Alarming Flu Reports From Mexico

 Posted by on 26 April 2009 at 11:01 pm  Health, Health Care
Apr 262009

BBC News has posted a number of “in the trenches” readers’ reports on the swine flu epidemic in Mexico. Here are two disturbing excerpts from Mexican physicians:

I’m a specialist doctor in respiratory diseases and intensive care at the Mexican National Institute of Health. There is a severe emergency over the swine flu here. More and more patients are being admitted to the intensive care unit. Despite the heroic efforts of all staff (doctors, nurses, specialists, etc) patients continue to inevitably die. The truth is that anti-viral treatments and vaccines are not expected to have any effect, even at high doses. It is a great fear among the staff. The infection risk is very high among the doctors and health staff.

There is a sense of chaos in the other hospitals and we do not know what to do. Staff are starting to leave and many are opting to retire or apply for holidays. The truth is that mortality is even higher than what is being reported by the authorities, at least in the hospital where I work it. It is killing three to four patients daily, and it has been going on for more than three weeks. It is a shame and there is great fear here. Increasingly younger patients aged 20 to 30 years are dying before our helpless eyes and there is great sadness among health professionals here.

Antonio Chavez, Mexico City

…I work as a resident doctor in one of the biggest hospitals in Mexico City and sadly, the situation is far from “under control”. As a doctor, I realise that the media does not report the truth. Authorities distributed vaccines among all the medical personnel with no results, because two of my partners who worked in this hospital (interns) were killed by this new virus in less than six days even though they were vaccinated as all of us were. The official number of deaths is 20, nevertheless, the true number of victims are more than 200. I understand that we must avoid to panic, but telling the truth it might be better now to prevent and avoid more deaths.

Yeny Gregorio Dávila, Mexico City

A few natural questions:

1) How will this affect border control policy?

Mexico has arguably been teetering on the edge of being a “failed state” for a few years now. If a flu pandemic causes the central government to lose effective control over the country, will we see a flood of desperate illegal immigrants seeking to cross into the US to escape the problems in Mexico? And given that some of those people may be infected, how will the US respond?

Although I support open immigration in the sense that Craig Biddle discusses in his article “Immigration and Individual Rights” from the Spring 2008 issue of The Objective Standard, I also completely agree with him that it is a legitimate function of government to prevent people with deadly communicable diseases from entering this country. In an emergency, this may require fairly drastic steps (such as deploying the US military along the border).

Hence, border security may become a big issue in the near future.

2) If the pandemic strikes the US, will this lead to a permanent increase in government control over our lives?

Again, in a mass casualty medical emergency, I think the government can legitimately impose controls that would not normally be justified. For instance, it might restrict normal commerce, assume temporary control of hospitals and health care facilities, impose quarantines/curfews on neighborhoods and cities, etc. One can argue over whether any specific proposed measures are justified for a given emergency, but the basic principle is valid.

But we also know that once government assumes “emergency” control over a sector of the economy, it rarely gives up that control after the emergency has passed.

Hence, a flu pandemic could lead to permanent new government controls over health care and/or other major sectors of the rest of the American economy, even after the immediate crisis has passed.

3) What would be the long-term economic effects of a flu pandemic on the US?

If there is significant loss of life, the individual tragedies will be bad enough.

But I expect this would be compounded by significant disruption of normal economic activity. In the present political climate, this could deepen our current recession, thus creating more pseudo-justification for further government controls over the economy, which would further worsen the recession, etc. How far could this downward economic spiral go?

We’ll soon know the answers to these questions.

I also wish to emphasize that I am not taking an alarmist position. For instance, I think it’s a huge positive that medical technology has advanced immensely since the flu pandemic of 1918.

If you want to read some good practical advice, take a look at this page from epidemiologist Dr. Tara Smith (not the Objectivist philosophy professor) written during the bird flu scare of two years ago. In short, she recommends:

Don’t panic
Wash your hands
If you’re sick, stay home
Don’t touch your eyes/nose/mouth
Stock up on food, water, and other household necessities (i.e., standard prep for blizzard, earthquakes, or other natural disasters)

There is also recent research suggesting that Vitamin D may help strengthen your ability to fight off the flu. (The article doesn’t specifically address swine flu, but my guess is that correcting any Vitamin D deficiency wouldn’t hurt and would likely help against this new virus.)

[Note from DMH: As I've mentioned before -- here and here and here -- most Americans are deficient in vitamin D. For example, a recent study showed that 72% of men over 65 are deficient using 30 ng/ml as the cutoff. From what I've read, levels should be over 60 ng/ml. For some people, that can require thousands of IU supplementation per day.]

So don’t panic, keep informed, and stay tuned for updates!

(BBC link via Instapundit.)

Today’s X-Ray Case

 Posted by on 20 April 2009 at 11:56 am  Health Care
Apr 202009

This one isn’t really a diagnostic dilemma. Instead, I’m presenting it because of the history:

“During seizure, patient’s friend placed nail clippers in friend’s mouth because he was worried patient would bite tongue.”

I’m sure you can guess what happened next:

I think this qualifies as a “Want to Get Away?” moment… (Via K.D.)

Hsieh LTE in NY Times

 Posted by on 30 March 2009 at 11:02 am  Activism, Health Care
Mar 302009

The March 30, 2009 New York Times has printed my latest LTE on health care. It’s the 6th one down:

Re “A Health Plan for All and the Concerns It Raises”:

To the Editor:

It would be just as wrong for the government to compete with private insurers to provide health insurance as it would be for the government to compete with G.M. or Ford to build taxpayer-subsidized “public automobiles.”

The unfair competition from a public plan would destroy the private health insurance industry. The inevitable result would be the rationing and other horrors of a Canadian-style single-payer system, which most Americans neither wish nor deserve.

Paul Hsieh
Sedalia, Colo., March 25, 2009

The writer, a medical doctor, is a co-founder of Freedom and Individual Rights in Medicine.

It was written in response to their March 25, 2009 story, “A Health Plan for All and the Concerns It Raises“.


The online political commentary/opinion website has published my latest OpEd, entitled “Health Insurance Industry Sells Its Soul to the Devil“.

Here’s the introduction:

Health Insurance Industry Sells Its Soul to the Devil

Summary: Health insurance companies are on the verge of a Faustian bargain that will take the rest of us down with them.

March 22, 2009 – by Paul Hsieh

In German folklore, Johann Faust was a physician who sold his soul to the Devil in exchange for knowledge. Of course, the pact destroyed him. The American health insurance industry is on the verge of striking its own Faustian bargain with the U.S. government. But this bargain won’t just destroy the insurance industry; it will also drag 300 million Americans into the pit of government-run “single payer” socialized medicine…

Read the rest here.

Today’s X-Ray

 Posted by on 11 March 2009 at 11:33 am  Fun, Health Care
Mar 112009

History: Leg Pain

Yeah, I bet his leg is a little uncomfortable!

ER History

 Posted by on 3 March 2009 at 1:18 pm  Health Care, Humor
Mar 032009

I worked the “nighthawk” 9pm-7am shift all week not long ago, which is mostly emergency radiology. Here’s a history from a middle-of-the-night CT scan of the head and face that I recently interpreted:

As my on-call partner said, “I’m sure we’re getting paid for that one!”…

Hsieh OpEd in Washington Examiner

 Posted by on 24 February 2009 at 1:06 pm  Activism, Health Care
Feb 242009

The February 23, 2009 Washington Examiner published my latest OpEd entitled, “America Doesn’t Need a Health Care Czar”. Here is the intro:

America doesn’t need a ‘health care czar’

By Paul Hsieh, MD, OpEd Contributor – 2/23/09

KEY DATA: Free market health reforms could reduce health insurance costs by over 50%.

TAKE HOME: President Barack Obama’s plans for a “health czar” would represent an unprecedented and dangerous intrusion of government into the practice of American medicine.

Former senator Tom Daschle’s withdrawal as President Barack Obama’s nominee for Secretary of Health and Human Services has left the White House administration scrambling to find a new “health czar” to implement their goal of government-run “universal health care.”

But while the primary focus had been on Daschle’s tax problems, Americans should also ask a more fundamental question: Why do we need a health czar in the first place?…

Read the rest here.

As usual, feel free to leave comments on the article website, as well as to forward it to friends, family, co-workers, elected officials, etc.

Update: The OpEd has started a vigorous discussion at LittleGreenFootballs!

Two Hsieh LTEs in Rocky Mountain News

 Posted by on 24 February 2009 at 12:01 am  Activism, Government, Health Care
Feb 242009

The Rocky Mountain News has published two (!) of my LTEs on consecutive days.

On February 18, 2009, they printed this letter opposing the latest proposal for “single payer” health care in Colorado:

Single-payer health care has failed in every other country
Paul Hsieh, Sedalia

Response to your story, “Dems’ bill shoots for universal health care” from 2/5/2009 by Ed Sealover.

Single-payer health care has failed in every other country that has tried it. Canada controls health costs by forcing patients to wait months for MRI scans and cardiac surgeries that Americans can get in a few days.

Single-payer advocates mistakenly claim that health care is a “right”.

Health care is a *need*, not a right. Rights are freedoms of action (such as the right to free speech), not automatic claims on goods and services that must be produced by another.

Instead of single-payer health care, America needs free-market reforms, such as allowing patients to purchase insurance across state lines and use health savings accounts for routine expenses. Insurers should be allowed to sell inexpensive, catastrophic-only policies to cover rare but expensive events.

Such reforms could reduce costs and make insurance available to millions who cannot currently afford it, while respecting individual rights.

On February 19, 2009, they printed this letter on the Obama Administration’s expanded welfare state programs:

Heads they win, tails we lose
Dr. Paul Hsieh, Sedalia

When the economy is bad, welfare statists say, “We must expand government programs because everyone is hurting.” When the economy is good, they say, “We must expand them because we can finally afford it.”

If I didn’t know better, I’d think that they wanted to increase people’s dependency on government programs regardless of the reason.

X-Ray Answer

 Posted by on 18 February 2009 at 11:01 am  Fun, Health Care
Feb 182009

The patient’s heart has been removed!

He is a heart transplant patient about to receive his new heart, and of course the surgeons had to remove his old failing heart first. The film was taken after his native heart had been removed but before the transplanted new heart was placed. Again, here is the abnormal film and a comparison normal film.



When I’ve shown the abnormal film to medical students, they usually know that something is amiss, but they can’t quite put their finger on what’s wrong.

Many med students learning introductory radiology find it much harder to recognize the absence of a normal structure than to recognize the presence of an abnormal structure. Or as one of my former professors used to put it, “The hardest thing to see is something that isn’t there.”

This principle is not unique to medicine, of course. For instance, the “dog that didn’t bark” (when it should have) was the key to a Sherlock Holmes mystery story.

And part of radiology residency training is to develop the appropriate mental checklists so that when one analyzing any radiology exam (ranging from a chest x-ray to a brain MRI scan), one is methodically looking both for “things that should be here but aren’t” as well as “things that shouldn’t be there but are”.

A few comments on some secondary findings:

The lungs are “dirtier” than usual (i.e., with more white), because of fluid build-up from his prior congestive heart failure. There are also various life-support lines and tubes that project over different portions of his chest. The dark vertical stripe in the midline is the incision used to remove the heart.

Today’s X-Ray

 Posted by on 17 February 2009 at 1:00 pm  Fun, Health Care
Feb 172009

Today’s x-ray is from a 55-year old man. The film was taken in the operating room (“OR 3″). Notice anything interesting?

(Answer tomorrow.)

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