Category: healthcare

There’s Something About Mary

Between 1900 and 1907 a number of families living in New York City would mysteriously contract typhoid and fall ill. Typhoid is a bacteria that causes severe diarrhea, nausea, vomiting, and fever.  One by one New York families contracted the disease, seemingly at random with no explanation as to the cause. Finally, in 1907 one family  who had contracted typhoid hired a medical investigator to determine how they had become ill.  The investigator examined the household and discovered that the hired family cook, an Irish woman named Mary Mallon, had to pretty disturbing habits, most atrocious of which was that she didn’t wash her hands after she pooped. Did I mention that typhoid is typically spread via contact with fecal matter? The investigator then examined her work history. All of her former clients happened to be the families that had contracted typhoid over the past 7 years.  She would cook for the family, they would get sick, and she would flee and sell her services to another family, who in turn would get sick.  It was no coincidence, as under medical examination it was discovered that Mary was an asymptomatic carrier, meaning she was infected with typhoid, but had no symptoms of the disease.

Mary was immediately quarantined at a clinic on North Brother Island. She denied she was a carrier and refused all medical treatment, including the removal of her gallbladder which was infested with the bacteria. Without her cooperation state medical authorities didn’t know what else to do except hold her in quarantine.  Finally in 1910 the NY State Health Commissioner ordered her release when she signed an affidavit to abide by certain sanitary conditions like washing her hands and to never work as a cook. After her release, the typhoid epidemics began again.

Over the next five years Mary Mallon worked as a cook for larger institutions such as schools, factories, orphanages, and hospitals.  As a result major typhoid outbreaks would occur all over the city. In 1915 a typhoid outbreak occurred at the Sloane Hospital for Women resulting in 25 sick and 2 dead.  When medical officials arrived to investigate, they found Mary Mallon cooking in the kitchen, having taken the alias “Mary Brown”. She still didn’t wash her hands after she pooped. 

Mary Mallon was placed under arrest and once again placed in medical quarantine.  Once again she denied that she had typoid and refused all medical treatment.  This time, the authorities held her indefinitely, and as the years and decades went by Mary still refused to be treated or admitted that she had typhoid. Her story became a news sensation, with the media branding her with the nickname “Typhoid Mary”.  Mary Mallon would spend the rest of her life in medical quarantine until her death in 1938. During her culinary career she had sickened hundreds of people, resulting in 3 confirmed deaths with the possibility of many more unconfirmed deaths.

Dr. Goldberger and the Great Pellagra Epidemic,

Pellagra was a disease common in North American and Europe around the late 19th and early 20th century. Common symptoms included painful sores on the mouth and skin, diarrhea, and in severe cases dementia. Between 1900 and 1940 it is estimated that around 3 million people suffered from the disease causing 100,000 deaths in the United States alone. In 1914 a physician with the US Public Health Service named Dr. Joseph Goldberger was tasked with discovering the cause of the disease and coming up with a treatment or cure.  By the turn of the century pellagra cases were skyrocketing in the United States, with the vast bulk of cases occurring in the south. Originally born in Hungary, Dr. Goldberger was a veteran epidemiologist who had worked on cases all over North America, Central America, and the Caribbean, and had been infected with serious diseases such as typhus and yellow fever no less than five times. Just a hazard of the job.

At the time pellagra was believed to be a communicable disease caused by bacteria or a virus.  However many doctors disagreed and after examining patients Dr. Goldberger likewise questioned it’s cause. Dr. Goldberg noted that almost all patients who had pellagra tended to have two things in common; first they were very impoverished or lived in a facilities such as asylums or orphanages. Second, they had a very inadequate diet. For most poor Southerners and those who were institutionalized, the common diet was cornbread and grits, with some meat, and if you were lucky canned vegetables. Since before the American Civil War southern agriculture was becoming more and more of a monocrop system dominated by cotton.  By the turn of the century cotton had almost drowned out all other crop production, and as a result fresh fruit, vegetables, and meat were no longer on the menu for poor sharecroppers. The resulting diet was severely deficient in protein, vitamins, and minerals. Dr. Goldberger hypothesized that pellagra was not a communicable disease, but caused by a dietary deficiency. 

To treat pellagra Dr. Goldberger began feeding patients a healthy diet full of fruit, vegetables, eggs, milk, and meat.  In no time the vast majority of patients quickly recovered.  Dr. Goldberger published his results but met harsh skepticism, particularly among southern politicians.  For them it seemed impossible that pellagra was a dietary efficiency. In essence Dr. Goldberger’s diagnosis was that pellagra was a socio-economic disease and it would be much more convenient if it was a communicable disease. Dr. Goldberger was challenging southern economics and the southern way of life.

To further prove his theory Dr. Goldberger gathered a sample of 11 prison convicts who volunteered in exchange for forgiveness of their sentences. Dr. Goldberger sequestered the men and fed them a diet lacking nutrition for 6 months. As expected, six men showed symptoms of pellagra. Dr. Goldberger then fed them a healthy diet, the symptoms went away.

Regardless, Dr. Goldberger’s results were ridiculed and ignored. Finally Dr. Goldberger decided to stage an experiment/publicity stunt to remove all doubt. Gathering together his friends, family, and colleagues he hosted a “pellagra party”.  The party consisted of activities including swabbing themselves in the noses with q-tips that had previously swabbed the noses and mouths of pellagra patients, injecting themselves with “pellagra infected” blood, then swallowing tablets filled with the urine, feces, and sore scabs of pellagra patients. None who attended were infected with pellagra. 

Based on Dr. Goldberger’s discovery President Warren G. Harding moved to set up a food program for southern states in order to combat pellagra. A lobby of southern governors and congressman responded by blocking the action, even going as far as to refuse government aid from food programs. Frustrated Dr. Goldberger continued his studies with the goal of finding a cheap cure, this time using dogs for medical experiments. Dr. Goldberger tried to feed the dogs a high cereal diet but the dogs wouldn’t eat the slop. So he flavored their food with brewers yeast.  Incredibly the dogs didn’t suffer from black tongue, the doggie version of pellagra. Dr. Goldberger changed the flavoring in the food, and suddenly the dogs developed black tongue. Dr. Goldberger had his cure but couldn’t isolate what exactly was in brewers yeast that prevented pellagra. He died in 1929 without ever finding the connection between brewers yeast and pellagra.  It wasn’t until 1937 that chemists discovered that it was niacin (vitamin B3) that was the cure and that pellagra is a result of a niacin deficiency.

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In 1941, as the United States entered World War II, the US Government feared that pellagra rates would increase as a result of wartime food rationing. A program was started to fortify foods such as flour and cereal with niacin to prevent pellagra. Many other countries would follow, and thus pellagra is a very rare condition in first world countries.  In poor, less developed countries however it still continues to be a menace. 

We are a very sick country.  We are overweight, sick, and riddled with disease. Unsurprisingly people who have co-morbidities like high blood pressure, diabetes, heart disease, obesity, and chronic respiratory diseases are more likely to have bad outcomes compared to healthy people. High blood pressure is a scary one because half the people in the country have high blood pressure, many don’t even know it. Sure, we have been hearing stories of young, perfectly healthy people in hospital ICU’s and on ventilators. There are stories of 30 year old fitness trainers dying of the virus, and stories of 104 year World War 2 veterans getting through it with mere sniffles and coughies.  Outliers can be unpredictable but for the most part the general trends show that if you are healthy you have better odds of getting through the disease than people who are not.  And holy crap Americans are sooo damn unhealthy. The vast, VAST majority of my patients are people who have ruined their health through poor lifestyle choices such as eating garbage food, not exercising or being active, smoking, drinking, doing drugs, etc. 

I’ve said it before, 75% of our healthcare infrastructure would become unnecessary if everyone would change their bad habits! More and more I’m seeing younger people in terrible health, people in their 60′s, 50′s, even 40′s, and that’s deeply concerning. Yes, I’m seeing 40-50 year olds who have so ruined their health that their diabetic feet are rotting off, their immobile, and they can’t wipe their own asses. You think Covid-19 is bad? Covid will come and go eventually, most likely in fits and spurts. But the chronic disease and obesity epidemic will continue on and get worse and worse.  Worst case scenarios estimated that if nothing was done like social distancing and self isolation, 2 million Americans could die and latest projections say that 100,000 -250,000 could die.  Currently around 250,000 – 300,000 Americans die annually of obesity related illnesses alone. Add more for smoking, alcoholism, and drug overdoses. So its like having a coronavirus epidemic every single year for the past two or three decades and getting increasingly  worse the next several decades to come if nothing changes because we are getting fatter and unhealthier.

So with Covid-19 ravaging the country it’s clear that we need to start looking after our health better, here’s what we all need to do and we need to start doing it NOW!

— Stop eating garbage food.  Eat whole foods, foods that have minimal processing like fruit and vegetables, nuts, seeds, meats, fish, beans, oats, rice, potatoes, sweet potatoes, etc. Fresh if possible, frozen is acceptable.  Avoid processed and refined foods like pasta, bread, REFINED SUGAR AND CORN SYRUP, oils, fats, excess salt, fried food, junk food, fast food, TV dinners, and all that garbage.  Especially watch your liquid calories, like soda, fruit juice (many people think it is healthy but has as much sugar as soda) sports drinks unless you are running a marathon, coffees that are full of fat and sugar like your daily 1000 calorie pumpkin spiced latte, iced teas that are crammed with sugar and junk. Save these foods for holidays, not everydays. Cut out refined carbohydrates. Eat more high fiber carbohydrates. Most Americans are fiber deficient, its the number one nutrient efficiency in the country. During this quarantine period, please do not just sit on your ass eating garbage, watching Netflix and playing video games.

— Look at food labels. Check the food labels of everything you eat.  Find out what you are eating. You will be surprised how much sugar, salt, and other things are hiding in foods, even foods normally considered healthy like yogurt and juice. Also pay particular attention to serving sizes.  A food that has only 100 calories but there are 30 servings in a tiny box probably isn’t good for you.

— Start exercising.  In most places in the country you can still go outside for exercise purposes like walking, running, biking, and hiking. Talk a long walk everyday. Don’t let sunny days go to waste because this can increase your vitamin D levels which boost your immune system.  Do it if you can and are able to maintain social distancing.  While at home or if you can’t leave, find workouts you can do at home. There’s all kinds of stuff on youtube and there’s something for everyone.  Use this time well. Become a Yoga guru, become a Tai Chi grandmaster. Do Pilates because nobody knows what the fuck Pilates is. Don’t sit around and do nothing and while eating garbage. Keep doing it after this pandemic is over. One of my fears is that most people are gong to do nothing and eat garbage. Then they will become de-conditioned and their health will slide, which will cause their immune systems to become compromised which will make this pandemic so much worse! 

— Stop doing other bad habits like smoking, limit drinking, stop doing drugs, stop doing other risky shit.

— Drink lots of water. Basic information I know but many people don’t do it.

— Get lots of sleep, at least 7-8 hours a day. Have regular sleep patterns if possible, got to sleep and wake up the same time everyday.

— Chill out! If you have anxiety problems learn to keep calm or get psychological help.  Learn to meditate. Learn to deal with stress. Deal with your psychological issues. Anxiety causes increases in cortisol levels which can decrease your immune system.

Take care of yourself and your body will take care of you. In a post covid world we cannot let our health deteriorate any more! There are no guarantees, some things are out of our control like our genetics or congenital diseases. Unexpected acts of god happen. Some people can do everything right and still have bad shit happen to them. But for the most part if you do these things you will stack the deck in your favor against Covid-19 and ensure better health for yourself in the long run.  So do it, and START DOING IT NOW!

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