Thursday, August 18, 2022

Let's get real about Zolpidem and Insomnia

 I believe the reason insomnia sufferers clamor for (not just prefer) Zolpidem (Ambien) is because it is the one prescription sleep drug – that doesn't feel at all like a drug.  No hours of lingering numbness (OTC  antihistamines), no all day yucky feeling (most or all other prescription drugs) – nor all day, sleep deprived, brain fog (no medicine at all).  

You can cut a 10mg into thirds and take one third to catch the last two hours of sleep (my most regular use) and wake up bright eyed and bushy tailed – no drug after haze whatsoever.  
    
Why, then, does the whole medical profession, lately, seem down on Zolpidem?  My doctor cut me off after 12 years on it (with different prescribers), my brother’s doctor cut him back from 10mg to 5 mg, my brother’s 60s age friend had hers cut off completely.  A Zoom call nurse practitioner from Minded refused me down because of my age.

Doctor’s lately arriving qualms: reports of (maybe doubled) household falls and traffic accidents, memory impairments, weird sleep walking.
 * * * * * *

Me – slips and falls: if you break out the numbers, most of the serious damage comes from traffic accidents.  At my age (78) my mother was still bringing home the first place trophies from the amateur ballroom dance contests.  A lot of deep athletic ability in my family.

Me – driving: 28 years driving taxicabs in New York, Chicago and San Francisco.   Enough said?

Me -- memory: Zolpidem doesn't make you forget what you already know, doesn’t make you forget how processes work that you newly learned, may inhibit ability to make new memories of simple facts (what movie you watched Sunday).  “Clinically significant" harm visited upon less than 1%.  After 12 years on the drug, if it causes me any impairment, any damage should have been visited very long ago.  
 * * * * * *

Today, 38 million Americans take Zolpidem (85% of all sleep med users).  What is the medical profession going to do, take them all off Zolpidem just as they get old enough to need it the most – condemn them to an old age of hours of daily antihistamine numbness, all day yucky drug left-over, or 19 hours or more in sleep deprived fog?

Sensible legal goal, once patients get it nailed down (in court?) -- If a patient refused a new improved fracture cast, leaving only an old model wrap an option, a doctor could not ethically refuse to offer the old style -- drug ditto: doctors should not be allowed to refuse Zolpidem if it is the only sleep aid patients will accept – not if the patient would be better off with Zolpidem than without it.  Goal #1!

Why do doctors today feel so ethically free to abandon insomniacs -- who will accept only Zolpidem – to no treatment at all?  

I suspect it has to do with the incorporality of insomnia – it fails to light up their “midbrain radar" (that even migraine headaches show up on).  They can’t measure it, can’t weigh it, can’t take its temperature, can't sew it up, no idea where to put it back.  :-)

I recommend that insomniac patients make journals, day-by-day of their struggles living without Zolpidem – with or without substitutes.  30 day, 60 day, 90 day journals – will hopefully get past physicians' motivation-gates -- with the tale that insomniac patients have a deeply unhealthy condition that MUST be dealt with.

Typical trouble day: At 10:30AM, will need to drive mother downtown.  No antihistamine in the middle of the night (main effect lasts 4 hours, unsafe driving, hours longer).  Zolpidem would act for 2 hours after first 5 hours sleep (25 minute wait, 45 minutes sedated—can think if I wish to, 50 minutes more coming out of it), waking fit as a fiddle.   Couldn’t sleep -- took Trazodone, barely able to drive, barely safely.

Once we nail down patients' legally and ethically entitled choice – not to exist in an antihistamine numbness or
a permanent drug hangover or no drug at all brain fog – because the medical profession is afraid we might slip and fall – then, we can spread the word to every civil law firm in the country – and get our lives back!!!

PS  My extra hours-numbing, OTC substitute -- Diphenhydramine: https://www.medicalnewstoday.com/articles/288546#Taking-anticholinergics-for-more-than-3-years-linked-to-higher-dementia-risk

Tuesday, December 31, 2019

Putin is just Khrushchev-lite (very lite)


Debunk Putin’s “return-Russia-to-great-power-status” sales pitch to Russians: compare to Nikita Sergeyevich Khrushchev who was infinitely more dangerous to the world than Vladimir Vladimirovich Putin.

Khrushchev put IRBMs in Cuba that could have wiped out the last of US Strategic Air Command bases housing 750 B-52s without warning. IRBMs had already made our 1400 B-47s vulnerable to 10 minute knockout in bases that needed to be right up against the borders of our eleven time zone adversary, given the B-47's intermediate range.

Khrushchev threatened to take West Berlin — surrounded by East German territory and vulnerable to tens of thousands of Soviet tanks. Khrushchev materially supported the communist insurgency in Laos. Just to name a few hot spots. Khrushchev ran around the world fomenting any serious trouble for us that he could.

Khrushchev was a true believer. Russians say Khrushchev was a communist before he knew the communists would win.  Meaning Khrushchev meant well — he imagined he was fighting to free mankind from the oppression of capitalism.
https://www.amazon.com/Khrushchev-Man-His-William-Taubman-ebook/dp/B007DAP6IQ/ref=sr_1_2?keywords=khrushchev&link_code=qs&qid=1575044502&sourceid=Mozilla-search&sr=8-2

Putin in his bid to revive (at least the feeling) of Russian the super power attempts to build influence in the Middle East by aiding the pipsqueak president of Syria carpet bomb his own country from end to end for five years, killing half a million Syrians in the process. The true believer would not have perpetrated that. Putin landed a couple hundred troops in troubled Venezuela to prop up a socialist dictator who was about to abscond to Cuba (why we didn’t land a couple of hundred troops to neutralize them I’ll never guess — oh, I forgot; Putin does have big time influence one place in the world, in Donald Trump’s White House, but that’s not something he accomplished, it was given freely to him).

Putin is just Russia's Al Capone.

Kompare Khrushchev's gigantic reality to Putin's pipsqueak's PR: debunk Putin in one-step.

Thursday, December 20, 2018

Vladimir De Gaulle, Charles De Putin? The "glory" of France -- oops; I mean of Russia?


Recently I pulled apart the reality of the so-called Russian horde at the height of the cold war, supposedly ready to overwhelm Western Europe like Attila the Hun.

Performance of Russian armored equipment versus NATO equipment in the Gulf War -- need I dissect?  Russian troops in mid-eighties probably no better than Arab troops -- 180 armored divisions to train in a country that cannot produce a respectable passenger automobile.  Syria's Russian bought fighter jets went 0 to 90 against Israel's NATO planes in 1982.

Russia has first quality fighter aircraft these days, but I'm talking back when Europe was supposedly overrun-able by the hordes.  Back then, Russia's most numerous front line fighter, the Mig-23/27 series, had the same high wing loading and low thrust to weight ratio as the original "iron butterfly", our F-105, which was never intended to take on other fighters, only deliver tactical nukes on hordes.

Rule of thumb is it takes 3 to 1 to successfully invade.  In the mid-eighties, Russia and Warsaw Pact armies had 135 armored divisions facing NATO's 30 in Central Europe (4.5 to 1).  Following the Reagan rebuild (M-1 tanks, F-16s, etc.) and going by comparative performance in the Gulf War it looks like any mid-80s Warsaw Pact invasion attempt would have been cleaned out.  (It would have been hard to sneak 45 divisions across 11 time zones from China; ditto for 30 up back roads from Turkey.)

With all this unconsciously rattling around in my head for the last couple of weeks that old first impression of overwhelming hordes may have faded out of my head.  Without such first impression, Putin's monkeying around in the Ukraine and fiddling with the Sea of Azov and sending two supersonic Blackjack strategic bombers to Venezuela to taunt us begin to look like France trying to hold on to Algeria -- if not trying as seriously.  (Russia produced 36 of these 1987 bombers -- at our strategic air command's 1960s height it counted 750 B-52s, 1400 B-47s and 100 supersonic B-58s.)

Maybe it's time for Russia to consider that it never was a first class power and sit back and get over it -- time to settle back to watch our hegemony displaced by China and India who will in turn be displaced by a world with one language and one currency, etc.  Just saying.

Saturday, December 8, 2018

1968 fed min wage, DOUBLE-indexed for inflation and per cap growth = $23.44 an hour


1968 fed min wage, DOUBLE-indexed for inflation and per cap growth = $23.44 an hour.

yr......per capita...real min...(nominal)...[1968 wage inflation indexed alone]...% per cap growth ... (DBL-index)
(2017 dollars)

68.....16,911.....11.49.....(1.60)...[1.60].........100%...........(11.49)
69-70-71-72-73                                                              
74.....19,983.....10.51.....(2.00)...[2.40]       
75......20,015.....9.87......(2.10)...[2.58]
76.....20,705.....10.13.....(2.30)...[2.72]..........122%............(14.00)    [11.49 X 1.22]
77                                                                                 
78.....22,320.....10.39.....(2.65)...[3.15]
79......22,639....10.40.....(2.90)...[3.53]
80......22,117.....9.76......(3.10)...[3.98]      
81......21,997.....9.43......(3.35)...[4.38]...........130%............(14.94)     [11.49 X 1.3]
82-83-84-85-86-87-88-89
90......26,244.....7.31.....(3.80)....[6.26]
91......25,728.....7.73.....(4.25)....[6.45]...........152%.............(17.46)    [11.49 X 1.52]
92-93-94-95
96......28,306.....7.54.....(4.75)....[7.43]
97......29,395.....7.93.....(5.15)....[7.58].............174%...........(19.99)     [11.49 X 1.74]
98-99-00-01-02-03-04-05-06
07......31,767.....7.08.....(5.85)....[9.80]
08......30,775.....7.60.....(6.55)...[10.16]
09......30,385.....8.41.....(7.25)...[10.16].............180%...........(20.68)      [11.49 X 1.8]
10-11-12-13-14-15-16-17
18......34,489.....7.16.....(7.25)...[11.49]...............204%...........(23.44)       [11.49 X 2.04]
https://www.census.gov/data/tables/time-series/demo/income-poverty/historical-income-people.html
https://data.bls.gov/cgi-bin/cpicalc.pl?cost1=1.60&year1=196801&year2=201706
 * * * * * *


Let Americans raise their wages naturally -- like other modern economies:
https://onlabor.org/why-not-hold-union-representation-elections-on-a-regular-schedule

Sunday, April 22, 2018

Ms. Foundation -- Annual Minimum Needs Budget Without Employment Health Benefits


From Ms. Foundation book Raise the Floor -- p. 44, table 2-3
Annual Minimum Needs Budget Without Employment Health Benefits -- two adults, one child (1999 dollars table adjusted for 2018 dollars at https://data.bls.gov/cgi-bin/cpicalc.pl -- health care skyrocketed since 1999 in mind)

Housing  *  11,792
Health Care  *  9,722
Food  *  7,089
Child Care  *  6,987
School Ave Care  *  0
Transportation  *  3,135
Clothing and Personal Expenses  *  1,741
Household Expenses  *  745
Telephone  *  836
Subtotal Before Taxes  *  42,052

 
Payroll Tax  *  3,217

Federal Tax (including credits)  *  1,759
State Tax (including credits)  *  631
Total  *  47,661

Tuesday, February 6, 2018

Will truckers be automated? (lifted from the comments of Tyler Cowen's Marginal Revolution)


Will truckers be automated? (from the comments)
by Tyler Cowen on February 4, 2018 at 12:03 am in Economics, Web/Tech

Dan Hanson writes:

I wonder how many of the people making predictions about the future of truck drivers have ever ridden with one to see what they do?

One of the big failings of high-level analyses of future trends is that in general they either ignore or seriously underestimate the complexity of the job at a detailed level. Lots of jobs look simple or rote from a think tank or government office, but turn out to be quite complex when you dive into the details.

For example, truck drivers don’t just drive trucks. They also secure loads, including determining what to load first and last and how to tie it all down securely. They act as agents for the trunking company. They verify that what they are picking up is what is on the manifest. They are the early warning system for vehicle maintenance. They deal with the government and others at weighing stations. When sleeping in the cab, they act as security for the load. If the vehicle breaks down, they set up road flares and contact authorities. If the vehicle doesn’t handle correctly, the driver has to stop and analyze what’s wrong – blown tire, shifting load, whatever.

In addition, many truckers are sole proprietors who own their own trucks. This means they also do all the bookwork, preventative maintenance, taxes, etc. These people have local knowledge that is not easily transferable. They know the quirks of the routes, they have relationships with customers, they learn how best to navigate through certain areas, they understand how to optimize by splitting loads or arranging for return loads at their destination, etc. They also learn which customers pay promptly, which ones provide their loads in a way that’s easy to get on the truck, which ones generally have their paperwork in order, etc. Loading docks are not all equal. Some are very ad-hoc and require serious judgement to be able to manoever large trucks around them. Never underestimate the importance of local knowledge.

[To read the rest click here]
http://marginalrevolution.com/marginalrevolution/2018/02/will-truckers-automated-comments.html?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+marginalrevolution%2Ffeed+%28Marginal+Revolution%29

Friday, January 15, 2016

One more example why government support for ALL drug and medical device research should be the norm


Up until now a spectacular argument for government taking over all drug and medical device research has been the example of Sovaldi: the Hepatitis C cure. We all know the story.

Now, for the first time ever, all three million Hep C sufferers can clean the virus from their system — for only $300 billion dollars ($100,000 each) with 84 pills that costs $1 each to manufacture.

Hep C — PS: 30% more likely to come down with Parkinson’s — and who knows what else. Jingle, jingle, jingle goes the cash register.
http://www.medicalnewstoday.com/articles/304405.php 


Now we have a story supporting gov research from the opposite angle — if you ask me anyway.  

Until now, heart failure has been progressive and surely terminal. In 2012 a trial or an innovative medical device in England with 20 patients ended with 25% cured and everyone else improved. It involved a balloon like cuff wrapped around the upper aorta that aided pumping — and apparently allowed the less strained organs to heal.  

Now, a much bigger trial on two continents is being arranged (hopefully) but may potentially fall apart for lack of private funding.
Link to very long — what I can only call a — prospectus below

     [cut and paste]
Summary
Sunshine Heart develops the C-Pulse device for HF (Heart-Failure) patients. C-Pulse showed outstanding clinical results in the US feasibility study, and EU study, including improvement in HF condition, and recovery.  

Heart Failure is poorly treated, resulting in 5 year mortality rate of 60%. C-Pulse targets a huge unmet market of 5.2 million patients in relatively progressed HF stages.  

Slow enrollment in the US pivotal trial (the equivalent of an FDA phase III trial), and circumstantial pause and resumption of trial enrollment have lead to dwindling cash. 

SSH share price fell rapidly, fueled by panic, tax purposes selling, inability to raise additional cash, fears of approaching bankruptcy, and a poison-pill mechanism preventing an otherwise likely take-over.  

Sunshine Heart basically has no other option but pursuing a strategic move soon, that is explored in this article, and can result in substantial gains in the next 6 months.
      [snip]
Heart Failure condition overview
HF (Heart Failure) is a terrible disease , but unfortunately is very common. It is currently poorly treated, and is one of few diseases that increase in mortality YoY. More than 7 million HF patients exist in the US, with more than 800,000 new HF cases every year. The number of HF patients is expected to exceed 10 million by 2030. The HF increase in prevalence is driven by the epidemics of obesity, diabetes, and high blood pressure. Additionally, 7-10% of the aging population above 65 years old suffer from HF.  

The outcomes of HF are very poor: 5 year mortality rate is higher than 60% – worse than many types of cancer. There are 1 million hospitalizations per year due to HF in the US. HF accounts from more hospitalization-days than any other disease. HF is the number 1 cause for readmission within 30 days – higher than 20% re-admission rates. The current annual cost of HF to the US economy is a huge $31B, with annual cost projected to reach $70B by 2030.  

Figure 1 shows the poor outcomes of patient hospitalizations due to heart failure, as reflected by high mortality rates at 30 days, 12 months, and 5 years, and high rate of hospital readmissions. Figure 2 shows the poor and deteriorating median survival time after every HF hospitalization. Kidney failure accounts for more than 50% of mortality, as the kidneys heavily depend on sufficient blood pressure, and blood flow for their operation, which is obviously affected by HF.
     [snip]
PS. The insertion procedure is minimally invasive and there is no risk of clots as with other pumping aids, the whole device being outside the bloodstream.
     [snip] 
http://seekingalpha.com/article/3811136-sunshine-heart-a-speculative-biotech-play-for-substantial-short-term-gains?auth_param=17tckm:1b9fvn8:1e097e95787e20c025e6c8de8e008836&dr=1 

THE  LONG  POST  SCRIPT
Headline:  Drug shortages in American emergency rooms have increased more than 400 percent
     [snip]
"Of the nearly 1,800 drug shortages reported between 2001 and 2014, nearly 34 percent were used in emergency rooms. More than half (52.6 percent) of all reported shortages were of lifesaving drugs, and 10 percent of shortages affected drugs with no substitute."
     [snip]
"It seems simple enough: If companies produce more drugs, more drugs will be available to ERs. But given that the majority of drugs on shortage in emergency rooms are sterile injectables with low profit margins, don't expect that to happen anytime soon."
     [snip] 
http://www.chicagotribune.com/lifestyles/health/ct-emergency-room-drug-shortages-20160124-story.html 

SEE  ALSO  (long): 
http://www.nytimes.com/2016/01/29/us/drug-shortages-forcing-hard-decisions-on-rationing-treatments.html  

MORE:
“ Less than a year ago, Pearson’s cheerleaders—many of them professional money managers, such as Bill Ackman of Pershing Square Capital Management—were saying that he was revolutionizing the pharmaceutical industry. Pearson had long argued that the industry wasted too much money on unprofitable research and development projects. He said drugmakers were better off buying other companies and exploiting their portfolios. Accordingly, he had turned Valeant into an acquisition machine and, though he rarely discussed it, a serial hiker of drug prices, another pillar of the company’s strategy. ” (my emphasis)
     [snip]
 " Other pharmaceutical companies learned from Pearson’s model, too. Pfizer, the maker of drugs such as Viagra, was essentially going down a path blazed by Valeant when it announced it would buy Allergan in a $160 billion deal that would be the largest in the industry and that would transform (or “invert”) it into an Irish-domiciled company, enabling it to avoid American corporate taxes. ” 
http://www.bloomberg.com/news/articles/2016-03-03/valeant-s-boss-is-back-can-the-ceo-save-the-day-again

EVEN MORE
https://www.washingtonpost.com/news/wonk/wp/2017/02/10/an-old-drug-gets-a-new-price-to-fight-a-rare-disease-89000-a-year/?utm_term=.8da3618f14b3
” Less than a year ago, Pearson’s cheerleaders—many of them professional money managers, such as Bill Ackman of Pershing Square Capital Management—were saying that he was revolutionizing the pharmaceutical industry. Pearson had long argued that the industry wasted too much money on unprofitable research and development projects. He said drugmakers were better off buying other companies and exploiting their portfolios. Accordingly, he had turned Valeant into an acquisition machine and, though he rarely discussed it, a serial hiker of drug prices, another pillar of the company’s strategy. ” (my emphasis)
” Other pharmaceutical companies learned from Pearson’s model, too. Pfizer, the maker of drugs such as Viagra, was essentially going down a path blazed by Valeant when it announced it would buy Allergan in a $160 billion deal that would be the largest in the industry and that would transform (or “invert”) it into an Irish-domiciled company, enabling it to avoid American corporate taxes. ”
Read all about it here: http://www.bloomberg.com/news/articles/2016-03-03/valeant-s-boss-is-back-can-the-ceo-save-the-day-again
* * * * * *
” … but my experience in med-tech tells me that there is almost always a way around IP and that good ideas (or what companies think will be good ideas) are copied pretty quickly – notice how many companies got into renal nerve ablation once that seemed promising or how many companies have launched clinical programs in transcatheter heart valves. ”
http://seekingalpha.com/article/3934666-can-sunshine-heart-survive-see-dawn?auth_param=17tckm:1bd3k0r:1333c28776918ba740d9bea4d932addc&dr=1

Novel, implantable device ‘could slow, reverse heart failure’
Read all about first ever device to successfully treat or even for the first time ever even cure some patients with heart failure — with on add risk of stroke or clots because it is outside the bloodstream. Too bad under US research culture or whatever you call it it may lie neglected because investors are afraid it is too easy to copy.
http://www.medicalnewstoday.com/articles/283566.php
* * * * * *
We all know the story of Sovaldi where the company paid $11 billion to a company who was going to sell the $1-to-make pills for $350 so they could sell it for $1000 a pill. Cure for Hepatitis C permanently put on hold so Wall Street can gouge. The first company relied on government research funds until it smelled money than it was able to find investors to finish the job. The chief scientist made $446 million for himself — enough to manufacture the virus out of business.

We’ll never do anything about any of this — or anything else — if we don’t return to the union density of the 50s and 60s.
- See more at: http://angrybearblog.com/2016/03/open-thread-march-8-2016.html#comments
” Less than a year ago, Pearson’s cheerleaders—many of them professional money managers, such as Bill Ackman of Pershing Square Capital Management—were saying that he was revolutionizing the pharmaceutical industry. Pearson had long argued that the industry wasted too much money on unprofitable research and development projects. He said drugmakers were better off buying other companies and exploiting their portfolios. Accordingly, he had turned Valeant into an acquisition machine and, though he rarely discussed it, a serial hiker of drug prices, another pillar of the company’s strategy. ” (my emphasis)
” Other pharmaceutical companies learned from Pearson’s model, too. Pfizer, the maker of drugs such as Viagra, was essentially going down a path blazed by Valeant when it announced it would buy Allergan in a $160 billion deal that would be the largest in the industry and that would transform (or “invert”) it into an Irish-domiciled company, enabling it to avoid American corporate taxes. ”
Read all about it here: http://www.bloomberg.com/news/articles/2016-03-03/valeant-s-boss-is-back-can-the-ceo-save-the-day-again
* * * * * *
” … but my experience in med-tech tells me that there is almost always a way around IP and that good ideas (or what companies think will be good ideas) are copied pretty quickly – notice how many companies got into renal nerve ablation once that seemed promising or how many companies have launched clinical programs in transcatheter heart valves. ”
http://seekingalpha.com/article/3934666-can-sunshine-heart-survive-see-dawn?auth_param=17tckm:1bd3k0r:1333c28776918ba740d9bea4d932addc&dr=1

Novel, implantable device ‘could slow, reverse heart failure’
Read all about first ever device to successfully treat or even for the first time ever even cure some patients with heart failure — with on add risk of stroke or clots because it is outside the bloodstream. Too bad under US research culture or whatever you call it it may lie neglected because investors are afraid it is too easy to copy.
http://www.medicalnewstoday.com/articles/283566.php
* * * * * *
We all know the story of Sovaldi where the company paid $11 billion to a company who was going to sell the $1-to-make pills for $350 so they could sell it for $1000 a pill. Cure for Hepatitis C permanently put on hold so Wall Street can gouge. The first company relied on government research funds until it smelled money than it was able to find investors to finish the job. The chief scientist made $446 million for himself — enough to manufacture the virus out of business.

We’ll never do anything about any of this — or anything else — if we don’t return to the union density of the 50s and 60s.
- See more at: http://angrybearblog.com/2016/03/open-thread-march-8-2016.html#comments