The Grumpy Doc – Grumpy opinions about everything.

Vaccinations for Older Adults

On October 14, 2024

What You Need to Know

As we age, our immune systems naturally weaken, making us more susceptible to infections and illness. For senior citizens, staying healthy can sometimes be a challenge, but one of the most effective ways to protect yourself is through vaccinations. In this article, we’ll explore the key vaccines that are especially important for older adults and discuss why staying up to date with them can have a significant impact on your health and quality of life.

Why Vaccines Matter for Seniors

Vaccines are not just for children. In fact, as we get older, some vaccines lose their effectiveness, and the risks of certain diseases increase. Conditions such as pneumonia, shingles, and flu can become more severe in older adults, leading to complications like hospitalization or even death.

Additionally, some seniors may have underlying health conditions like diabetes, heart disease, or chronic lung disease, which further increase the risks associated with preventable infections. Vaccinations help reduce these risks by boosting your immune system and offering protection against specific diseases.

Key Vaccines for Senior Citizens

Influenza (Flu) Vaccine: The flu is not just an inconvenience, it can be dangerous, particularly for people over 65. Every year, the flu leads to serious complications in seniors, including pneumonia. The CDC recommends that everyone 65 and older get a high-dose flu vaccine annually, as it is formulated to better stimulate the aging immune system. Even if the flu vaccine doesn’t entirely prevent infection, it often reduces the severity of the illness. Remember, the Spanish Flu pandemic of 1918-1920 was one of the deadliest of all time with estimates of death ranging from 17 to 50 million with some estimates as high as 100 million.
Pneumococcal Vaccine: Pneumococcal diseases, such as pneumonia, meningitis, and bloodstream infections, are significant threats to older adults. The CDC recommends two types of pneumococcal vaccines for those 65 and older:
1. PCV20 or PPSV23: Typically given once, offering broad protection against the most common strains of pneumococcus. If you have never been vaccinated, the PCV20 is the main recommendation.
1. PPSV23: If PCV15 was given initially, a dose of PPSV23 should be given at least one year later. If you had the older PCV13 (but not PCV15), your physician may recommend the PCV20 for additional coverage. The combinations of pneumococcal vaccines can be confusing, so check with your physician.
Shingles Vaccine (Herpes Zoster): Shingles is caused by the reactivation of the chickenpox virus (varicella-zoster) and is more common and severe in older adults. The shingles vaccine, Shingrix, is recommended for adults over 50 and is given in two doses. Shingrix provides strong protection against shingles and its most serious complication, postherpetic neuralgia (PHN), a painful condition that can last for months or even years after the rash disappears.
Tetanus, Diphtheria, and Pertussis (Tdap): Every adult should receive a Tdap booster, which protects against tetanus, diphtheria, and whooping cough (pertussis). For seniors, a Td booster is recommended every 10 years to maintain protection. Tetanus can enter the body through cuts or scrapes. Both pertussis, which is increasing in incidence, and diphtheria, which is extremely rare, can be serious, or fatal, for older adults.
COVID-19 Vaccines and Boosters: While the pandemic has become more manageable, COVID-19 still poses a threat, especially to older adults. COVID vaccines and boosters have significantly reduced severe illness and hospitalization. Unvaccinated patients are 2.5 times more likely to die from a COVID-19 infection than are the vaccinated. The discrepancy is even higher among older patients. The CDC continues to update its guidelines for boosters, so it’s important for seniors to stay current with recommendations, especially if they have underlying conditions.
Respiratory Syncytial Virus (RSV) Vaccine: RSV is a common virus that can cause severe respiratory illness in older adults. It is recommended for most adults beginning at age 60. Consideration should be given to vaccinating younger adults with chronic heart or lung disease, diabetes, or a weakened immune system due to cancer or chronic immunosuppressant medications.

The Benefits of Staying Up to Date

Vaccinations for seniors are about more than just preventing illness. They help reduce the severity of disease, prevent complications, and decrease the likelihood of hospitalization. Staying current with vaccines also has a community benefit. By protecting yourself, you help limit the spread of contagious diseases to more vulnerable populations, including those with weakened immune systems.

Talk to Your Healthcare Provider

As always, it’s essential to consult with your healthcare provider before getting vaccinated, especially if you have underlying health conditions. Your doctor can help you determine which vaccines are most appropriate for you based on your age, medical history, and lifestyle.

Conclusion

Vaccinations are a critical part of staying healthy as we age. By keeping your vaccines up to date, you not only protect yourself but also contribute to the overall health of your community. If you’re unsure about which vaccines you need, schedule an appointment with your healthcare provider to discuss a vaccination plan that will keep you protected for years to come. Remember: Prevention is the best medicine, and vaccines are a simple, safe, and effective way to reduce the risk of serious illness as we get older.

Understanding Vitamins, Supplements, Herbal Preparations, Patent Medicines, and Homeopathic Medications

By John Turley

On October 4, 2024

In Commentary, Medicine

What you should know.

The cost of prescription medications is almost constantly in the news. It has even become a topic of debate in the current presidential elections. Americans spend over $500 billion annually on prescription medications. This includes drugs covered by insurance, and out of pocket costs and specialty drugs for chronic conditions.

But this is not the only expense Americans have for drug related health care items. Almost $90 billion a year is spent on nonprescription preparations.

The shelves of pharmacies, health food stores and convenience stores are lined with a vast array of vitamins, supplements, patent medicines, herbal preparations, and homeopathic medications. They are also available from hundreds of online sources, both reputable and of questionable origin.

Many people turn to these products in the hope of improving their health, boosting their immune systems, or addressing specific ailments. However, the development, testing, approval processes, and regulation of these products can be confusing, even for the most educated consumer. We will delve into each of these classes of health products, exploring how they are developed, tested, and regulated, and highlighting some potential drawbacks of which you should be aware.

Vitamins and Dietary Supplements

Development and Testing

Vitamins and dietary supplements include a broad range of products such as vitamins, minerals, amino acids, and other nutritional components. These products are typically developed through a combination of scientific research and commercial interest. Manufacturers may isolate nutrients from food sources or create them synthetically. Testing often involves ensuring that the products contain the stated ingredients in the correct amounts. However, unlike pharmaceuticals, these products are not usually subject to rigorous clinical trials to prove efficacy and safety before they are marketed.

Approval Process

In the United States, vitamins and dietary supplements are regulated by the Food and Drug Administration (FDA) under the Dietary Supplement Health and Education Act (DSHEA) of 1994. Under DSHEA, manufacturers are responsible for ensuring the safety and labeling of their products before they reach the market. However, the FDA does not approve dietary supplements before they are sold. Instead, the FDA can take action against any supplement that is found to be unsafe once it is on the market.

Drawbacks

One of the primary drawbacks of dietary supplements is the lack of pre-market approval, which means that the burden of proving safety is often on the consumer or the FDA post-market. This can lead to situations where unsafe or ineffective products remain on the market until sufficient adverse events are reported. Additionally, the quality of supplements can vary widely between manufacturers, and contamination with other substances is a known risk. Although, given the competitive nature of these products and the number of distributors, questionable products are usually forced out of the market early.

Herbal Preparations

Development and Testing

Herbal preparations include products made from plants or plant parts, used for their supposed medicinal or therapeutic properties. The development of these products is often rooted in traditional medicine practices, although modern herbal preparations may undergo some degree of scientific research. Testing for herbal preparations can vary widely; some are backed by clinical studies, while others rely on anecdotal evidence or traditional use.

Approval Process

The FDA considers herbal supplements as foods, not medicines. So, they are not subject to the same testing, manufacturing, and labeling standards and regulations as medicines.

This means they do not require pre-market approval by the FDA. However, in other parts of the world, such as Europe, herbal products may undergo more rigorous testing and regulation. All herbal products that display an intended use must be accompanied by a box warning stating: “These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnosis, treat, cure or prevent any disease.”

Drawbacks

The primary concerns with herbal preparations are the variability in potency and the potential for contamination or adulteration with other substances. Additionally, the lack of standardization in the preparation of herbal products can lead to inconsistent effects. Herbal supplements, unlike medicines, do not need to be standardized to make sure of batch-to-batch consistency. Some herbs can also interact with prescription medications, leading to adverse effects.

Homeopathic Medications

Development and Testing

Homeopathic medications are based on the principle of “like cures like,” where substances that cause symptoms in a healthy person are believed to cure similar symptoms in a sick person when taken in highly diluted forms. The development of homeopathic remedies typically involves diluting a substance repeatedly until little to no trace of the original substance remains.

While counterintuitive, homeopaths believe that a homeopathic medicine is more powerful the more times the active ingredients have been diluted. A 6X potency indicates that the drug has been diluted at a ratio of 1 to 10 for a total of six times. A C potency means the dilution ratio is 1 to 100. The higher the numeral, the lower the concentration of active ingredients in the medicine.

Testing in homeopathy is controversial, as traditional scientific methods, such as randomized controlled trials, often find no evidence that homeopathic remedies are more effective than a placebo. Some supporters claim that homeopathic remedies are developed for a specific patient making general testing irrelevant.

Approval Process

In the U.S., homeopathic medications are subject to regulation by the FDA under a different framework compared to dietary supplements. Historically, these products were allowed to be sold without pre-market approval as long as they were prepared according to the guidelines of the Homeopathic Pharmacopeia of the United States (HPUS) and the FDA’s Good Manufacturing Practices. All products are required to be clearly marked as “homeopathic”. In recent years, the FDA has increased scrutiny of homeopathic products, particularly those marketed for serious conditions, or containing potentially harmful ingredients, as well as those for eye conditions, and all homeopathic injectables.

Drawbacks

The major drawback of homeopathic medications is the lack of scientific evidence supporting their efficacy. Most scientific reviews and clinical trials have found that homeopathic remedies do not perform better than placebos. Moreover, because homeopathic products are so highly diluted, they are generally considered safe, but they may delay patients from seeking effective medical treatments for serious conditions.

Patent Medicines

History and Evolution

Patent medicines have a colorful history. They began in the 19th century and were popular into the early 20th century before evolving into the over-the-counter industry that we now know. This class includes many modern over the counter medications produced by reputable drugs companies and also medications of dubious quality and effectiveness produced in garages and basements.

In the late 19th and early 20th centuries, medicine wagons and medicine shows became popular vehicles for the promotion and sale of patent medicines. These traveling shows often combined entertainment with health claims, featuring acts such as music, magic tricks, and even wild west performances. At the center of the spectacle, a charismatic “doctor” or salesman would tout the benefits of their patent medicine—a proprietary formula claimed to cure a wide range of ailments.

Patent medicines of this era were largely unregulated, and their ingredients were often a secret. Some contained alcohol, opium, or other stimulants, which provided temporary relief or a placebo effect. Because there were few laws governing their production and sale, these concoctions could be marketed without scientific proof of their efficacy or safety.

Medicine shows traveled to rural and urban areas alike, attracting customers who had little access to conventional medicine, particularly those in remote regions. Unfortunately, these products were often ineffective or even dangerous. The rise of the Pure Food and Drug Act of 1906, which required the labeling of ingredients and restricted misleading claims, signaled the decline of these shows and the broader patent medicine industry.

A few of the original patent medicines stayed on the market until the late 20th century. The most famous of these was Carter’s Little Liver Pills which was touted for curing headaches, constipation, dyspepsia and biliousness. Lydia Pinkham’s Vegetable Compound which was sold for “female complaints “, is still on the market though it has been significantly reformulated. A number of medications on the market now could be considered as the descendants of early patent medicines, perhaps the best known of these is Geritol

Approval Process

Modern patent medicines fall into the category of over the counter (OTC) drugs. Preparation of these medicines must either follow a monograph established by the FDA (essentially a recipe book) or undergo New Drug Application (NDA) process. All patent medicines must comply with strict labeling standards and include accurate ingredient lists, dosage instructions, and warnings. Any health claims must be supported by scientific evidence.

Drawbacks

There are several drawbacks to over the counter (patent) medications. There’s a significant risk that people may intentionally take more than the recommended doses. This is particularly dangerous with some medications such as Tylenol which can lead to liver damage. People may use medications for a longer than the recommended period. They may also be used in an attempt to treat conditions for which they are not intended. They may mask symptoms of a more serious condition leading to a delay in seeking appropriate medical care.

Conclusion

Vitamins, supplements, herbal preparations, patent medicines and homeopathic medications each occupy a unique space in the health and wellness industry. While they offer consumers more choices in managing their health, the differences in how these products are developed, tested, and regulated are significant. As a consumer, it’s essential to be informed about these differences to make safe and effective choices.

I’d like to thank my friend Steve Kaplan, a Registered Pharmacist, who is also my coauthor for this post.

An Observation

By John Turley

On October 1, 2024

In Uncategorized

Never underestimate the power of stupid people in large groups.

-George Carlin

Of Echo Chambers And Filter Bubbles

By John Turley

On September 27, 2024

In Uncategorized

The time has come, the Walrus said,
To talk of many things:
Of shoes – and ships – and sealing-wax –
Of cabbages and kings –
Louis Carroll
“The Walrus and the Carpenter”

Introduction

Recently, I have been researching the role of social media and the spread of modern propaganda. One of the things that surprised me, although it probably shouldn’t have, is how rapidly misinformation spreads over the internet as compared to verifiable fact-based information. I choose to use the term verified or verifiable rather than true or truth. It seems to me that we have entered an age where each person decides on their own version of truth. Truth has become relative. It’s based not on verifiable and reproducible facts but rather on who said it, where you read it, or if you agree with it. If it doesn’t fit with your preconceived notions, it can’t possibly be true.

A study by three MIT researchers found that false news spreads more rapidly on the social network Twitter (now X), by a substantial margin, than does factual news. “We found that falsehood diffuses significantly farther, faster, deeper, and more broadly than the truth, in all categories of information, and in many cases by an order of magnitude,” reported Sinan Aral, a professor at the MIT Sloan School of Management.

They found the spread of false information is not due primarily to bots programmed to disseminate inaccurate stories but rather due to people intentionally retweeting inaccurate news items more widely than factual statements.*

To better understand how social media impacts propaganda, it is important to understand how this phenomenon occurs. This leads to two related concepts, Echo Chambers and Filter Bubbles.

Echo Chambers

An echo chamber is a social structure in which individuals intentionally surrounded themselves only with those who share similar views and opinions. Within these chambers, dissenting opinions are either absent or actively suppressed, leading to the reinforcement of existing beliefs. On social media, echo chambers are created by users themselves, as they choose to follow, like, and share content that aligns with their views while ignoring or blocking contrary perspectives. This self-selection creates a feedback loop where individuals only hear what they already believe, which further entrenches their views.

Filter Bubbles

While echo chambers are largely the result of individual choices, filter bubbles are often shaped by algorithms. Social media platforms and search engines use algorithms to curate content for users based on their past behavior, what they click on, like, or share. The stated intention behind these algorithms is to provide users with content that is most relevant to them. But we shouldn’t overlook that it is also a method to make users more receptive to focused advertising and other forms of influence. The net result is a significant narrowing of the variety of opinions presented.

Individual Choice

Both echo chambers and filter bubbles limit the diversity of information by consistently show users content that aligns with their established interests and beliefs, isolating them from conflicting viewpoints and leading to a narrow and sometimes distorted understanding of the world. Over time, this can result in a skewed perception of reality, where the individual believes that their perspective is universally accepted or unquestionably correct.

While echo chambers and filter bubbles are often discussed in terms of algorithms and platform design, it is crucial to recognize the role of individual decisions in their creation and perpetuation. Each time we choose to follow a particular account, share a piece of content, or engage in a discussion, we are making decisions that shape our information environment.

The choices we make, whether to engage with diverse perspectives or retreat into familiar territory, have a profound impact on the information we encounter and share. When we choose to engage only with like-minded individuals and content, we contribute to the formation of echo chambers. Similarly, when we rely on algorithms to curate our content without seeking out alternative viewpoints, we become trapped in filter bubbles.

Echo chambers and filter bubbles are not exclusive to any political affiliation, religion, ethnicity, or social class. They are found across society. The willing acceptance of echo chambers and filter bubbles is the antithesis of critical thinking. When we fail to recognize that we are not considering alternative views, regardless of our political orientation, we are succumbing to indoctrination rather than education. We become unthinking automatons rather than critical thinking individuals who decide what is best for ourselves. Failure to actively engage with the information that we receive, to ensure that we receive multiple viewpoints (even those with which we disagree) and then failing to critically evaluate everything presented is a sure recipe for a loss of freedom.

*The paper, “The Spread of True and False News Online,” was published in Science, 9 March 2018

A Simple Guide to Understanding Common Blood Tests

By John Turley

On September 21, 2024

In Medicine

Introduction

Blood tests are a common part of both health maintenance and diagnostic visits. Doctors order blood tests to assess and monitor various aspects of a patient’s health. Blood tests can help detect illnesses, confirm a diagnosis, or monitor ongoing health conditions. For example, a complete blood count (CBC) checks for conditions like anemia or infection, while a lipid panel measures cholesterol levels to aid in assessing heart disease risk. Blood tests can also monitor organ function, such as the liver and kidneys, ensuring they are working properly. They are used to track how well treatments, like medications, are working, or to detect side effects that might not be immediately apparent. Additionally, blood tests provide crucial information about electrolyte levels, hormone balances, and metabolic activity, helping doctors make informed treatment decisions. Overall, these tests give doctors a detailed look at the body’s internal functions, often identifying potential issues before they become more serious or even apparent.

Understanding Normal Ranges

Before discussing the individual tests, let’s look at how you should go about understanding the results that are being presented. Blood tests are reported quantitatively, that is the results are shown as numbers. Along with the value for your individual test you will find the reference range. This is the range of normal values from low to high established by the lab. It can vary slightly from lab to lab. Values from one lab are not always directly comparable to those of another. Individual labs may also change their reference range from time to time.

How are these normal ranges established? They are established through population studies that consider large samples of healthy individuals and look at factors like sex, age and ethnicity. The standard normal values are developed using a bell-shaped curve. “Normal” is usually defined as those test results that fall within two standard deviations of the mean, that includes about 95% of all results. This leaves about 5% of the normal healthy population with test results that will be slightly outside the normal range presented. That’s why it’s important to discuss your individual results with your doctor to get a better understanding of where you fit in the normal range and whether a minimally abnormal result is of true clinical significance.

Commonly ordered blood tests

1. Complete Blood Count (CBC)

A CBC measures the different components of your blood, which includes:

Red Blood Cells (RBCs): These carry oxygen from your lungs to the rest of your body. Low levels could indicate anemia. There are also several conditions that can cause elevated levels.
White Blood Cells (WBCs): These help fight infections. If they’re too high, it might mean an infection, inflammation, or other conditions such as leukemia.
Hemoglobin: This is the protein in red blood cells that carries oxygen. Low hemoglobin often points to anemia which can be caused by several underlying problems.
Hematocrit: This is the percentage of red blood cells in your blood. It helps to diagnose anemia or dehydration.
Platelets: These help your blood clot. Abnormal levels can lead to excessive bleeding if levels are low or excessive clotting problems if levels are high.

Why it’s important: CBC is a key test to diagnose infections, anemia, or clotting issues.

2. Comprehensive Metabolic Panel (CMP)

A CMP checks the body’s metabolism and organ function. It includes:

Electrolytes: Sodium, potassium, and chloride are vital for nerve and muscle function. Abnormalities can cause weakness or heart arrhythmias.
Blood Urea Nitrogen (BUN) and Creatinine: These measure kidney function. High levels may indicate kidney disease.
Glucose: Blood sugar levels; important for diagnosing diabetes.
Liver Enzymes (ALT, AST): Elevated levels can indicate liver damage.
Albumin: A protein made by the liver; low levels may be associated with liver or kidney disease or other metabolic disorders.

Why it’s important: The CMP gives a broad view of how your liver, kidneys, and metabolism are functioning.

3. Thyroid Panel

The thyroid panel includes:

Thyroid-Stimulating Hormone (TSH): Signals the thyroid to produce hormones. High TSH often means low thyroid activity (hypothyroidism), while low TSH can indicate overactivity (hyperthyroidism).
T3 and T4: These hormones regulate metabolism. Abnormal levels can affect energy, weight, and mood.

Why it’s important: Thyroid issues can cause fatigue, weight changes, and mood disturbances; this panel helps evaluate the cause of those conditions.

4. Hemoglobin A1C

This test measures your average blood sugar levels over the past 2-3 months. It’s used to:

Diagnose diabetes: An A1C of 6.5% or higher from most reference labs indicates diabetes.
Monitor diabetes: For people with diabetes, it helps gauge how well blood sugar is being controlled.

Why it’s important: A1C is crucial for diagnosing and managing diabetes, as it provides a long-term view of blood sugar control. A1C will be discussed in more detail in a future article on diabetes.

5. Vitamin D Levels

Vitamin D helps regulate calcium and phosphate, which are important for bone health. Low levels are common and can lead to:

Bone weakness: This can cause conditions like osteoporosis.
Fatigue and muscle pain.

Why it’s important: Many people are deficient in vitamin D, and low levels can increase the risk of bone fractures and other health issues.

6. Vitamin B12 Levels

Vitamin B12 is essential for nerve function and producing red blood cells. A deficiency can cause:

Fatigue and weakness: Low B12 can lead to anemia.
Nerve damage: Tingling, numbness, or memory problems may occur with long-term deficiency.

Why it’s important: Identifying B12 deficiency is key, especially in older adults, as it can prevent neurological and cognitive problems.

7. Prostate-Specific Antigen (PSA)

PSA is a protein produced by the prostate gland. High levels of PSA can indicate:

Prostate cancer.
Benign prostatic hyperplasia (BPH): An enlarged prostate, which is common as men age.
Prostatitis: Inflammation or infection of the prostate.

Why it’s important: PSA is used primarily for early detection of prostate cancer, especially in men over 50. PSA will be discussed further in a future article on prostate cancer.

8. Cholesterol Panel (Lipid Panel)

This test measures fats in the blood, including:

Total Cholesterol: High levels indicate increased risk of heart disease.
Low-Density Lipoprotein (LDL): Often called “bad” cholesterol, high LDL can lead to plaque buildup in arteries.
High-Density Lipoprotein (HDL): Known as “good” cholesterol, HDL helps remove LDL from the arteries.
Triglycerides: Another type of fat that, when elevated, raises the risk of heart disease.

Why it’s important: Monitoring cholesterol is crucial for heart health, as high cholesterol is a major risk factor for heart disease and stroke.

Significance of Abnormal Results

Abnormal test results don’t always mean something immediately serious, but they can be early warning signs. For example:

High glucose or A1C: Could indicate diabetes or prediabetes.
Low red blood cells or hemoglobin: Suggests anemia, possibly from iron deficiency or chronic disease.
High liver enzymes: May indicate liver inflammation or damage, possibly from alcohol use or infections like hepatitis or overuse of medications such as acetaminophen.
High PSA: Could be a sign of prostate cancer, but it could also result from less serious conditions like an enlarged prostate or a prostate infection.

Review your blood tests with your doctor. The better you understand your individual results, the better you can participate in your own health management. This knowledge can be empowering when choosing the health care plan that is best for you.

The Grumpy Doc says see your doctor and ask questions. Your doctor should never be offended by questions; they will be glad you are taking an active interet in your health care. Take a written list of your concerns with you so you don’t forget what you wanted to ask. Even The Grumpy Doc occasionally forgets things (as difficult as that may be to believe).

A Philosophical Chuckle

By John Turley

On September 18, 2024

In Humor

Words to live by.

The Pot Predicament

By John Turley

On September 13, 2024

In Commentary, Politics

Recently, the Charleston City Council passed a bill to reduce the penalties for the possession of marijuana for personal use. This started me thinking about marijuana and its long intertwining with my generation. I first became aware of marijuana in my early teenage years, more than sixty years ago. At that time, possession of marijuana for personal use was a crime, as it still is in much of the country now, and it remains a federal crime. Soon after I became conscious of the whole thing, marijuana was incorporated into President Nixon’s war on drugs.

This is a war which sadly we continue to lose. This doesn’t stop us from pouring resources into a part of that war that doesn’t need to be fought. For as long as I can remember, we have continued to prosecute and imprison people who possess marijuana for their own use. I’m not going to discuss possession of marijuana for distribution, that’s a separate problem, one I think will take care of itself if we properly address marijuana for personal use.

Laws against personal use of marijuana remind me much of the failed experiment of prohibition. If people want something enough, they will find it regardless of what the law says. Most of the people imprisoned for personal possession of marijuana represented little or no threat to society as a whole and no one benefited from their imprisonment.

I know the arguments for and against. The health arguments on the pro side say it relieves glaucoma, chronic pain and anxiety. On the con side, there are arguments saying that it is addictive, it can cause cognitive delay and accelerate the development of psychosis. There have been many arguments surrounding marijuana as a gateway drug. I haven’t seen any convincing evidence that restricting personal use of marijuana makes any difference in use of other drugs. The only exception may be those cases where people become hooked on fentanyl or heroin that has been used to lace their marijuana.

My argument against laws criminalizing personal use is that they don’t work. We have spent millions, perhaps billions, of dollars and hundreds of thousands of law enforcement hours to enforce laws that in the long run have no real benefit.

I think it would make better sense to legalize marijuana for personal use. That way, like the alcohol and tobacco industries, it can be regulated with inspections and oversight activities. Customers would know it had not been contaminated with other dangerous drugs. It could also be taxed and distributed through businesses that would benefit from legitimate sale. The tax revenue could be used to fund drug treatment plans for our serious opioid crisis. That is the one war on drugs that we must win but in which we continue to fall further behind. Redirecting funds from marijuana enforcement to opioid treatment and enforcement will help save lives.

If personal use of marijuana is legalized, criminal distribution will rapidly fall away as there will be no profit. The street corner pot dealer will become a historical footnote, much like the prohibition era bootlegger.

I know some of you are thinking I must be an old hippie sitting around my living room smoking a joint and listening to the Grateful Dead. Even though I came of age in the Age of Aquarius, I’ve never tried marijuana and have no plans to do so whether it’s legalized or not. I have no objection to it, it’s just that as a younger man I preferred beer, as I got older, I migrated to wine and martinis, and now I’m too old to change.

The bottom line is this: we live in an age of limited resources, and we need to decide how we are going to utilize those resources. I would like to see us take those financial and human resources and utilize them to address the opioid and methamphetamine crises. We are currently wasting too many of these precious resources trying to enforce unnecessary and ultimately unenforceable laws against personal possession and use of marijuana. If we legalize personal possession, we will reduce crime and all but eliminate the illegal trafficking in marijuana.

That is my grumpy opinion.

A Book Report

By John Turley

On September 8, 2024

In Commentary, History, Politics

On Tyranny: Twenty Lessons From The Twentieth Century

Timothy Snyder

I don’t believe I have written a book report since I was a freshman in college. This is a small book that I believe is well worth your time to read. I mean small book quite literally. It’s about 4 1/2 inches by 6 1/2 inches and only about 126 pages of fairly wide spaced text. You can read the entire book in an afternoon and still have time left over. The book is also available as an audiobook, and it’s combined with Twenty New Lessons From Russia’s War On Ukraine. I got the audio book and listened to it as well. That will take about eight hours to complete.

I’m calling this a book report rather than a book review because I want to tell you what’s in the book rather than what I think about it so that you can form your own opinion. First, I’ll give you an overall impression. It’s thought provoking and raises issues of concern to us today. You may not agree with it. I don’t agree with everything that he said. I found some of his 20 lessons to be redundant because I thought he was stretching to get 20 lessons for the 20th century. I also found one or two of them to be painfully obvious. What follows is just a summary of the book. Read it and e-mail me or call me if you’d like to discuss it. I will send the book to the first person who asks for it, but only if you promise to pass it on when you’re finished.

Doctor Snyder is a professor of history at Yale University. He specializes in Central and Eastern Europe and has spent considerable time in Ukraine. He’s the author of 15 books and reads five European languages and can converse in ten.

Preface

The book begins with a preface in which Doctor Snyder establishes the importance of historical awareness. He describes the failure of some 20th century European democracies and their descent into authoritarian rule. He uses these examples to illustrate how democracy cannot be taken for granted. He makes the argument that democracy is fragile and must be defended. He further argues that even in the United States, the continuation of our democracy is not a given and we must fight for freedom and maintain constant vigilance over our democratic processes.

Each of his twenty lessons is contained in a separate chapter, varying from a few pages to a single sentence.

The Twenty Lessons

Do Not Obey In Advance: Many authoritarian regimes have achieved their power from the people’s willingness to conform without being forced. Do not comply with unjust policies that are not being actively enforced.
Defend Institutions: Democratic institutions such as courts, the press, and unions are an important part of a free society. We must support and defend them against attacks and subversion.
Beware The One-Party State: A multiparty system is crucial for the survival of liberty. The rise of a one-party system often precedes the decline of democratic government.
Take Responsibility For The Face Of The World: The use of symbols in public spaces matters. Authoritarian regimes can shape public perceptions by co-opting national symbols and using them to create division rather than unity. Be vigilant for and challenge symbols of hate and remove these symbols from our public spaces.
Remember Professional Ethics: Professionals, especially those in law, medicine, education and government service must uphold ethical standards, even when pressured to conform to the aims of authoritarian regimes. Their integrity is vital for maintaining democracy.
Be Wary of Paramilitaries: Resist the rise of unofficial armed groups that support authoritarian figures. Such groups may eventually take the place of the legally constituted police and military services. “When the men with guns who have always claimed to be against the system start wearing uniforms and marching with torches and pictures of a leader, the end is nigh. When the pro-leader paramilitary and official police and military intermingle, the end has come.”
Be Reflective If You Must Be Armed: If you are part of law enforcement or the military, refuse to participate in unjust actions or repressions of the population. Ensure that those who bear arms do so with a deep sense of responsibility and ethics and a great regard for the value of democracy.
Stand Out: Authoritarian regimes thrive on compliance. Demonstrate opposition publicly and show visible descent and encourage others to show resistance whenever possible.
Be Kind To Our Language: Be precise in your use of language and avoid repeating the phrases made popular by authoritarian leaders. Independent thinking is facilitated by the careful use of language. Manipulation of language is a powerful tool for the control of the population.
Believe In Truth: Truth is the linchpin of justice and democracy. Uphold and defend objective truths. Reject the false narratives or “big lies” spread by authoritarian regimes. Make every attempt to shed light on their falsehoods regardless of how often or loudly they proclaim them.
Investigate: Seek out reliable sources of information. Support independent journalism. Identify, evaluate and encourage trusted sources. Do not accept any claims by the authoritarian regime without your personal verification. Remember critical thinking is important to resisting manipulation.
Make Eye Contact and Small Talk: Build personal connections within the community to foster solidarity and resilience. Visible civic involvement demonstrates unity and a commitment to democratic principles.
Practice Corporal Politics: Participate in protests, marches, and public events. Physically demonstrating support and civic engagement shows a strong commitment to democratic principles.
Establish A Private Life: Protecting your privacy from surveillance is essential. Authoritarian regimes often invade personal spaces to control and manipulate individuals.
Contribute To Good Causes: Support organizations and causes that defend democracy and human rights. Both financial and moral support will strengthen resistance.
Learn From Peers In Other Countries: Understand how some nations have succumbed to authoritarianism while other nations have resisted it. Learn from their experiences and strategies.
Listen for Dangerous Words: Be alert to the use of language that demonizes opponents or glorifies violence. Such rhetoric often precedes more severe actions against targeted groups. Be sensitive to efforts to convert the population to harmful ideologies through repeated derogatory speech.
Be Calm When The Unthinkable Arrives: Stay composed in moments of crisis and resist the urge to act impulsively. Authoritarian leaders often attempt to exploit chaos to seize power. Be alert for such attempts and be ready to counter them.
Be A Patriot: True patriotism involves defending democratic values and principles, not blind loyalty to a leader or party. Waving flags and shouting slogans is not patriotism. Defending democracy is the true mark of a patriot.
Be As Courageous As You Can: “If none of us is prepared to die for freedom, then all of us will die under tyranny.” (That is the total of this lesson; perhaps the most important one of all.)

Epilogue

The book concludes with an epilogue entitled History and Liberty. In the epilogue Doctor Snyder discusses his theories of the Politics of Inevitability and the Politics of Eternity.

The Politics of Inevitability is the belief that history naturally progresses in a linear forward direction typically towards a better future. It assumes that liberal democracy and capitalism will inevitably spread across the world leading to a more prosperous and freer global system. Human forces are seen as predictable and human activity is often downplayed. People who live under the politics of inevitability tend to believe that the current state of affairs will persist because it represents the end point of political and economic evolution.

The Politics of Eternity, on the other hand, rejects the linear progression of history and emphasizes a cyclical view. It supposes that nations are perpetually threatened by external forces. It glorifies a supposed golden age of the past that is idealized and mythologized. It views current politics as a struggle to return to that idealized past.

I found his discussions to be more theoretical than practical. I can see aspects of both in most current societies. I invite you to please read this and I would love to discuss it. I may be missing something in his presentation of inevitability and eternity.

In Conclusion

If you are concerned about the survival of democracy, read this book.

Dr. Google Will See You Now (Revised)

By John Turley

On September 3, 2024

In Commentary, Medicine

There are few words that cause more trepidation among doctors than having a patient start off a visit by saying, “I was reading on the internet”. It’s not that we don’t want our patients to be well informed; a knowledgeable patient is an important part of successful health care. It is what we call the therapeutic alliance.

What we worry about is what they may have been reading on the Internet. There is a lot of good information available, and I always encourage my patients to learn as much as they can about their own health issues. There are many professionally researched and peer reviewed medical websites. They include such commercial sites as Medscape and WebMD. They also include patient advocacy sites such as the American Diabetes Association and the American Heart Association. And, of course, there are the government sites such as the Centers for Disease Control and the National Institutes of Health. All these present the best available science and benefit from rigorous research and review.

That is not to say that they won’t change. Science evolves and knowledge improves. What is our best knowledge now may at some point in the future be proven wrong. However, your best chance of getting solid information is on these well documented sites.

What I worry about are the undocumented or unverified websites that provide what can best be called rumor or conspiracy. Any time a patient tells me,” I was reading on the Facebook page “The Truth About….,” I cringe. Any Facebook page entitled “The Truth About…” is unlikely to contain much truth.

False information takes on a life of its own on the internet. The big lie almost always buries the truth. Long after the article that was the basis for a false claim linking the MMR vaccine with autism was withdrawn by the British medical journal The Lancet, and long after the physician who wrote the article was found by the British General Medical Council to have falsified the data and long after he lost his medical license, the study is still quoted by many anti-vaccine people as being a fundamental truth.

Even when the authors of such false information repudiate it, people still believe it. It becomes part of the legend that “they” forced the author to remove it. No one ever explains who “they” are or why “they” want to keep the public in ignorance. Of course, there is never any source documentation or research reference.

The websites espousing false medical information may be second in number only to those espousing false political information. At times it seems that the more outlandish the claim the more readily their adherents will believe it. It doesn’t even seem to matter that this type of information is frequently published anonymously. You would think the readers would wonder why a person in possession of such great knowledge would refuse to take credit for it. They will frequently require you to make a purchase or enter a credit card number before you’re allowed in on the secret. Clear references from reliable sources are almost always absent. If they do refer to reliable sources, check and make sure their claims are actually backed up on the site they reference.

How do you evaluate reliable medical websites? First, they should have clear authorship; the site should identify the author(s) and their credentials. There should be frequent updates. Health information should be current. You should look for a publication or review date. There should be clear citations as reliable sites will provide references for their information. The site should be objective in tone; the content should be balanced and should not be focused on selling you something. And finally, reputable sites will have clear privacy policies on how they handle user data.

In summary, I want all my patients to be well informed and take an active interest in their health care. I encourage you to Google any medical questions you have. Just be sure that what you are reading is accurate and verified and scientifically based. Are the authors, their qualifications, and their affiliations clearly identified? Are reliable references cited? Has the article been peer reviewed by experts in the field? Is the article little more than a cleverly prepared sales pitch? Don’t allow conspiracy theories and “crackpot science” to have a detrimental effect on your health.

If in doubt, ask your doctor. If you don’t trust your doctor to give you factual information and prefer to consult with anonymous pseudo medical websites, then perhaps it’s time to find a new doctor. But please, think twice before disregarding the advice of someone whose entire professional life is dedicated to your good health.

Something To Make You Smile

By John Turley

On September 3, 2024

In Uncategorized