Monthly Archives: December 2015

PHI and Politicians

Posted on by vadocdoc
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As the political season heats up, there once again have begun the perennial rumblings that the media is “too intrusive” or doesn’t treat one candidate as fairly as another. I don’t worry about this much; there are as many publications on the left as on the right, and if one politician gets heat from a certain sector, you can rest assured that the politician’s opponents will be similarly scrutinized by partisans of the other camps. It can be loud and messy, but I’m convinced it all balances out in the end.

However, and invariably, as the political microscope becomes more focused, there will be more talk about what is ‘fair game’ for journalists. A politician’s family? Dumb things that person may or may not have done in college half-a-century prior?

With HIPAA and Protected Health Information (PHI) in mind… are politicians owed privacy as the rest of us? And if so, to what degree?

Would FDR’s polio be pertinent today to the landmark legislation he championed and his stewardship of the nation through WWII?

Should Thos Eagleton’s history of depression have removed him from contention for the second highest position in the land?

I read recently that, the week following his inauguration in 1961, John F. Kennedy appointed his personal doctor, Janet Travell, M.D., as presidential physician, marking the first time that a woman had held that important post.

This breaking of the glass ceiling, though, came with some additional baggage. Dr Travell had an impressive professional resume, including prestigious academic appointments in pharmacology, orthopedics, and cardiology. She then-already enjoyed an established reputation as a pioneer in the treatment of chronic pain conditions.

[sidebar: it is said to have been her recommendations on ergonomics that later resulted in the iconic images of JFK sitting in rocking chairs]

But when expressly asked about rumors of JFK’s health during the 1960 campaign, she stated that he did not have Addison’s Disease and that she had never treated him for same – both statements found after his death to be inaccurate.

In short, she lied.

Additionally – though this may be a reflection of the times and not as much the clinician – Dr Travell prescribed for JFK an astounding array of potentially habituating agents to treat his pain, including high doses of Luminal, Librium, Miltown, Laudanum, Meperidine, and Dolophine. Add to that his frequent, sometimes nightly, use of Nembutal for sleep. Though the Kennedy family credited Dr Travell with enabling a determined JFK to maintain his punishing schedule in the face of physical difficulties, Dr Jeffrey Kelman, who later researched and published a book on Kennedy’s health, has since stated that the president’s ailments probably would earn him social security disability benefits were he were alive today. And as one who had seen combat, he’d also arguably be 100% service connected through the Veterans’ Administration for such serious and chronic debilities.

All of this occurring concurrently with the Bay of Pigs and the Cuban Missile Crisis!

However, one might say, he successfully navigated those challenges. Yes, others will add, but what if his sensorium had been clouded by that potentially stupifying drug cocktail?

As physicians, we deal with the headaches of HIPAA daily, the near-constant concerns over aspects of privacy – presumed, expressed, implied – that any/ all practitioners can readily appreciate. We worry about minutiae like names on the spines of filed charts being visible from a distance.

The media has no such worries in reporting on the body politic. Or should it?

All points worth keeping in mind as we enter the nominating primaries.

[Have an idea for a post topic? Want to be considered for a guest-author slot? Or better, perhaps you’d like to become a day-sponsor of this blog, and reach thousands of subscribers and Facebook fans? If so, please contact the Alienist at vadocdoc@outlook.com]

[Copyright 2013 @ The Alienist’s Compendium]

Anno Domini

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For Christians, December 25th by tradition marks the birth of Jesus of Nazareth, and therefore the start of a new year in their calendar.

[sidebar: that the Western new year actually begins a week after Christmas goes back to Julius Caesar and, by necessity of length, will be fodder for another post]

From where, then, do we get ‘BC’ (‘Before Christ’), ‘BCE/CE’ (‘Before/Common Era’), and ‘AD’ (Anno Domini, or ‘In The Year Of Our Lord’)? That’s not as simple a question as it may seem; no one in what would later come to be known as, say, 10 AD called the year thus, since Jesus was by then merely an unknown pre-adolescent in Judea.

The Christian calendar got off to a rocky start as the society from which it sprang, that of the Romans, measured the passage of time from pagan emperors and events. There were two competing Roman calendars, that of Anno Mundi (‘In The Year Of The World’) which counted from the founding of Rome (753 BC), and later that of Anno Diocletiani, created by its namesake (244-311 AD), which narcissistically measured time from his ascension to the purple robe.

Diocletian fomented numerous persecutions of Christians. He particularly enjoyed Damnatio ad Bestias, what the Romans called the amusement of throwing Jesus’ followers to the wild animals. Little wonder, then, that those potentially facing the lions didn’t want to measure the passage of their lives in reference to the man who so hated them.

Fast forward several centuries. Christians, along with everyone else, had been forced by lack of reasonable alternative to use the calendar of Diocletian. For a while, some tried to employ an Anno Adami system (‘In The Year Of Adam’), but it was confusing, impossible to accurately measure, and never caught on. In 525 AD, though, a monk, Dionysius of Scythia Minor (Romania), was tasked with creating a liturgical table to determine on what dates Easter was to occur in subsequent years.

[sidebar: recall that Easter is the Sunday following the first full moon after the spring equinox, which is why it changes every year]

Dionysius decided to be rid of all association with the Christian-hating Diocletian once and for all. He is the first author of whom we know whose extant work measured time from Jesus’ birth. He listed the first year of his table as 532 Anno Domini; why he didn’t use 525 AD is unclear, but as modern scholars believe that Jesus was actually born sometime between 6 BC and 4BC, not in 1 AD, Dionysius wasn’t actually far off.

But the Anno Domini system didn’t catch fire until after the Venerable Bede authored The Ecclesiastical History Of The English Peoples (731 AD), and used it throughout his discourse. Bede’s writings were also notable for introducing the concept of ‘BC’ (what he called Ante Incarnationis Dominicae, or ‘Before The Time Of The Lord’s Incarnation’) and setting 1 BC to have been the year immediately prior to 1 AD, ignoring any potential Year Zero.

After Bede’s landmark tome, both Emperor Charlemagne (742-814 AD) and the Holy See (11th century AD) officially adopted the Anno Domini system to measure the passage of time. From that point forth, it quickly became widespread in Christendom.

[sidebar: for some odd reason, in English, ‘Before Christ’ didn’t appear in writing until the late 17th century – ‘Before The Lord’s Incarnation’ was used instead – and one doesn’t see the published abbreviation ‘BC’ until the early 19th century]

So that explains BC and AD, but what of BCE and CE? Are they strictly used by non-believers, just as Christians eschewed the use of Diocletian’s calendar? Not entirely (and to no small degree because the modern conservative political prism and the so-called War on Christmas were still years in the future!)

While BCE/CE have been popular amongst Jewish authors since at least the mid-19th century (when Rabbi Morris Raphall published his widely read Post Biblical History Of The Jews), the nomenclatures’ uses far predate the middle of that century.

The German astronomer Johannes Kepler adopted his own terminology, Vulgaris Aerae (‘Vulgar Era’), freely interchangeably with Anno Domini in his scientific treatises of the early 17th century. This was in part because, in Kepler’s time, the Latin root of ‘vulgar’ was closer in meaning to ‘ubiquitous’ – that is, Kepler was merely employing a Christo-centric view of the civilized world. Later in that century, though, when ‘vulgar’ came to mean ‘uncouth’ in the non-academic English vernacular, many Western authors, staying true to Kepler’s intent but desiring to apply terminology that was not potentially pejorative, employed ‘Common Era’ in lieu of ‘Vulgar Era,’ both interchangeably with Anno Domini.

So despite what modern Christian apologists maintain – that ‘CE’ is short for ‘Christian Era’ – that is not borne by the historic record. And over the very years it was designed to measure, reference to the Common Era has gained much traction in modern scholarly circles in an attempt to sever the documentation of time from its semantically parochial roots.

Merry Christmas!

[Have an idea for a post topic? Want to be considered for a guest-author slot? Or better, perhaps you’d like to become a day-sponsor of this blog, and reach thousands of subscribers and Facebook fans? If so, please contact the Alienist at vadocdoc@outlook.com]

[Copyright 2013 @ The Alienist’s Compendium]

The Wonder Drug

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A (foreign-born) relative of mine – one with extensive medical training – has chronic difficulty sleeping. X has attempted all of the usual sleep-hygiene techniques. X has also tried the rather traditional drug/ health food store aids (e.g., Tylenol PM, Benadryl, Melatonin, l-Tryptophan) and much of the prescription stuff (e.g., Seroquel, Remeron, Ambien). X often sleeps in fits and spurts regardless, and has become frustrated, tired of going to the family doctor for help that doesn’t actually help.

One day recently, X and I were going through the belongings of another relative who had visited the U.S. and then departed, inadvertently forgetting some personal items and then asking for smalls to be mailed to her. In reviewing what to send and what to keep for the next visit, X came across a small bottle of liquid. X sat down, looking at the label, and smiling.

Corvalol

Corvalol

“What did you find?”

“Ah, this is what we used in [the Old Country]. It’s great stuff.”

“For what?”

“It’s a nerve medication. And a heart medication, for high blood pressure, angina, and tachycardia. It calms you down. It even works for gastrointestinal cramping. But most people also use it for sleep. Old people love it. You mix it with water and maybe some sugar. I used it years ago. It’s great.”

Intrigued by this rather vague and all-inclusive description from a fellow medical professional, I asked for translation, as the label was written in a tongue I do not speak.

C-O-R-V-A-L-O-L

Before I go further, let me remind readers that much-vaunted Western Medicine (and culture) has a long history of employing stuff back in the day that we wouldn’t be caught dead using now. Freud was a vocal proponent of cocaine, a sanguine view shared by the original recipe for Coca Cola. 7-Up at one time contained lithium. The Victorians freely employed alcohol for colicky children. Before it was outlawed in the 1960s, many residency programs employed LSD as a means of teaching budding psychiatrists about psychosis. Benzodiazepines (e.g., Valium and its brethren) were handed out like candy by some practitioners when first on the market, as a “safe” alternative to other sedative-hypnotics. You get the picture.

So, a MedPub search of Corvalol turns up some very interesting information.

It is OTC in many central and eastern European nations and in former Soviet states, and there is a booming market for it in immigrant communities. Usually brought into this country in small amounts as personal Rx (and with labels that can’t be read by customs anyway), it is available as scored tablets, though it is more often found as a (liquid) tincture to be mixed with a beverage of choice before consumption.

It is neither approved nor legal in the U.S. in its traditional formulation. It can be obtained online, but is then missing some of its key ingredients when shipped via approved channels, rendering it, in the words of one disgusted user, “piss water.”

Okay, so what comprises this wonder drug? As brewed by its two manufacturers – Farmak Pharmaceutical Manufactory of Kiev, Ukraine, and Krewel Meuselbach GmbH of Frankfurt, Germany – it contains myriad inactive ingredients (i.e., lactose monohydrate, magnesium stearate, β-cyclodextrin, potassium acesulfam, peppermint oil), and then

• Alcohol (the tincture 96% by volume) which needs no introduction;
• Ethyl ether of α-bromizovalerianate, a combination of bromide and herbal valerian root extract;
• Phenobarbital.

Bromides have been employed as flame retardants, gasoline additives, and pesticides – appetizing, yes? – though in humans, they have a long and storied history as anxiolytics and anticonvulsants starting in the 19th century.

[sidebar: for those readers from Baltimore who are familiar with the city’s landmark Bromo-Seltzer tower, that widely-known medicinal agent lost its namesake ingredient in 1975 by U.S. Food and Drug Administration fiat]

Valerian started as perfume in the 16th century Mediterranean basin. It has been historically used for insomnia and conditions associated with anxiety. It has also been applied in folk medicine for infantile convulsions, epilepsy, attention deficit, chronic fatigue, joint pain, asthma, migraines, menstrual cramps, and symptoms associated with menopause. Despite minimal scientific data that valerian can reduce coronary vessel spasm in certain cases, the remainder of these therapeutic claims are unsupported by any research at present.

As for Phenobarbital, it is an anticonvulsant barbiturate and DEA schedule IV controlled substance. There are no clinical trials supporting its use in cardiovascular or bronchospastic states. It can also alter the metabolism of other Rx when taken in combination – thus, gerontologists oppose its use in the elderly due to the high rate of physical dependence and risk of toxicity even at low doses.

And yet, the lack of controlled studies notwithstanding, in a number of countries, Corvalol is widely available – sometimes even mandated – in first aid kits (e.g., those accessible on public transportation), alongside aspirin, nitroglycerin, and activated charcoal, and freely dispensed as needed.

Sleep tight!

[Have an idea for a post topic? Want to be considered for a guest-author slot? Or better, perhaps you’d like to become a day-sponsor of this blog, and reach thousands of subscribers and Facebook fans? If so, please contact the Alienist at vadocdoc@outlook.com]

[Copyright 2013 @ The Alienist’s Compendium]