Items filtered by date: Friday, 15 November 2019

Two new cases of “smartphone blindness” has been described in the last month.   One case was a gentleman in China who was playing games on his phone at night and suffered a retinal artery occlusion or “eye stroke.” Another case was a woman in China, who was also playing on her phone at night but she sustained a bleed in her left eye.  Just as those who suffer from cerebral strokes, a “lack of blood flow” to the retina, or layer of the eye that helps create visual images, can be caused by a clot or hemorrhage.  Apparently these can be induced with excessive focusing and eye strain. This may result in temporary or permanent blindness.

UPDATED FROM JUNE 23, 2016

Some people are being evaluated for stroke or transient ischemic attacks when they come to the ER complaining of recurrent “temporary blindness” after checking their smartphone in the dark.  This phenomenon, known as ‘smartphone blindness’, has been experienced by many of us when we have the sensation of dimmed vision or poor visual acuity, feeling punished for peeking at our email when we should be sleeping.

 

In 2016, doctors reviewed the cases of two women who experienced episodes of “temporary blindness”; as the ladies put their cell phones down, one eye could not see the cell phone for 15 minutes.  Their vision restored after this length of time.Doctors investigated the cases thoroughly with a variety of medical tests including MRI’s and couldn’t find the cause.

Finally they conclude these transient episodes of “vision loss” were harmless, in that one eye was being used to look at the phone and the other eye needed time to “catch up”.  When the women, as many of us do, check our phones, one eye is snugly closed and resting on a pillow while the other is available to look at the phone.  When the ladies would turn over, the closed eye didn’t have a chance to catch up to the increased brightness of the phone screen, hence having a dimmed view.

If one uses both eyes to look at the screen, this phenomenon does not happen.

Smartphone Blindness Studies Are Cause For Concern

Studies surfaced a few years ago where great lengths of smartphone use can cause retinal detachment.  In these cases the layer of the retina which focuses images, detaches from the back of the eye, causing serious vision loss.  Though there are treatments, if not treated early can cause permanent blindness in the affected eye since the retina loses its blood and oxygen supply when detached.  A woman from China had been using her smartphone for 2-3 hours in the dark each night when this occurs.

Smartphones have also been linked to myopia, nearsightedness and sleeping disorders as the blue light emitted from the screen can disrupt melatonin production.

A recent study found that 30% of adults spend more than 9 hours a day using their smartphone. Physicians recommend avoiding extended use, adjust settings to black text on white background, and with this recent case study, use both eyes to look at the screen when using the phone at night.

Increasing the size of the font helps your eyes since they don’t need to strain as much to read.  Try to look at your smartphone with a distance of 1 1/2 feet. Blinking often helps rest the eyes as well and keeps them lubricated and moist.

Additionally, avoid using the phone in the dark, but in a lit room. 

Finally its good to use the 20,20,20 rule.  After every 20 minutes of use, look away at something 20 feet away for 20 seconds.  This may help avoid eye strain from excessive smartphone use.

 

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Daliah Wachs is a guest contributor to GCN news, her views and opinions, medical or otherwise, are her own. Doctor Wachs is an MD,  FAAFP and a Board Certified Family Physician.  The Dr. Daliah Show , is nationally syndicated M-F from 11:00 am - 2:00 pm and Saturday from Noon-1:00 pm (all central times) at GCN.

Published in Health

Income inequality among Americans has been a major subject of debate for a decade, and ever more so with leftwing extremists now dominating the ranks of Democratic presidential aspirants.  So, let’s get the basic facts and issues straight.

A salient claim in this area comes from the French economist Thomas Piketty in his 2014 book, Capital in the Twenty-first Century, a 700-page tome.  His starting point is that the rate of return on capital investment is generally significantly greater than the growth rate of a market economy (or, r>>g).  This is generally uncontested.

So, Piketty concludes that the rich, whose incomes derive greatly from their ownership of capital, will get ever greatly richer.  On the other hand, the middle and lower classes, whose incomes derive mainly from their labor, will see those incomes increase only at the growth rate of the economy.  Hence, they will fall ever farther behind the upper-income people.

If that were the full story, why didn’t income inequality spiral up long ago?  In part, it’s because taxes burden upper classes very disproportionately and government transfer payments (mainly welfare, food stamps and health-care subsidies) are concentrated on the lower classes.  Piketty’s comparisons are based on pre-tax income, not including transfer payments, as are almost all the data advanced by those obsessing about income inequality.

These folks also fail to adjust for declining household size in recent decades when they allege falsely that middle and lower family income levels have not increased.  And Piketty’s analysis overlooks that the wealthy usually divide their estates among charities and various heirs and other folks when they pass it on, thus counteracting the fast growth of family incomes based on capital.

But the important point is that taxes and transfer payments have continued to grow relative to our economy.  So, they now overwhelm every other factor, as shown by recent research by Phil Gramm, former economics professor and chairman of the Senate Banking Committee; and John F. Early, twice assistant commissioner at the federal Bureau of Labor Statistics.

When we consider family incomes after taxes and public and private transfer payments, the story is very different from that based on the pre-tax and -transfers data.  That’s because 80 percent of all taxes are paid by the top two income quintiles (that is, the top 40 percent) and 70 percent of all transfer payments are received by the bottom two quintiles.  Aggregate taxes paid and transfers received by the middle quintile are almost exactly equal.

The average bottom-quintile household earns $4,908 annually while the average top-quintile household earns $295,904, or 60 times as much.  But when we consider the $45,993 additional income the lowest-quintile homes get from public and private transfer payments, less taxes they pay, their average incomes rise to $50,901.  For the top quintile, the net of taxes and transfers is a reduction of $100,998, leaving them with $194,906.

So, the real ratio between the top and bottom quintiles is only 3.8 times, not 60 times.

And government and the private sector shift enough net income to the lowest quintile to raise their net income to middle-class levels at $50,901.

So, is a 3.8:1 ratio fair and reasonable?

One important fact is that income mobility is higher in America than in most other countries.

Also, 50 years of increasing transfer payments and rising and progressive taxes have had another effect.  When the War on Poverty transfers began in 1967, nearly 70 percent of bottom quintile prime-working-age adults were employed.  Today, that figure is only 36 percent.  For all the top three quintiles, however, labor-force participation has increased.

Ultimately, though, the question depends on what fairness is, as much as it does on data.  Progressives, populists and class warriors erroneously claim it means equal outcomes for everyone.  They forget that in market systems income flows to people roughly in proportion to the value they deliver to others – that is, proportionately to their contribution to human wellbeing and the public interest.   Not so for systems that politically allocate resources.

Finally, recent research shows that three-quarters of the high incomes made by entrepreneurs flows from their own “human capital” contributions, not from the financial capital they employ.  So, yes, 3.8:1 seems quite fair.

 

 

Published in Money
Friday, 15 November 2019 18:03

A Stethoscope Is NOT A Prop

Stock photos of “healthcare workers” who attend patients—physicians are no longer distinguishable—usually feature a stethoscope draped around the neck.

But some, such as cardiologist Eric Topol, consider the stethoscope obsolete, nothing more than a pair of “rubber tubes.”

The most important part of the stethoscope is the part between the ears. But some think that will be replaced by artificial intelligence, and the rubber tubes by sophisticated electronic gizmos costing at least ten times as much as the humble stethoscope.

High tech is wonderful and increasingly capable, but if the stethoscope is dying, so is the art of clinical medicine.

The proper use of the stethoscope requires the doctor to touch, listen to the patient, and spend some time with a living person, not a computer. Patient and physician must cooperate: “Stop breathing,” “Take a big deep breath,” “Lean forward,” and so on.

It may be true, as Dr. James Thomas said, that graduates in internal medicine and emergency medicine miss as many as half of murmurs using a stethoscope. There are several reasons for this. One is not taking enough time to listen in a quiet room, and failing to perform the special maneuvers required to bring out an otherwise inaudible murmur (lean forward and exhale fully, turn onto your left side, squat then stand up, etc.).

The other is inadequate training. There are excellent recordings of heart sounds and murmurs, which of course would take time away from the time-devouring electronic medical record or “systems-based” medicine. And a recording is not the same thing as a live patient. Much of today’s teaching in physical diagnosis may be by “patient instructors”—paid actors pretending to be patients, who are evaluating the students as the students examine them. Rounds may be in a conference room, focused on the electronic record, instead of at the bedside.

In the old days, all the members of the team got to examine a real patient who had an interesting finding, with the patient’s permission and under the supervision of an attending physician. It seemed to me that patients usually enjoyed being the center of attention and the star of the show, and hearing the professor discuss their case. We learned how to help patients to sit up, and about hairy chests, layers of extra insulation, noisy lung sounds, shortness of breath, and other impediments to an easy examination.

The stethoscope is not just for heart murmurs. It’s for finding subtleties in careful, slow measurement of the blood pressure. It’s for extra or abnormal heart sounds. One can sometimes hear evidence of vascular problems inside the skull, or in the arteries supplying the brain, kidneys, or limbs. Or signs of intestinal obstruction. One can check to make sure a breathing tube is in the right place.

I don’t know of any bedside technologic wonders for examining the lungs. The stethoscope can detect sensitive signs of heart failure, pneumonia, fluid in the chest, collapsed lung, or airway obstruction. One can listen frequently to monitor changes in the patient’s status—much more efficiently than bringing the portable x-ray machine around.

The stethoscope works even when the power is off, the batteries are dead, the computer is down, or some circuit in the ultrasound device is malfunctioning. It works in facilities too poor to have the latest technology, or with patients who can’t afford to pay for a more expensive examination.

The stethoscope has tremendous capabilities in trained hands. Patients might want to evaluate whether they have a clinician who knows how to use it or is just carrying around a prop or status symbol. If you have symptoms suggestive of a heart or lung problem, does the doctor listen to all the lung fields—upper, mid, and lower, front and back? To at least four places for heart sounds? Are you asked to cough, say “e,” whisper something, take deep breaths or slow quiet ones, or do other maneuvers if something in the history or examination suggests a possible problem? Is the tv off, and are visitors asked to be quiet?

Everybody including doctors loves fancy technology. But before we toss out the old reliable tools, backed by two centuries of experience, how about some serious comparative studies like those the proponents of evidence-based medicine constantly demand?

 

Jane M. Orient, M.D. obtained her undergraduate degrees in chemistry and mathematics from the University of Arizona in Tucson, and her M.D. from Columbia University College of Physicians and Surgeons in 1974. Her views are her own. This is an edited version of her column that originally appeared in pennypress.com. Reprinted with permission. 

Published in Opinion
Friday, 15 November 2019 17:52

Will CNN tank AT&T's management?

Apparently, AT&T bought CNN thinking it was some kind of an entertainment outlet.

 

It is, but only to those of us who understand that Ted Turner’s creation has devolved into something which no longer resembles, in any way, journalism.

 

How bad is CNN’s coverage of the President?

 

Well, depending on who you choose to believe, studies from Harvard to the Media Research Center place the ratio of positive to negative coverage between 91% negative to 93%.  Every media analyst agrees.  CNN’s coverage is so biased that it can hardly be called coverage.

 

And it seems to be cheerfully brought to you by the American Telephone and Telegraph Company.  At 208 S. Akard Street in Dallas, Texas.  CEO Randall Stephenson and Chief operating Officer John Stankey.

 

When these guys bought Directv, I was a fan.  When they brought out Directv Now (Now ATT TV Now) as a streaming service I was and still am a fan.  When they bought Warner Media, I was OK with that.

 

I figured that CNN was already so screwed up, it had only one way to go—up.  I was wrong.

 

I was against the Justice Department’s antitrust action.  Still am.

 

That said, who knew that the two executives I listed above (along with their emails) were closet liberals?

 

My suspicion still is that they’re not.  What they, are, I think, is scared to death—like the dog which caught the car.  They have no idea what to do.  Owning HBO is one thing.  You can always disavow Bill Maher.

 

But a news outlet?  That involves editorial judgment and CNN already had less than none.  It needs grown-ups to instill some discipline.  Stephenson and Stankey are supposed to be those adults.  Only nobody told them.  They were too busy getting Hollywood elite sweet nothings blown up their skirts.

 

On one hand, they don’t want to make the left mad.  After all, the left controls show biz—right?  On the other hand, they really don’t want to have to choose up sides against a President who could easily be re-elected.  Much of their communications business is heavily regulated.  And, just to make things interesting, an activist management company, Elliott Management, took a $3.2-billion position in AT&T and wants change as well as seats on the Board.

 

So, wouldn’t the smart money be to make those clowns in Atlanta actually run a news outlet as opposed to taking virtually every opportunity to tilt to the radical left?

 

Apparently, Mr. Stephenson’s testicles were there when he bought into the entertainment business, but seem to have softened when it comes to making tough decisions regarding the content of his acquisitions which could ultimately send his share price plummeting.

 

Here’s a hint as to how another executive has handled it.

 

Apple’s Tim Cook—hardly a Trump fan—has kept an open channel to the President even though he supported Trump’s 2016 opponent.  

 

That makes sense, considering their common interests, especially where it comes to China, trade and intellectual property.

 

Do you really think Trump would refuse Stephenson’s call?

 

As long as his company is channeling Nancy Pelosi, it is probably a difficult call to have.

 

But if Stephenson and Stankey could say, with straight faces, that they are aiming to make CNN a “just the facts” news outlet, you can bet Trump would take that call.

 

It’s high time the folks on Akard Street in Dallas started worrying about their shareholder value.  They could fix CNN in two weeks.  Nobody is asking that they try and duplicate Fox.  Just be fair.  If they don’t, and 63,000,000 Trump voters take offense, well, they don’t make fallout shelters deep enough to protect them from the economic consequences.

 

 

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Fred Weinberg is a guest columnist and the CEO of USA Radio Network. His views and opinions are his own and do not necessarily reflect the opinions of GCN. Fred's weekly column can be read all over the internet. You can subscribe at www.pennypressnv.com. This is an edited version of his column, reprinted with permission. 

 

Published in Opinion