We'll prevent Alzheimer's before we prevent obesity: lessons of The Pill

There are, I heard on NPR, about 9 promising Alzheimer's prevention therapies in trial [1]. It's likely that, sometime in the next decade, one of them will be a mega-blockbuster -- the biggest change in medical care since the discovery of insulin.

On the other hand, I doubt we'll see a great obesity prevention therapy, despite the billions pharmas are investing into obesity research.

Why is one relatively easy, and the other so hard? Why is it so hard to come up with a safe and effective male contraceptive, but so easy to render women infertile? The Pill (oral contraceptive pill, aka OCP), after all, made its debut over 40 years ago.

The trick is whether one is fighting nature, or not. Women in pre-industrial societies are naturally infertile for most their reproductive years. They're either pregnant, lactating, or cyclically infertile. These are natural states, OCPs need only send "pregnant-lactating" signals and the body does the rest. On the other hand there is no natural state of male infertility. When you try to render a male infertile, you are fighting hundreds of millions of years of evolution.

Obesity is what happens when a biological system engineered to manage scarcity runs into an environment of abundance. The system crashes. Humans did not evolve to have access to so many calories all the time, like all animals we're engineered to use energy as efficiently as possible. Changing that means defeating evolution.

Cancer appears to be a process that natural selection has carefully tuned to balance biological repair mechanisms. It's darned hard to fight cancer.

Alzheimer's though, is a universal lifelong proces that disables the aged post-fertile human. It does not appear to have any significant evolutionary advantage, it is probably the end-result of a garbage collection process that works well within its operational "design" parameters. To delay the Alzheimer's process doesn't require defeating natural selection, so it's a much easier task that defeating obesity.

So I'm betting on an Alzheimer's preventive therapy long before a really good obesity preventive therapy.

[1] Note prevention and cure are different. There's not much prospect yet for curing Alzheimer's, though one might hope a good preventive therapy might allow natural reparative functions to operate better.

American food for people and pets: an industry insider speaks out

The author of this WaPo article was "president of NutraSweet Kelco Co. from 1994 to 1997. He is a management consultant to many large food ingredient companies." In other words, an insider with both biases and credibility. Emphases mine:

Peter Kovacs - It's Not Just Pet Food - washingtonpost.com

Lost amid the anxiety surrounding the tainted U.S. pet food supply is this sobering reality: It's not just pet owners who should be worried. The uncontrolled distribution of low-quality imported food ingredients, mainly from China, poses a grave threat to public health worldwide.

Essential ingredients, such as vitamins used in many packaged foods, arrive at U.S. ports from China and, as recent news reports have underscored, are shipped without inspection to food and beverage distributors and manufacturers. Although they are used in relatively small quantities, these ingredients carry enormous risks for American consumers. One pound of tainted wheat gluten could, if undetected, contaminate as much as a thousand pounds of food.

Unlike imported beef, which is inspected at the point of processing by the U.S. Agriculture Department, few practical safeguards have been established to ensure the quality of food ingredients from China.

Often, U.S. officials don't know where or how such ingredients were produced. We know, however, that alarms have been raised about hygiene and labor standards at many Chinese manufacturing facilities. In China, municipal water used in the manufacturing process is often contaminated with heavy metals, pesticides and other chemicals. Food ingredient production is particularly susceptible to environmental contamination.

Equally worrisome, U.S. officials often lack the capability to trace foreign-produced food ingredients to their source of manufacture. In theory, the Bioterrorism Prevention Act of 2001 provides some measure of traceability. In practice, the act is ineffective and was not designed for this challenge. Its enforcement is also shrouded in secrecy by the Department of Homeland Security.

Even if Food and Drug Administration regulators wanted to crack down on products emanating from the riskiest foreign facilities, they couldn't, because they have no way of knowing which ingredients come from which plant. This is why officials have spent weeks searching for the original Chinese source of the contaminated wheat gluten that triggered the pet food crisis.

That it was pet food that got tainted -- and that relatively few pets were harmed -- is pure happenstance. Earlier this spring, Europe narrowly averted disaster when a batch of vitamin A from China was found to be contaminated with Enterobacter sakazakii, which has been proved to cause infant deaths. Thankfully, the defective vitamin A had not yet been incorporated into infant formula. Next time we may not be so fortunate.

Currently, most of the world's vitamins are manufactured in China. Unable to compete, the last U.S. plant making vitamin C closed a year ago. One of Europe's largest citric acid plants shut last winter, and only one vitamin C manufacturer operates in the West. Given China's cheap labor, artificially low prices and the unfair competitive climate it has foisted on the industry, few Western producers of food ingredients can survive much longer.

Western companies have had to invest heavily in Chinese facilities. These Western-owned plants follow strict standards and are generally better managed than their locally owned counterparts. Nevertheless, 80 percent of the world's vitamin C is now manufactured in China -- much of it unregulated and some of it of questionable quality.

Europe is ahead of the United States in seeking greater accountability and traceability in food safety and importation. But even the European Union's "rapid alert system" is imperfect. Additional action is required if the continent is to avoid catastrophes.

To protect consumers here, we must revise our regulatory approaches. The first option is to institute regulations, based on the European model, to ensure that all food ingredients are thoroughly traceable. We should impose strict liability on manufacturers that fail to enforce traceability standards.

A draconian alternative is to mount a program modeled on USDA beef inspection for all food ingredients coming into the country. This regimen would require a significant commitment of resources and intensive training for hundreds of inspectors.

Food safety is a bipartisan issue: Congress and the administration must work together and move aggressively to devise stricter standards. Rep. Henry Waxman (D-Calif.), chairman of the House Government Reform Committee, has deplored dangerous levels of lead in vitamin products originating in China. We must get to the bottom of this pressing public health issue, without self-defeating finger-pointing.

The United States is sitting on powder keg with uncontrolled importation and the distribution of low-quality food ingredients. Before it explodes -- putting more animals and people at risk -- corrective steps must be taken.

Regulatory standards are a very tempting way to create de facto "protection" for selected industries. The protectionist impulse can do great economic damage, and the profits associated with such de facto tariffs are a rich source of political corruption in America. Alas, there may be no alternative. We don't have a proven market solution to this kind of risk, and our present failure makes action unavoidable. We will need new regulations for human food.

As for pet food - as I wrote earlier - there's a simple quasi-Libertarian solution. Pet food manufacturers should formulate a product for human consumption derived from the same sources as the animal product. This premium product would therefore fall under FDA regulation. The CEO and board would eat at their regular meetings, and major suppliers would be also be sent snacks. Selected pet owners who are also ambitious lawyers would add it a few snacks to their diet every few months. If a problem were then discovered, the legal onslaught would be brutal, effective, and highly profitable for the lawyers involved. Food that carried the "We eat our own dog food" slogan would sell for a premium price of course. A major US accounting firm would be engaged to manage the certification process, and to ensure that the CEO was dining properly.

Nasty, brutal, short - the life of most humans

I recently wrote of 19th century American aspirations for a 50 year lifespan. John Hawks describes other settings when life expectancy was about 35 ...

John Hawks Anthropology Weblog : 2007 03

Kim Hill and colleagues (2007) report in the current Journal of Human Evolution on the mortality profile of recent Hiwi hunter-gatherers. Here is their abstract:

"To our knowledge, interview-based life tables for recent hunter-gatherers are published for only four societies (Ache, Agta, Hadza, and Ju/'hoansi). Here, we present mortality data for a fifth group, the Hiwi hunter-gatherers of Venezuela. The results show comparatively high death rates among the Hiwi and highlight differences in mortality rates among hunter-gatherer societies. The high levels of conspecific violence and adult mortality in the Hiwi may better represent Paleolithic human demographics than do the lower, disease-based death rates reported in the most frequently cited forager studies."

...Among pre-1960 Hiwi males, 57 percent could expect to survive to age 15, and 43 percent to age 30, with an average young adult mortality rate of around 2 percent annually. So it is not anything like as high as has been suggested for Neandertals and earlier humans (with annual mortality rates as high as 6 percent).

The most interesting aspects of the paper are the comparisons between the Hiwi and other ethnographically-known hunter-gatherers. Many of the differences in mortality profiles are attributable to strong cultural differences:

"Cause of death among the groups differs considerably. Disease is an important cause of death in all groups, but represents only 20% of deaths in the precontact Ache, 45% among the precontact Hiwi, and about 75-85% of all Hadza, !Kung, and Agta deaths. Respiratory disease is the main killer of the Ache, whereas gastrointestinal pathogens are most important among the Hiwi and probably Hadza. Among the !Kung, respiratory and gut infections are about equally important. Violence is the major cause of death among the precontact Ache (55% of all deaths) and very important among the Hiwi (30% of all deaths), but notably less important in the two African societies and the Agta (3-7% of all deaths). Indeed, the crude homicide/warfare death rates per year lived are more than ten times higher among the Hiwi and Ache than among the Hadza or !Kung (1/100 and 1/200 per year for precontact Hiwi and Ache, respectively, vs. 1/2500 and 1/3000 for the Hadza and !Kung, respectively)..."

"If high mortality, warfare, homicide, and accidental trauma are typical of our Paleolithic ancestors, the Hiwi mortality patterns may be more representative of the past than those derived from other modern hunter-gatherers. If so, several observations about the Hiwi are important. First, conspecific violence was a prominent part of the demographic profile, accounting for many deaths in all age and sex categories. Most of the adult killings were due to either competition over women, reprisals by jealous husbands (on both their wives and their wives' lovers), or reprisals for past killings. The criollo-caused killings were motivated by territorial conquest. Moreover, infanticide (especially on females) constituted the highest mortality rate component of all Hiwi conspecific violence. Second, no predation deaths were reported despite attacks by anacondas, Orinoco caimans, and piranhas, and the presence of jaguars in the area. Accidents associated with the active-forager lifestyle were common, but disease was a more important killer, accounting for nearly half of all deaths. This suggests an adaptive landscape in which success in social relations, competitive violence, and disease resistance are paramount. This may partially explain why many of the genes that appear to have been under strong selection in the past 50,000 years affect either disease resistance or cognitive function (Wang et al., 2006), presumably related to success in an atmosphere of frequent violent social competition (Hill et al. 2007:451)."

These communities vary greatly in their level of violence. The most violent of them sound comparable to chimpanzees. The big surprise is how dominant these pre-technological human predators are. They died of disease or from conspecific violence or from accidents, not from other predators.

Nutro products: how NOT to do a pet food recall

Our dog's primary foods were not involved in the melanine recall (so far), but the company that makes some snacks we use had recalled gluten products. So one might think Nutro Products would be very careful about their statements on the rice recall.

Alas, their rice recall page simply says their rice containing products aren't derived from the known contaminated sources. As always, the unsaid words are important. They don't tell us that the products do not contain Chinese manufactured rice protein.

So we should assume they Nutro Food snacks do contain Chinese manufactured rice protein, we should assume that source is unreliable until proven reliable, and we should assume Nutro Products is being a bit dishonest about the risks of their foods. I've tossed this company's products, and we'll avoid them in the future.

I wonder if anyone will keep a global list ranking the quality of vendor responses to the melanine affair. It would be a handy reference to guide future buying decisions. If you know of such a list, send a note to jfaughnan@spamcop.net and I'll link to it.

Calendar curses: remembering Palm

I'm working on our family's week schedule, and again I weakly curse the state of 21st century calendaring. I have a work calendar on Outlook, a personal calendar on my Palm, and a variety of paper based family calendars. It's a mess and there's no solution on the market.

Which brings back a memory of a product that was briefly on the market, but which I can't locate on Google.

Back in the 90s, before they decapitated themselves and were simultaneously disemboweled by Microsoft, Palm was very focused on solving this type of problem. They introduced, or almost introduced, a home device that basically a "Palm server". It would hold the family calendar, and every family member would sync to it. I think it was supposed to be a "thin client" for email and kitchen web browsing as well.

Am I imagining this product, or did it ever come to market? It was near the end-time for Palm as a meaningful platform.

For now, I merely await the iPhone. I'm not overly optimistic, Apple's .Mac screw-up strongly suggests they've decided this problem is too hard to tackle.

The missing WMDs - only one man knows the truth

The latest mass delusion to strike the demoralized drones of American neoconservatism is that Iraq had oodles of WMDs that were spirited away by Russia and Syrian. The truth was then hidden in a Bush/Democrat conspiracy until a whacko British journalist found Dave Gaubatz, a civilian agent who worked for The U.S. Air Force's Office of Special Investigations. Gaubatz, it turns out, is the only man who will tell the real story.

Salon provides the gory details: Right-wing blogs discover massive conspiracy to hide WMDs in Iraq and suggests a visit to Gaubatz's web site. You'll have to find the URL on your own, but here's the first quote I found:

National Existence is political order experienced by men of the nation as a Rise to Being. Its opposite is a replacement of political order experienced by men, women, children and slaves as a Fall from Being. This Redirection in the experience of the Terms of Being (Self, Society, G-d and World) results in the collapse of Self into Society and all into World. The goal, wittingly or otherwise: a World State.

SANE opposes this Redirection and its manifestations: chants of Racism, Democracy, Equal Rights, Human Rights, Women's Rights, Animal Rights, and the always growing list of what is the Single Concept: Certainty/Uncertainty = Science/Open Society = World. To understand this reciprocal and how it affects a convergence of factors bent on the destruction of National Existence is to be SANE...

Gaubatz's other hobby, per quotes on unqualified offerings, is promoting the rightly privileged "distinct people" of "White Christians". UO also mentions "Dave Gaubatz was the 1st U.S. Civilian Federal Agent sent into Iraq at the start of Operation Iraqi Freedom in 2003". You could summarize the incompetency of the GOP and Bush administration with that single data point.

The American right has become a recursive engine of self-satirization. They'd be easier to pity if they weren't so nasty.

4/21/07: I had to rework the post title, I'd posted with the default link title. It occurs to me that this may be the kernel of a whacko "far right" 9/11 conspiracy theory, the complement to the whacko "left" delusion that a martians blew up the WTC (or whoever it's supposed to have been). Perhaps the two will unite someday ...

South Korea apologizes, America puzzled

Soo Yun, an American Journalist who was a Fulbright scholar in South Korea last year, describes a national South Korean apology to an inattentive America. I imagine the American ambassador must on the one hand accept graciously, but on the other hand point out that no apology is expected. Most Americans are probably oblivious to South Korea's distress. Today Americans do not have as strong a sense of collective ethnic identity as South Koreans.

So, South Korea, it's ok if you want to apologize, but, on average, most Americans probably don't expect it.

South Korean "blood" mythology is unusually strong, but it is not qualitatively different from other nations. Japan has a similar belief, though probably it is less strong now than it was 30 years ago. China was likewise appalled when Fox news reported the assailant was a Chinese student, and massively relieved when he was found to be 'South Korean raised in America'.

More broadly, consider this tribal identity in the context of these examples:

1. Who, if anyone, should apologize for the annihilation of the Amerindian, or for American slavery? Why should they apologize? Who inherits guilt, and why? How do societies answers change over time?
   
   
2. When can Germany stop apologizing for the Holocaust? How many generations are required? Does Germany have any moral responsibility to keep the memory of the Holocaust alive? (I'd say yes to the last, because of a much stronger version of #3, but it's debatable.)
   
   
3. American soldiers, during the disastrous early days of the Korean war, killed South Korean civilians to speed their escape. (The US Military has recently confirmed this story after an internal investigation - very quietly.) Should anyone living today apologize? (I'd say yes, because there's clear institutional continuity in the US military, but it's a debatable point.)
   
   
4. A euro-American wins a Nobel. Should black Americans be proud? Euro-Americans? The winner's mother? Euros? What if it's a Chinese American?
   
   
5. Canada wins an Olympic medal in Hockey. Should Canadians be proud of their team? What if Montreal wins the Stanley Cup over the Mighty Ducks (ha!) and the teams are both Russian?
   
   
6. Most citizens of the Arab world appear to hate Israel and Jews. A significant number were, at one time, sympathetic to attacks on the WTC. (I suspect that number has shrunk as everyone realizes that a crazed America is not a good thing.) Should an Arab-American apologize for this? (I'd say no, but I bet some apologize anyway ...)
   
   
7. Should Idi Amin's parents have felt guilty for his crimes? What about his teachers?
   

South Korea is a bit extreme, but if we examine the responses to these questions I think we'd find the differences are quantitative, but not qualitative. All humans struggle with the distinction between individual, family, tribe, nation, and culture and the notion of responsibility. Except, of course, for those of us who dispense with the concept of responsibility ...

Pet poisons: FDA suspects deliberate contamination

The theory that Chinese manufacturers spiked food with melanine to increase its apparent nutritional value now has FDA support:

Spiking theorized in pet deaths | Chicago Tribune

... Stephen Sundlof, chief veterinarian for the Food and Drug Administration, said melamine, which has turned up in more than 100 brands of cat and dog food, may have been used to falsely boost the apparent nutritional content of rice protein.

'That's still a theory but it certainly seems to be a plausible one,' he said.

In other news deaths are increasing in South Africa and contaminated feed has been fed to pigs. So melanine has probably entered the human food chain in a few places in the US.

Meanwhile, the Chinese government is declining requests for FDA visits and at least one US pet food manufacturer has sworn off any future Chinese sources.

We're going ahead with plans to make our own pet food.

How would a pet food company get our confidence back? They'd apply for permission to sell food for human consumption. They wouldn't actually sell the food for humans, but that would bring them into full FDA scrutiny. Then they'd provide a human-oriented version of their product for snacks at board meetings. If a company did all of that, I might be inclined to trust them ...

Parental controls - not an Apple thing

I have to limit the kids access to Google Video. Limit, as in, eliminate. Alas, Apple's parental controls are mediocre in 10.4 (better, supposedly, in the now delayed 10.5). If you allow access to a domain in Safari, you allow access to all. Apple's Airport Extreme has NO parental controls, my ultra-cheap DSL router has more.

I wonder how old Jobs kids are ...

1900 Predictions for 2000 - my version

Several bloggers have lately been choosing their favorites from predictions made by John Elfreth Watkins in 1900. He based his predictions on interviews with the best thinkers of the day.

Some predictions were way off (we have UPS trucks instead of pneumatic tubes), others were close or correct. The population prediction (350 million) was based on the US annexing most of the Americas, but that isn't too far off our current number. Trains (in France) easily hit 2 miles/minute. Photos are indeed "telegraphed" from China. Our "shells" can destroy entire cities. Automobiles are more affordable to us than horses were to Americans in 1900. We do "see around the world". Our domestic animals have become atrophied meat producing drones.

Other predictions were understandable but misguided exaggerations of the technology of 1900, such as high speed boats crossing the Atlantic (a consequence of assuming airplanes would not be used for mass transit). Overall, I think Mr. Watkins did extremely well, despite being far bolder than our current crop of timid futurists. I doubt our predictions of 2100 will be as accurate, mostly because of those pesky singularities.

The ones that most interest me are those that reflect the concerns of the day ....

1900 Predictions

Predictions of the Year 2000 from The Ladies Home Journal of December 1900

The Ladies Home Journal from December 1900, which contained a fascinating article by John Elfreth Watkins, Jr. “What May Happen in the Next Hundred Years”.

... Prediction #2: The American will be taller by from one to two inches. His increase of stature will result from better health, due to vast reforms in medicine, sanitation, food and athletics. He will live fifty years instead of thirty-five as at present – for he will reside in the suburbs. The city house will practically be no more. Building in blocks will be illegal. The trip from suburban home to office will require a few minutes only. A penny will pay the fare.

Prediction #3: Gymnastics will begin in the nursery, where toys and games will be designed to strengthen the muscles. Exercise will be compulsory in the schools. Every school, college and community will have a complete gymnasium. All cities will have public gymnasiums. A man or woman unable to walk ten miles at a stretch will be regarded as a weakling.

Prediction #4: There Will Be No Street Cars in Our Large Cities.... Cities, therefore, will be free from all noises.

Prediction #11: No Mosquitoes nor Flies. Insect screens will be unnecessary... The extermination of the horse and its stable will reduce the house-fly.

Prediction #12: Peas as Large as Beets. Peas and beans will be as large as beets are to-day. Sugar cane will produce twice as much sugar as the sugar beet now does. Cane will once more be the chief source of our sugar supply. The milkweed will have been developed into a rubber plant. Cheap native rubber will be harvested by machinery all over this country. Plants will be made proof against disease microbes just as readily as man is to-day against smallpox. The soil will be kept enriched by plants which take their nutrition from the air and give fertility to the earth.

Prediction #13: Strawberries as Large as Apples will be eaten by our great-great-grandchildren for their Christmas dinners a hundred years hence. Raspberries and blackberries will be as large.... Melons, cherries, grapes, plums, apples, pears, peaches and all berries will be seedless. Figs will be cultivated over the entire United States.

Prediction #16: There will be No C, X or Q in our every-day alphabet. They will be abandoned because unnecessary. Spelling by sound will have been adopted, first by the newspapers. English will be a language of condensed words expressing condensed ideas, and will be more extensively spoken than any other. Russian will rank second.

Prediction #28: There will be no wild animals except in menageries. Rats and mice will have been exterminated. The horse will have become practically extinct. A few of high breed will be kept by the rich for racing, hunting and exercise. The automobile will have driven out the horse...

Life beyond age 35. Food in abundance -- especially fruit. Death to the pesky, fly infested horse. Elimination of insects, mice, rats and every wild animal. Escape from the squalor and noise of the city. These were the desires of a people who lived with disease, miserable diets, and pests.

Mostly, the dreams of 1900 did come true, though we came to like wild animals more than Watkins could have imagined. Watkins would say we lived like gods, albeit, fat, flabby gods. In his day many earned their pay by physical performance -- he'd be appalled by our sloth.

Sachs: a new enlightenment so we may live

I've begun listening to the Reith Lectures, a series of five weekly presentations by Jeffrey Sachs. I gather from his introduction that the audience is formidable, but so are his ambitions. Sachs feels that we're careening towards a big, thick brick wall, and he's using his Reith lectures to call for a course correction.

Seems like something one might want to hear. BBC 4 Reith Lectures 2007: Sachs and the modern world - by mp3, podcast and rss has directions on how to subscribe. I've got two in iTunes so far.

The government owns your medical history

Holy cow.

...Anyway, scrolling down to the section on “Use and Disclosure of Information”, we see that among the people authorized to check out your prescription drug history are:

any local, State, or Federal law enforcement, narcotics control, licensure, disciplinary, or program authority, who certifies, under the procedures determined by the State, that the requested information is related to an individual investigation or proceeding involving the unlawful diversion or misuse of a schedule II, III, or IV substance, and such information will further the purpose of the investigation or assist in the proceeding;

…as well as:

any agent of the Department of Health and Human Services, a State medicaid program, a State health department, or the Drug Enforcement Administration who certifies that the requested information is necessary for research to be conducted by such department, program, or administration, respectively, and the intended purpose of the research is related to a function committed to such department, program, or administration by law that is not investigative in nature;

…and a few other people as well.

So, no federal database, just fifty-one state databases that the feds and state and local governments can go browsing through every time they decide you’ve done something bad.

I feel like I've just passed into another dimension. I'd predicted this would happen in 1996 (I was hardly alone), though I'd naively thought it would take far more than 9/11 to send us down this road. This was all done by the party that claims to fear government. Obviously, what they meant was they fear any government but their own.

Their are no such thing as "privacy nuts", because their record of being right is unassailable.

How long to make the Blacksburg schizophrenia connection?

I've been curious how long it would take the media to make the obvious connection between the Blacksburg disaster and schizophrenia.

As of today, a Google news search has five hits.

If I were running the planet (be afraid), I'd assemble a group to review what policy, educational, and legal changes should be made to improve the recognition and management of psychotic disorders (schizophrenia, major depression, mania, etc) in young adults. The group would be asked to consider management in the context of families, tribes, and cultures that deny the biological reality of psychiatric disorders. The denial group is large, and it includes most American social conservatives.

As ruler of earth, I'd also ask my science czar (I'd have a large science department) to review research on the prevention and management of schizophrenia, and to review the relationships between autism-spectrum disorders and schizophrenia.

I can only hope the worldmind will see things my way, and that the hit count will be higher a week from now.

Update 4/21/07: There's been much more discussion about the schizophrenia (and even autism) connection, including a Slate article that linked to an FBI analysis of the Columbine murders. That's a link worth following, btw.

Why are so many products so bad? Assymetrical information theory

Does this explain why we can't buy a good toaster any more? Or why pet food doubles as a euthenasia agend?

Schneier on Security:

...In a market where the seller has more information about the product than the buyer, bad products can drive the good ones out of the market...

This is asymmetric information theory, which won a Nobel in 2001. In a market where brands are not meaningful, doesn't the seller always have more product information than the buyer?

Returning vets: medical care and other support

I'm attending the annual CME program of the Minnesota Academy of Family Practice, and I'm impressed. Regardless of the parlous state of American primary care in general, and family medicine in particular, this inexpensive [1] educational program just keeps getting better. The most memorable presentation thus far is unique enough, I think, to merit a post.

Colonel Basic LeBlanc, MD, of the 1BCT 34th ID "Red Bulls" (Minnesota) spoke on the medical care and global support of the returning soldier. Here are my quick notes. They are not his words, but even so I will try to separate my comments:

• Wounded to death ratio in Vietnam: 2.6/1. In Iraq: 16/1.
  [jf: If one adjusts for this, then the 3,000 American dead today would have been about 15,000 in the 1970s. That's a significant fraction of the 50,000 US soldiers who died over 20 years in Vietnam. Is this war more routinely violent than the Vietnam war?]
  
  
• 25-30% of returning soldiers will experience some form of emotional "disorder", usually transient.
  
  
• Driving behavior is a significant issue for many.
  [jf: My take home -- I'll strive to be sympathetic to aggressive and seemingly irrational drivers. They may be struggling with "transitioning the combat skill". Of course I always give "bad" drivers lots of room, but it will help me be more patient.]
  
  
• Questions to avoid asking vets: "Did you kill anyone?" [jf: apparently it does get asked], "How's it going over there?", and "When do you go back?".
  
  
• Question for caregiver to ask: "How are you and your family doing?"
  [jf: In general the returning vets are said to welcome comments of appreciation, presumably not including any personal opinions on the incompetence of the President.]
  
  
• Traumatic Brain Injury (TBI): LeBlanc spoke on this, but he didn't give numbers. I got the feeling this was a sensitive topic, but maybe I'm imagining things. If one speculates that there are 48,000 significantly wounded vets, and that half of them have moderate to severe TBI, that's a lot of eternal disability. That would make sensitivity understandable. Many of the care references LeBlanc provided were for Traumatic Brain Injury care.
  
  
• The VA will likely be swamped, much vet care will have to be done in coordination with the VA by non-VA staff. If you're providing medical care, the key to coordination with the VA is to learn the "soldier's VA representative".
  
  
• Military OneSource (1-800-342-9647) is the 24x7 coordinating site for many care related issues.
  

Additional resources:

1. Post deployment health evaluation and management
2. Craig hospital brain injury information
3. Defense and veterans brain injury center
4. Brain injury resource center
5. Book: Courage after Fire
   

[1] OK, so it's heavily subsidized by drug companies, none of whom are doing this from the goodness of their mercantile hearts.