Thursday, May 19, 2022

Black market tattoos in S. Korea: “No one’s trying to go to medical school to become a tattoo artist,”

 Tattooing is illegal (but tattoos are not) in S. Korea.  The NY Times has the story:

Tattoos, Still Illegal in South Korea, Thrive Underground. Tattoo artists, long treated as criminals for their work, say that it is time to end the stigma against their business.  By Christine Chung

"Under a ruling that has been in place since 1992, tattooing without a medical license can result in fines of up to $40,000 or even imprisonment. Opponents of decorative tattoos have invoked concerns about longstanding associations with organized crime, as well as fears about inadequate hygiene and potential harm inflicted by tattoo artists, who they say lack adequate skills.

"Attempts to overturn this ban have repeatedly failed. In March, the Constitutional Court in Seoul reaffirmed the tattoo industry’s illegality in a 5-to-4 ruling. South Korean tattoo artists and customers believe that the ruling is at odds with reality, citing drastically changed social norms that have fostered a thriving underground industry, greater openness and acceptance of tattoos, and rising international demand for what are known as “k-tattoos.”

"While tattoos have grown in acceptance in most parts of the world — exceptions include several Islamic countries — South Korea remains one of the few where the artists are treated as criminals. Tens of thousands of them work in secret here, under constant threat of exposure to law enforcement.


“No one’s trying to go to medical school to become a tattoo artist,” she said.


"Mr. Kim is the founder of a 650-member tattoo labor union that advocates rights of artists. Legalization would create safer, more sanitary environments for both customers and artists, he said.

"Tattoo artists often meet clients alone and trust strangers to keep their secret. Female artists are particularly vulnerable to sexual violence. In the past, the police have conducted sweeps rounding up artists, Sanlee said. Rival shops have been known to flag artists to the police.

“Since what we’re doing is illegal, we’re in the blind spot,” she said. “Because of that, there are many people that are exploiting the situation.”

Wednesday, May 18, 2022

Medical resident sleep time reduces harmful errors

 Here's a new study of the effect on patient safety of the limitation on resident work hours to no more than 16 hour shifts, which was in effect in the US from 2011 to 2017.

National improvements in resident physician-reported patient safety after limiting first-year resident physicians’ extended duration work shifts: a pooled analysis of prospective cohort studies  BMJ Quality & Safety Published Online First: 10 May 2022. doi: 10.1136/bmjqs-2021-014375by Matthew D   Weaver1,2, Christopher P Landrigan1,3,4, Jason P Sullivan1, Conor S O'Brien1, Salim Qadri1, Natalie Viyaran1, Charles A Czeisler1,2, Laura K Barger1,2

Abstract: Background The Accreditation Council for Graduate Medical Education (ACGME) enacted a policy in 2011 that restricted first-year resident physicians in the USA to work no more than 16 consecutive hours. This was rescinded in 2017.

Methods "We conducted a nationwide prospective cohort study of resident physicians for 5 academic years (2002–2007) before and for 3 academic years (2014–2017) after implementation of the 16 hours 2011 ACGME work-hour limit. Our analyses compare trends in resident physician-reported medical errors between the two cohorts to evaluate the impact of this policy change.

"Results 14 796 residents provided data describing 78 101 months of direct patient care. After adjustment for potential confounders, the work-hour policy was associated with a 32% reduced risk of resident physician-reported significant medical errors (rate ratio (RR) 0.68; 95% CI 0.64 to 0.72), a 34% reduced risk of reported preventable adverse events (RR 0.66; 95% CI 0.59 to 0.74) and a 63% reduced risk of reported medical errors resulting in patient death (RR 0.37; 95% CI 0.28 to 0.49).

"Conclusions These findings have broad relevance for those who work in and receive care from academic hospitals in the USA. The decision to lift this work hour policy in 2017 may expose patients to preventable harm."


"From 2003 to 2011, the Accreditation Council for Graduate Medical Education (ACGME) limited residents in their first postgraduate year to a maximum of 30 consecutive work hours, including 6 hours for continuity of care and educational activities (30 hours 2003 ACGME work-hour limit).2 Subsequent evaluations found that shifts of 24 or more hours were associated with increased odds of fatigue-related medical errors and preventable adverse events (PAEs),3 percutaneous injuries4 and motor vehicle crashes.5 A randomised controlled trial found that limiting first-year resident physicians to 16 consecutive work hours significantly improved resident alertness and patient safety.6 7 Altogether, a body of evidence accumulated suggesting that reducing or eliminating shifts longer than 16 hours did not negatively impact resident education and likely improved patient safety and resident quality of life.8 Subsequently, the Institute of Medicine of the National Academies (IOM) reviewed the available evidence and concluded that it was unsafe for any resident physician to provide clinical care for >16 consecutive hours without sleep.9 10 In response, the ACGME issued new work-hour regulations on 1 July 2011, limiting first-year resident physicians to a maximum of 16 consecutive work hours and emphasising a commitment to patient safety and mitigation of fatigue-related risks (16 hours 2011 ACGME work-hour limit).11

"The response within the medical community to the 16 hours 2011 ACGME work-hour limit was mixed.12 Many stakeholders expected the changes to diminish the educational experience.13 The increased frequency of patient handoffs raised concerns, as physician-to-physician handoffs have historically been non-standardised and prone to error.14 In addition, the work-hour limitations were not accompanied by an increased number of residency slots, leading to work compression and a shift in some responsibilities to other clinical providers,15 as well as concerns about resident physician understaffing. Several studies of the 16 hours 2011 ACGME work-hour limit found that it had no impact on hospital-level mortality or mortality following surgical procedures.16–18 In light of these studies and opposition to the work-hour limit from within the medical community, the ACGME lifted the 16-hour limit as of 1 July 2017, again allowing first-year resident physicians to be scheduled for 24 hours of continuous work, plus up to 4 hours for care transitions (28 hours 2017 ACGME work-hour limit)."

Tuesday, May 17, 2022

Fentanyl test strips save lives. Why do Kansas and Missouri ban them?

 You can imagine a world, with virtually no drug abuse, in which we would want to inhibit the recreational use of fentanyl and so might outlaw tools that might promote it.  But that isn't the world we live in, and instead simple tests for the presence of fentanyl can save lives by preventing fatal accidental overdoses.

Here's an editorial bemoaning the fact that these tests are sometimes banned.

Simple, cheap fentanyl test strips save lives. Why do Kansas and Missouri ban them? BY THE KANSAS CITY STAR EDITORIAL BOARD

 "As the Kansas and Missouri legislative sessions come to a close, there’s at least one more matter lawmakers in both states should attend to. They could save lives with tiny strips of paper that can detect the presence of fentanyl in recreational drugs. 

"Fentanyl test strips are designed to prevent people from overdosing on illegal recreational drugs that have been spiked with potentially fatal amounts of the synthetic opioid fentanyl. 

"Overdose deaths have risen to well over 100,000 a year in the United States. Synthetic opioids — primarily fentanyl — are the primary reason for the overall increase in total drug overdose deaths, according to the U.S. Drug Enforcement Administration. 


"But in some states, including Kansas and Missouri, the strips are considered drug paraphernalia and are not legal. Now there are proposals before both state legislatures to decriminalize them. This is not a partisan issue, and no one should oppose this move."

Monday, May 16, 2022

Happy birthday to Bob Wilson

  Happy birthday Bob!

Sunday, May 15, 2022

U.S .annual overdose deaths surpass 100,000, a new high

The CDC has released some new (still preliminary) data on drug overdose deaths in the U.S.

Here's the NYT:

Overdose Deaths Continue Rising, With Fentanyl and Meth Key Culprits. New data shows a surge in overdose deaths involving fentanyl and methamphetamine. Overall, the nation saw a 15 percent increase in deaths from overdoses in 2021.  By Noah Weiland and Margot Sanger-Katz

"After a catastrophic increase in 2020, deaths from drug overdoses rose again to record-breaking levels in 2021, nearing 108,000, the result of an ever-worsening fentanyl crisis, according to preliminary new data published on Wednesday by the Centers for Disease Control and Prevention.

"The increase of nearly 15 percent followed a much steeper rise of almost 30 percent in 2020, an unrelenting crisis that has consumed federal and state drug policy officials. Since the 1970s, the number of drug overdose deaths has increased every year except 2018.


"Drug overdoses, which long ago surged above the country’s peak deaths from AIDS, car crashes and guns, killed about a quarter as many Americans last year as Covid-19.


The Guardian  also has the story:

‘Completely devastating’: US passes 1m overdose deaths since records began. 2021 was a record year for overdose deaths with an estimated 107,622, CDC says, an increase of 15% from the previous year  by Melody Schreiber

"US overdose deaths in 2021 [were] a record year for such fatalities with an estimated 107,622, the US Centers for Disease Control and Prevention (CDC) said on Wednesday.

"It was an increase of 15% from the previous year, which was also a record.

"The US has now passed 1m overdose deaths since the CDC began collecting data about two decades ago.

"The surge in deaths in 2021 was fueled primarily by fentanyl, a highly dangerous synthetic opioid that accounted for about 70% of fatalities.

"Black American men and boys have the highest fatality rates from drug overdoses, followed closely by American Indian and Alaska Native men and boys – a significant increase among these demographics in recent years.


"The almost fiftyfold increase in illicit pills containing fentanyl happened between 2018 and 2021, she said – a “huge proliferation”.


Here's a CDC chart:

12 Month-ending Provisional Number and Percent Change of Drug Overdose Deaths

Saturday, May 14, 2022

Xenotransplantation and pork chops

 There's been recent news about xenotransplantation, with attempts made to transplant kidneys or hearts from genetically modified pigs into humans.  Those haven't been successful yet, but the organs weren't immediately rejected, because the special pigs involved don't have the alpha-gal sugar molecule on their cells that non-human mammals have and that immediately alerts human immune systems to reject the organ.

But while pig organs aren't ready for transplant yet, it turns out that there are some people who are allergic to the alpha-gal sugar, and hence to meat. But they can eat the meat of these almost-transplant-ready pigs.

The Atlantic has the story:

A Tick Bite Made Them Allergic to Meat. And an organ-transplant company has an unexpected solution. By Sarah Zhang

"It just so happens that the same molecule—a sugar called alpha-gal—that causes the human immune system to reject pig organs also causes the tick-associated red-meat allergy, known as alpha-gal syndrome. To make a pig whose organs could be harvested for transplant, Revivicor first had to make an alpha-gal-free pig. And when it did, the company realized that transplant surgeons weren’t the only ones interested.

"Since last fall, Revivicor has been quietly sending refrigerated packages of alpha-gal-free bacon, ham, ground pork, chops, and pork shoulders to people in the alpha-gal-syndrome community. These packages were free, but Revivicor has told the FDA it is exploring a mail-order business. And so a biomedical company has found itself an accidental purveyor of specialty pork products."


In the background of this story is Revivicor part of the public benefit corporation United Therapeutics, founded by the remarkable Martine Rothblatt.


Friday, May 13, 2022

The No Club, by Babcock, Peyser, Vesterlund and Weingart

 I had the pleasure of hearing Lisa Vesterlund talk about her new book, The No Club: Putting a Stop to Women’s Dead-End Work, by Linda Babcock, Brenda Peyser, Lise Vesterlund, and Laurie Weingart.

One nice market design suggestion comes from the (well documented) observation that it's disproportionately women who volunteer for 'non-promotable' tasks, such as note-taking at meetings, and writing up the minutes afterwards. These are tasks that anyone can do pretty well, so the suggestion is that they should be assigned by lottery, rather than by seeing who volunteers...