We are each day breaking human and other genetic codes down. We are more and more implementing genetic engineering into “fixing” disease. We can clone. You would be fooling yourself if you thought that we have not yet cloned a human. We should be able to “birth” a human and “build” their components. Sort of like when you buy a car and add options- blond, aggressive, male/female, strong Trapezius and Lats, etc. (You already knew that this would happen didn’t you). But, like our political and religious leaders, you are hoping it will go away or that it is “God’s Will”. It will NOT go away and this is NOT natural or God’s evolution!

6.There is already a movement to add organic components to computers. With synthetic DNA, we can begin the process of merging “humanity” and machine either by “rewiring” our brains to interface with computers OR by creating a synthetic “being” that is part DNA and part computer. (Does this remind you of any Terminator you know?). Already there are computers (admittedly primitive compared with what I am discussing but showing you the direction in which things are going) that can help the mind move a limb on a quadriplegic. The American soldier can have a contact lens fitted that displays important battlefield information, and Google has glasses that have displays in them. They are just not directly wired to your brain——–yet!

7.In 20- 50 years a single chip may (I believe will) have the memory AND the intellectual power of a MILLION humans. Each generation of these computers will then generate yet more efficient ones. What will our world be like? Will this new species co-exist with us? Tolerate us? Eliminate us? Will we in effect merge with the new species to create another “being”. Will we need to worry about pollution? We may not “breathe” or drink. Will we worry about whether there is enough food on the planet? We might not need food as we know it anymore. Will we have “reproduction” as we know it now? Will we have “eternal life”? This my friends is the “real deal”- not science fiction and not so far off in the future that you should not be thinking about it and that nations of the worlds should not be discussing it. This topic would finally give some meaning to the United Nations. This is happening so fast and from such a diverse base intellectually, geographically, politically, philosophically and scientifically that as of now there is NO control, NO brakes, and NO moral compass applied to its progression!

8.Along the way to SINGULARITY things will look pretty good. As all of this technology is developed we will see incredible artificial limbs and computerized nanotechnology pancreases. We will see stem cell and genetic therapies that will appear nearly miraculous thanks to better, faster computers that will be adding reason, memory and computing power to their caches. With great genius will come great advances? SINGULARITY could be inconceivably- miraculous. Or, it could signal the complete end of our species and values. How can you tell when we will have created “beings” millions of times more intelligent than we are? Will they have values? Will they help us?

So, again, I may be off the mark somewhat. I am not a computer guy or a geneticist or a biomechanical engineer, but you get the picture I hope. While politicians in this country are wasting time picking on stupid things like “free market” vs. socialism and religious leaders are worried about contraception and gay rights, the streets of the entire world- the fabric of our lives- is folding up behind us and will soon race ahead. This will be an entirely new world. The way I see it now, we and other industrialized countries are sitting back and letting it evolve on its own. The problem is that this evolution that is racing to a new global destiny is a revolution- SINGULARITY!

On Payoffs And Bribes

I am no fan of breaking the law (our law) or of Wal-Mart! But, this whole big deal about “bribes” to expand stores in Mexico is really a non-issue- at least on the Mexican side of the border. Pay offs/Bribes (Mordidas) has always been a part of the CULTURE of Mexico. NO business is conducted if you do not pay respect in this unwritten “law”. It is the cost of doing business. While I feel bad that Wal-Mart does not have competition from Mexican retailers, the “bribes” they paid are entirely within the operational norm of Mexico. As for what is legal or not on this side of the border, I have no idea. But, for Wal-Mart to have expanded there was no other way to operate.

That no one has acknowledged this shocks me. What is even more shocking is that there are those here in the U.S. that talk of the Mordida as if we are “better” than these “corrupt” Mexicans. First, do you think that Super Pacs is not a form of bribery? What about $50,000 lectures on who knows what and a private plane to get you there after you leave public office? Is that not pay BACK?

I cannot comment about OUR laws with regard to what we do in another country. I appreciate the intent to keep us “clean” elsewhere, but, in fact, we need to start operating within the accepted system of the nation we are working with or in. I am not condoning the bribe, but I am not prepared to criticize anyone else’s culture- at least until we clean up our own.

Summer Vacation: Cruise Ship Health Risks

 

Schools are out and summer travel is in fulls swing as families prepare for holidays that they waited for all year. However, there are some health issues that should be considered before you head off to wherever your travels may take you.

General Cruise Vessel Health

Viruses are extremely tiny infectious agents that are only able to live inside a cell, and are the leading cause of major outbreaks on cruise vessels. The Centers for Disease Control and Prevention (CDC) warns that most viruses are associated with cruise ships due to close living quarters, unsanitary precautions, and infected passengers. Passengers touching many surfaces in concentrated areas increase the chances of a person catching a virus. The Vessel Sanitation Program (VSP) works to help stop the spread of viruses onboard. The CDC reports that in the past 10 years, the Norovirus, Legionnaire’s disease, and vector-transmitted diseases were most commonly contracted aboard cruise ship vessels. The VSP encourages travelers to learn how these viruses are transmitted, understand the health consequences, and be familiar with prevention and treatment.

The Norovirus

Noroviruses (previously known as Norwalk-like viruses) are a group of viruses that affect the stomach and intestines. They may cause gastroenteritis, an inflammation of the stomach and the large intestines, and may be contracted at any age. The symptoms of noroviral infection can sometimes be misdiagnosed as food poisoning. This human pathogen results in over 200 million annual infections worldwide. Outbreaks occur more often where there are more people in a small area, such as aboard cruise vessels. Noroviruses are found in the stool or vomit of infected people and on infected surfaces that have been touched by ill people and are highly contagious. The incubation period, the development of an infection between the time the pathogen enters the body and the time the first symptoms appear, is usually 24 to 48 hours after first exposure to the virus. Signs and symptoms usually last one to five days. The diversity within noroviral infection genus makes it difficult to control.

Transmission: Noroviral infection is highly contagious, so transmission can easily happen. One of the most common means of transmission is through eating contaminated food or drinking water. In May 2004, the VSP investigated an outbreak of norovirus gastroenteritis onboard a cruise ship sailing in Alaskan waters to identify a common food source item that caused the outbreak. In summer 2006, several cruise-related viral gastroenteritis outbreaks were reported in Europe. Two of these occurred on a river cruising vessel and were linked to tap water. This virus is transmitted by touching objects or surfaces that are contaminated and then touching one’s own mouth, nose or eyes, or by person-to-person transmission, such as shaking hands. It may also be transmitted by a lack of hygiene, such as keeping hands clean after using the bathroom or changing diapers, and then preparing or eating foods.

Symptoms: The most common symptoms of noroviral infections are vomiting, loose stool, and abdominal cramps. Other symptoms include low-grade fever, chills, headache, muscle aches, nausea, and fatigue. Sometimes infected people show no symptoms, but may continue to shed the virus via feces for several days, with potential for infecting others.

Prevention: The best way to prevent the spread of the norovirus is with thorough and frequent hand washing with hot water and soap. Passengers should wash hands after every trip to the bathroom, after every diaper change, and after preparing or eating food. Passengers should also avoid shaking hands of others, but use of hand sanitizers when available is recommended. The VSP and CDC work with vessel owners to develop Norovirus action plans, which include training of all employees and materials with instructions. These plans are designed to stop person-to-person transmission with disinfectants to kill these highly contagious pathogens. Private cabins and public areas are the places of greatest concern onboard. In addition, the CDC has created the Outbreak Prevention and Response Protocol (OPRP) to help control and prevent Norovirus transmission. The OPRP uses code yellow and code red to distinguish the level for threat of possible infection. In the case of a code yellow or code red, the vessel’s staff takes the appropriate actions, such as isolating passengers in cabins, using disinfectants, and evaluating passengers for symptoms. After the ship has returned to normal operations, a meeting is held to review which procedures went smoothly and which need modification.

Treatment: There is no treatment for Norovirus, but passengers who exhibit the symptoms of the virus should be evaluated by a medical professional. Treatment also focuses on alleviating symptoms while the body fights the virus. Because there is a chance that dehydration can occur, patients are often given fluids. Other treatment options include rest, abstaining from food for several hours and then slowly re-introducing mild foods, and avoiding foods and drinks that could upset the stomach or contribute to dehydration, such as caffeine and alcohol.

Legionnaires’ Disease

Legionnaires’ disease is a serious and potentially fatal type of lung infection caused by a type of bacteria called Legionella. The bacteria got its name in 1976, when a group of American Legionnaires contracted it at a convention in Philadelphia, during which 34 of 221 persons died. Although this type of bacteria existed before 1976, since then, detection of Legionnaires’ disease has increased; each year, between 8,000 and 18,000 people are hospitalized with Legionnaires’ disease, and in the United States it continues to be a public health concern on passenger ships. The Legionella bacteria are found naturally in the environment, usually in water. Because they thrive in warm, moist areas, they may be present in hot tubs and air-conditioning systems. People over the age of 65 have the highest risk for contracting Legionnaires’ disease, as do smokers and those with lung deficiencies and weak immune systems. Detection of the disease is confirmed with urine and blood tests. Most of the time, patients can be successfully treated with antibiotics, and healthy people usually recover completely.

Transmission: Legionnaires’ disease is contracted by breathing water vapor, such as steam from a hot tub that has been contaminated with the bacteria. It cannot be spread from person to person. This disease can easily be transmitted to passengers with weak immune systems aboard cruise vessels with contaminated water systems. Drinking water, bathing water, spas and pools, and even air conditioning units within cabins may be contaminated. Pontiac Fever, a flu-like illness, may occur after contraction of Legionella bacteria. In January 2003, two cases of Legionnaires’ disease on cruise ships were reported to the National Epidemiological Surveillance of Infectious Diseases (NESID). One patient, a 70 year-old male heavy smoker with mild emphysema, contracted the disease in the ship’s indoor spa. Another patient on the same ship was a 73 year-old female. Environmental investigation revealed that absorbent natural stones in the filters of the spas had harbored bacteria that transmitted Legionnaires’ disease.

Symptoms: The symptoms of Legionnaires’ disease are similar to the symptoms of pneumonia. They include high fever, chills, cough, muscle aches, and headaches, and usually begin 2-14 days after exposure to the bacteria. Gastrointestinal symptoms such as diarrhea are also common. A milder form of the infection caused by the same bacteria is Pontiac Fever. Symptoms include a fever, headaches, and muscle aches, and usually subside after 2-5 days with no treatment. Most patients who have Legionnaires’ disease need chest X-rays to check for pneumonia.

Prevention: Cigarette smoking seems to be the most common risk factor in contracting this type of bacteria, so it is important for patients to quit smoking. Avoiding this disease can be difficult because it is spread through the environment, and not through personal contact. Demanding diligent disinfecting is a great form of preventative measure. Passengers should learn the history of the vessel on which they plan to travel and ask questions about air conditioning maintenance, disinfection of spas and pools, and history of outbreaks onboard. The VSP also requires that all vessels should disinfect all showerheads every six months to prevent the growth of Legionella bacteria.

Treatment: Antibiotics are the most effective way to treat Legionella bacteria.

Insect and Rodent Diseases

Minimizing the risk of vectors that cause diseases, such as insects and rodents, is also important. Mosquitoes, rats, mice, flies, and bedbugs are all potential transmitters of disease. Rats and rodents may be vectors of many diseases, such as rat bite fever and salmonella. The most common vector-transmitted disease is malaria, which is spread by mosquitoes and may be fatal.

Transmission: Ports pose the greatest risk factor to vessels becoming contaminated with disease vectors because they are constantly receiving deliveries and managing supplies from many other ports. Food items also attract many species of pests and parasites. Mosquitoes transmit malaria parasites to humans, in which the parasites attack the blood. Over one million people die from malaria each year because there is no vaccine. The mosquito carries the disease from one human to another. Also, many cases are attributed to travelers returning from parts of the world where malaria is prominent, such as Africa. Rat bite fever is also an infectious disease that could be a risk factor for travelers on unmaintained vessels. Rats or other rodents may become infected with either Streptobacillus moniliformis or Spirillum minus. Humans may become infected when either scratched or bitten by the infected rat, or when ingesting food or drink that has been contaminated with rat feces.

Symptoms: Typically, symptoms of malaria begin 10 days to four weeks after the initial mosquito bite, although they may appear as early as eight days or as late as one year. Symptoms include asymptomatic infections, fever, chills, sweating, headaches, muscle pain, anemia, and kidney failure. The severity of the symptoms depends on several factors, such as the species of infecting parasite and the patient’s acquired immunity and genetics. Fever in the first week of travel to a malaria-risk area is unlikely to result from malaria, but travelers who feel ill should seek immediate medical care. Symptoms of Rat bite fever occur 2-10 days after transmission. The most common symptoms include chills, a fever, vomiting, headache, and muscle and joint pain.

Prevention: Prevention is based on avoiding exposure to mosquitoes and taking antimalarial drugs if traveling to areas where malaria is common, such as Africa. There are several types of antimalarial drugs, such as doxycycline, mefloquine (Lariam®), chloroquine, and the combination of atovaquone and proguanil (Malarone®). Doxycycline is the least expensive anitmalarial drug. It is good for last minute travelers because the drug is started one to two days before traveling to an area where malaria transmission occurs. It is taken daily, but it cannot be taken by women who are pregnant or by children under eight years of age. It may upset the stomach and increase sun sensitivity. Chloroquine is a drug that is good for long trips because it is taken weekly. It is not good for a last minute traveler because it needs to be started 1-2 weeks prior to travel. It may also exacerbate psoriasis. The VSP recommends that cruise vessels use an Integrated Pest Management Plan, which involves training crew, monitoring areas of the ship that attract pests, surveillance, and the use of pesticides. The VSP encourages documentation of all items entering the ship for the presence of vermin. Vessels also use traps, glue boards, and bait stations onboard to catch insects and rodents. There are many things that passengers should do to prevent getting Rat bite fever, such as avoiding contact with rats or rat dwellings, hand-washing, and avoiding hand-to-mouth contact.

Treatment: In many cases, medication or the immune system eventually helps stop the infection. The CDC recommends that treatment be guided by three main factors: the infecting Plasmodium species, the clinical status of the patient, and the drug susceptibility of the infecting parasites as determined by the geographic area where the infection was acquired. The drugs used for prevention are also used for treatment. These drugs are active against the parasite that forms in the blood. Other drugs that are used include Fansidar® and Lariam®. Fansidar® may have severe or fatal side effects. This drug must be discontinued if there is the appearance of a skin rash or occurrence of active bacterial or fungal infections. Lariam® was invented by the U.S. Army and is routinely given to soldiers overseas. Lariam® may cause neuropsychiatric adverse effects. Rat bite fever can be treated with antibiotics. Penicillin is the most recommended antibiotic, but erythromycin may be prescribed, as well.

Salmonella

Salmonella are bacteria that cause infection. Salmonella are a group of bacteria that may cause diarrheal illness in humans. The illness usually lasts 4- 7 days, but in more severe cases it may be fatal. The elderly, infants, and people with weak immune systems are more likely to have severe cases. The bacteria live in the intestinal tracts of humans and animals, including birds.

Transmission: Salmonella are transmitted to humans by eating foods contaminated with animal feces. The contaminated foods usually look and smell normal and are often of animal origin, such as beef, poultry, milk, and eggs. However, any type of food may become contaminated. Food may also become contaminated by the hands of an infected food handler onboard who did not wash his or her hands with soap after using the bathroom.

Symptoms: Most persons infected with Salmonella develop diarrhea, fever, and abdominal cramps after infection. In some cases, the diarrhea may be so severe that the passenger needs to be hospitalized. Some people may develop Reiter’s syndrome, which leads to pain in their joints, irritation of the eyes, and painful urination. This can last for months and sometimes years, and can lead to arthritis.

Prevention: There is no vaccine to prevent Salmonella poisoning. Passengers should avoid eating raw or undercooked foods. Food handlers should avoid cross-contamination of foods by keeping uncooked meats from produce and cooked foods, and hand-washing between handling different food items. Infected people should avoid preparing food and pouring water for others.

Treatment: Salmonella infections can usually resolve in days without treatment. Oral fluids are recommended for dehydration. Antibiotics, such as ampicillin or ciprofloxacin, are used if the infection spreads to the intestines.

Seasickness

Seasickness is a form of motion sickness caused by the motion of a floating platform, such as a ship, boat, or raft. Seasickness is characterized by nausea and, in extreme cases, vertigo, which is a balance disorder. It is brought on by the rocking movement of a ship or boat, and visual confusion when objects move with the ship. The severity of seasickness is influenced by the irregular pressure of the bowels against the diaphragm as they shift with the rising and falling of the ship.

Symptoms: Symptoms of seasickness include headaches, vertigo, nausea, pale and moist skin, increased saliva, constipation, alteration of sense and smell, and muscular relaxation.

Prevention: Passengers should avoid alcohol, fat and spicy foods to prevent seasickness. They should also avoid small spaces, participate in onboard activities to occupy the mind, stay in fresh air and take deep breaths, drink plenty of water, and get a good night’s sleep the day before boarding.

Treatment: Over-the-counter medications are available, such as Dramamine®. Ginger capsules or crystallized ginger is also recommended for settling the stomach. Passengers experiencing seasickness should try to focus their eyes on the fixed horizon. They may also try lying down on their backs and closing their eyes.

The Truth About Supplemental Calcium

The issue of how much, if any,  supplemental calcium you should take is unknown at this point in time. What is known is that there are many different uses, types, dosages, and risks of which the general public is shockingly unaware.

For instance, supplemental calcium may play a role in weight loss, possibly controlling lipids (fats in the blood like cholesterol and triglycerides), blood pressure and, of course, in maintaining healthy bones. However, in a number of studies taking more than approximately 800 mg of elemental calcium daily could increase the risk of a heart attack by 30%.

It is very important to specify that I am referring to elemental calcium because many people are unaware how much actual calcium is in various supplements. Calcium citrate- like Citracal or chewable O Purity- is only 21% elemental calcium. So, 1,000 mg of Citracal contains about 210 mg of elemental calcium. Calcium carbonate- like Tums, Caltrate or Caltrate Chewable contains about 40% elemental calcium. So, 1,000 mg of Caltrate contains approximately 400mg of elemental calcium. Calcium Phosphate, Calcium Lactate, and Calcium Gluconate are sources with VERY LITTLE elemental calcium and are pretty much a waste as far as I am concerned because you need to take too many to reach any reasonable level of supplemental elemental calcium.

It is important to note there is NO advantage to coral calcium and there have been reports of lead contamination. Coral calcium comes from limestone and is calcium carbonate.If you do decide to take calcium carbonate, then take it with a meal because it requires much more stomach acid to be digested than calcium citrate.  I think calcium citrate is best for anyone and certainly for those above 40 because stomach acid begins to decrease at this point.

In addition to the calcium you get from supplements, it is important that you are getting enough calcium from your diet:
8 oz Milk & Yogurt 300- 450 mg elemental calcium 3 oz Cheese 300- 450 mg elemental calcium 3 oz Bones in Canned Sardines and Salmon 181- 315 mg elemental calcium 8 oz calcium Fortified Foods (OJ, Soy Milk) 200- 300mg elemental calcium 1 cup Dark green, leafy vegetables 100- 200 mg elemental calcium
Your body absorbs calcium less efficiently as your intake increases, therefore it is best to take your calcium in smaller doses throughout the day to aid absorption. You should not take more than 500 milligrams of elemental calcium at one time and allow 4 to 6 hours between doses.
If you have osteopenia or osteoporosis or have a high risk you should take elemental calcium. However, taking higher amounts then I recommend have not necessarily shown to incrementally decrease your risk of fracture!.Long term use of medications, such as corticosteroids, and anti-convulsants can be damaging to bone. These medications are used for chronic conditions such as asthma, rheumatoid arthritis, and psoriasis. If you need to take these medications for extended periods of time you may need to increase your intake of calcium with supplements.If you rely on laxatives , the transit time in your bowel increases and may leave enough time for calcium to be absorbed in which case you should discus with your physician taking supplemental calcium.Ditto for those who take a lot of fiber. I would take no more than 800 mg of elemental calcium daily because cardiovascular risk increases above this amount according to the data so far. If you are pre, peri, menopausal or post menopausal and your bone density is normal, then I would not take supplemental calcium. Much the same applies to men (do not forget that 10% of osteoporosis is in males). Unless you are at high risk or already have an issue with your bone density, I would rely on a good dietary intake of calcium.
The issue here is that the National Institute of Health Consensus Conference and The National Osteoporosis Foundation support a higher calcium intake of 1,500 elemental milligrams per day of calcium for postmenopausal women not taking estrogen and adults 65 years or older.However, they have NOT yet accounted for the cardiovascular risk which I think is considerable.
NEVER forget to take an adequate amount of Vitamin D regardless of the path you choose with calcium.