Causes of Addison's disease

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Addison's disease results when your adrenal glands are broken, manufacturing insufficient amounts of the hormone cortisol and infrequently aldosterone similarly. These glands are located simply higher than your kidneys. As a part of your endocrine system, they turn out hormones that offer directions to nearly each organ and tissue in your body.

Your adrenal glands are composed of 2 sections. the inside (medulla) produces adrenaline-like hormones. The outer layer (cortex) produces a bunch of hormones referred to as corticosteroids, that embrace glucocorticoids, mineralocorticoids and male sex hormones (androgens).

Some of the hormones the cortex produces are essential forever — the glucocorticoids and therefore the mineralocorticoids.

• Glucocorticoids. These hormones, that embrace cortisol, influence your body's ability to convert food fuels into energy, play a task in your immune system's inflammatory response and facilitate your body answer stress.
• Mineralocorticoids. These hormones, that embrace aldosterone, maintain your body's balance of sodium and potassium to stay your blood pressure traditional.
• Androgens. These male sex hormones are made in little amounts by the adrenal glands in each men and ladies. They cause sexual development in men and influence muscle mass, libido and a way of well-being in men and ladies.

Primary adrenal insufficiency
Addison's disease happens when the cortex is broken and does not turn out its hormones in adequate quantities. Doctors confer with the condition involving harm to the adrenal glands as primary adrenal insufficiency.

The failure of your adrenal glands to provide adrenocortical hormones is most typically the results of the body attacking itself (autoimmune disease). For unknown reasons, your immune system views the adrenal cortex as foreign, one thing to attack and destroy.
 Other causes of adrenal gland failure might include:

• Tuberculosis
• different infections of the adrenal glands
• unfold of cancer to the adrenal glands
• Bleeding into the adrenal glands

Secondary adrenal insufficiency
Adrenal insufficiency may occur if your pituitary gland is diseased. The pituitary gland makes a hormone referred to as adrenocorticotropic hormone (ACTH),

that stimulates the adrenal cortex to provide its hormones. Inadequate production of ACTH will cause insufficient production of hormones normally made by your adrenal glands, albeit your adrenal glands are not broken. Doctors decision this condition secondary adrenal insufficiency.

Another additional common reason behind secondary adrenal insufficiency happens when folks that take corticosteroids for treatment of chronic conditions, like asthma or arthritis, abruptly stop taking the corticosteroids.

Addisonian crisis
If you've got untreated Addison's disease, an addisonian crisis could also be provoked by physical stress, like an injury, infection or illness.

Treatment of Addison's disease

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All treatment for Addison's disease involves hormone replacement therapy to correct the amount of steroid hormones your body is not manufacturing. Some choices for treatment include:

• Oral corticosteroids. Your doctor might prescribe fludrocortisones (Florinef) to replaces aldosterone. Hydrocortisone (Cortef), prednisone or cortisone acetate is also used to switch cortisol.
• Corticosteroid injections. If you are unwell with vomiting and cannot retain oral medications, injections are an choice.
• Androgen replacement therapy. To treat androgen deficiency in ladies, dehydroepiandrosterone will be prescribed. Some studies recommend that this therapy might improve overall sense of well-being, libido and sexual satisfaction.

An ample intake of sodium is usually recommended, particularly throughout significant exercise, when the weather is hot, or if you've got gastrointestinal upsets, like diarrhea. Your doctor also will recommend a short lived increase in your dosage if you are facing a stressful state of affairs, like an operation, an infection or a minor illness.

Addisonian crisis
An addisonian crisis could be a life-threatening state of affairs that leads to low blood pressure, low blood levels of sugar and high blood levels of potassium. this case needs immediate medical care. Treatment usually includes intravenous injections of:

• Hydrocortisone
• Saline resolution
• Sugar (dextrose)

"Global" health care spending caps-the push ramps up

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The clumsy, global health care spending caps enacted in Massachusetts is a harbinger of what the medical planning elites are pushing for the whole country. Global should be in scare quotes because it does not mean the entire world- just the US in regard to both pubic and private health care spending.

Let that sink in, the elite class wants to control how much everyone can spend on health care. This is central economic planning much more restrictive and coercive than what ACA has in store for roughly 1/6 of the US economy. I use the adjective clumsy because the Mass Plan does not have real teeth to enforce spending caps on the total amount spent on health care . A federal plan even it is nominally executed via numerous individual state plans will not make that mistake.

Dr Paul Hsieh talks about an article in the September 6,2012 issue of NEJM written by an all star team of proponents of central control. See here for his commentary. Here is one quote from the NEJM article :


"We recommend that an independent council composed
providers,payers,businesses,consumers and economists set and enforce the spending targets."

Folks associated with the Center for American Progress are well represented in the article's 23 authors (the Center sponsored the gathering of "health-policy experts) as are folks who have worked with the Obama and Clinton administrations. Peter Orszag,now with Citigroup, and Ezekiel Emanuel both played roles in the health planning of the Obama administration. The former president of the SEIU contributed as well as did Tom Daschle

Uwe Reinhardt was also a contributor and his affiliation on the print version of the article listed Princeton as an employer but his roles on the boards of Boston Scientific and Amerigroup Corp and as a trustee of Q Capital Management were not. However, those positions were designated on the ICMJE form which can be accessed via the online version of the article.There we learned that Dr. Reinhardt received stock and stock options from those organizations. I mention Reinhardt particularly because this is not the first time his paid associations with health care related companies does not appear on the print version of articles and commentaries to which he has contributed. Dr Roy Poses has been tireless in his efforts to point out various conflicts of interests in those who hold themselves out to be health care experts.See here for one of Poses's posting regarding COI s and Dr. Reinhardt.

Left unsaid was how the spending targets would be enforced.

Rule of law,property rights erode and USA economic freedom index drops to 18 th in world

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Not too long ago the United States was one of the most economically free countries..Not so now, as measured by the Frazier Institute in Canada. See here for economist Lynn Kiesling's. comments on the latest ranking of the various countries on the economic freedom scale.

See here for the Executive Summary of the "Economic Freedom of the World.2012 Annual Report."

Forty-two variables are used  in this ranking exercise that cover five areas:

1.Size of government
2.Legal system and property rights
3.Sound money
4.Freedom to trade internationally
5.Regulation

So why did the US drop further in the rankings?

"During the past decade, the U.S. rating fell nearly a full point on our 0-to-10 point scale, from 8.65 in 2000 to 7.70 in 2010. While it is difficult to pinpoint all the reasons for this decline, the increased use of eminent domain, the ramifications of the wars on terrorism and drugs, and the violation of the property rights of bondholders in the bailout of automobile companies have all clearly weakened private property and the rule of law tradition of the United States."

 It is getting worse.From 1980 to 2000 the US trails only Hong Kong and Singapore,by 2005 US fell to
 8th and now 18th.

Although I could find no analysis of the role of the Affordable Care Act in their publication, clearly the ACA did not enhance freedom economic or other wise. The regulations ( many of which are still being written) will limit the freedom of all elements of the health care system. The ACA which in this respect has been validated by the Supreme Count,forces individual to purchase a certain product ( health insurance). If  that is not the opposite of economic freedom, I don't know what is. If that were factored into the analysis (maybe it was),US would be even lower than 18th.

The developing Vison of Primary Care in the Big Rock candy Mountain

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Probably the primary care physicians in training who authored a recent commentary in the NEJM describing their view of what primary care should be may will have to google the candy mountain reference in the title or just look here.

KA Barnes,J. Kroening-Roche and BW Comfort wrote a perspective piece in the Sept 6 201212 issue of the NEJM.

In it they describe their vision of primary medical care in the U.S. I will not quote their description of what they hope primary care will be but I will quote a sentence that is the essence of what I believe to be a bogus concept.

"Primary care cannot be primary without the recognition that it is communities that experience health and sickness."

Their description of a typical day a primary care practice can be dismissed as idealistic and naive or wishful thinking as in lemon aid springs of the Big Rock Candy Mountain ( at least to an increasingly curmudgeonly old retired doc) but the quoted sentence expresses a conceptual error.

No, communities do not experience anything;nor do they choose anything nor do they suffer or rejoice. Only sentient beings can do any of those things and communities are an abstraction . Similar terms ( society,the country, etc) can be useful summary ways of thinking and talking- a useful short hand. To say that a community is ill or well is a figure of speech;to say that Mr. Brown is sick is an empirical fact. Mr.Brown can regret his earlier excessive use of alcohol, to say the community regrets anything is a category error.

This is not to deny that there are economic factors and social factors that might impact someone's health but to the degree that such things happen they impact the health of individual real life people not society and not a community.Government programs can improve the health of individuals, with such thins as immunization campaigns and providing health care to the indigent.But it is not the community whose health improves it is the individuals who can benefit.

Society or communities are not some super being or entity apart from the individuals who comprise it. To consider that they are or to reify this abstraction lays the foundation for consideration of weighing the value of the individual against this mythical creature and presto we have the new medical ethics.

Reification refers to the treating of an abstraction as if it were a concrete real thing or an actual physical entity.In short turning an idea into a thing and treating it as if the idea posses the attributes on an actual being.

It is the public health paradigm taking over clinical medicine. I hope that when I get older and ill that the physician I consult will realize that I am her patient and not the community in which I reside.

Quality adjusted life years (QALY)-More to life than counting the dead

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Counting deaths is much easier than assessing quality of life.Drs Pamela Hartzband and Jerome Groopman discuss the vagaries and uncertainly of clinical decision analysis and in quantifying the impact of disease on a person's life in the September 13,2012 issue of NEJM in a perspective piece entitled There is More to Life than Death.

The authors point out in regard to the recent USPTF pronouncement regarding PSA testing that while the data are conflicting and the study (the PLCO trial) that largely controlled the panel's decision against PSA testing has serious defects the chairperson spoke as if the call was a slam dunk or in her words "a no brainer". The authors of the NEJM article were polite in their criticism. but I cannot talk about the panel's actions and comments without using the word hubris. Reasonable, well trained statisticians have differed in their analysis of the set of data on PSA testing. Actually hubris is not strong enough a descriptor.

The Harvard husband and wife team asks " Is it possible to put numbers on the "utility"or impact of these conditions on a man's life? Is the concept of aggregating utility valid? I have argued before that it is not. See here.

Hartzband and Groopman discuss methods to attempt to quantify utility. One such method is call the "time trade off". Here a person is simply asked how many years of life she would be willing to give up to reverse a medical condition and return to health. On the face of it this is a absurd counter factual. One is asked to imagine having for example a cancer and what number of years of life they would give up to not have the cancer? A similar absurdity is the "standard gamble" which asks which odds you would take to risk sudden death to reverse some condition.

H and G :

"People cannot anticipate the global impact of a specific future change in their lives".

Of course they cannot.The quality adjusted life years concept is built on a dual fallacy.The fallacy of determining of some one else"s quality of life-based on a hypothetical and the absurdity of adding those determinations to conjure up; some aggregate utility. Yet organizations such as ACP seems to proceed on making cost effectiveness "determinations" that likely will be used to limit a person's access to some element of medical care.Are they aware that the father of utilitarianism expressed the folly of adding up happiness (or the modern equivalent - utility)?

At least the authors of an Annals of Internal Medicine article hyping the cost effectiveness analysis did not claim their analysis were no brainers but rather assured the reader that those type decisions were complex and needed to be made by highly trained professionals.This meant training more advanced that the 7-10 years of post college education that a physician accumulates.The tone of the article made it clear than the Annals article authors were just the folks for that type of very difficult analysis.No hubris there.

When you urge coercion by the government,don't be shocked if you get coerced as well

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The following quote explains the title.See here for further details

All people have the moral obligation to care for those who are less fortunate. But replacing morality with legality is the first step in replacing church, religion and conscience with government, politics and majority vote. Coercing people to feed the poor simply substitutes moral poverty for material poverty.
The bishops dance with the devil when they invite government to use its coercive power on their behalf, and there’s no clearer example than the Affordable Care Act. They happily joined their moral authority to the government’s legal authority by supporting mandatory health insurance. They should not have been surprised when the government used its reinforced power to require Catholic institutions to pay for insurance plans that cover abortions and birth control.

Dancing with the devil is dangerous business.