Tuesday, December 15, 2015

Fun With C-Diff!

Several weeks ago, our infant daughter began experiencing frequent diarrhea. As the stomach bug had recently ravaged our home, we simply assumed that the last holdout had fallen. However, after almost two weeks she had lost 10% of her body weight and we decided to perform a test for Clostridium difficile colitis.

For the uninitiated, Clostridium difficile colitis (C-Diff on the streets) is a bacterial infection of the lower intestine that causes cramping and severe infectious diarrhea. It is most commonly seen in hospitals and nursing homes where a patient’s gut flora (the worst of all flower arrangements) has been wiped out by anti-biotics.

As you can imagine, testing for the ailment requires a stool sample. This becomes exponentially more difficult when the patient is an infant and the infection has transformed her colon into a dung cannon. For the test to be most accurate, the sample should be captured before it hits an absorbent surface (like a diaper).

To compensate for this, we were instructed to Cling-Wrap our child’s nether-regions before applying the diaper so that (in theory) we could simply wrap the unadulterated sample and bring it to the doctor’s office. The logistics of this proved to be more difficult.

For one thing, when you child has explosive diarrhea all the Cling-Wrap does is create a fecal slip & slide that guarantees a hull breach. Regardless, we placed a roll of plastic wrap, some sandwich bags, and some gloves on her changing table. Every time we swapped diapers I felt like I was working at a deli counter.

The first sample was not “substantial” enough so we had to take another one. Three samples in, we finally got a positive diagnosis. With C-diff the testing is almost incessant and the lab procedure is prone to false negatives. This usually meant that while on lunch my wife would hand me a Ziploc bag of excrement and ask me to take it by the clinic on my way back from work. I am just thankful that I was never pulled over and had to explain my cargo.

Since there is no real way to retain your dignity while standing in a line holding a bag poop, I usually would just loudly announce to the receptionist that “with all due respect I would like to hand you a bag of human feces.” The results of this strategy tended to vary based on the receptionist working the window that day. Most of the time this drew a chuckle and I was out the door in a few minutes.

On my final delivery, I utilized the same technique on a rather serious woman who asked that I fill out some paperwork. This was the first time that I had been asked to do so and when the form asked me to categorize my business that day as a “Check-up” or a “Problem” I coyly requested her guidance. She dryly indicated I could write “Other.” She then inquired as to whether or not the nurse was expecting the turd I had placed on the counter. I replied that while I had not spoken to the nurse that day, she was expecting us to bring a sample by today or tomorrow. She seemed unconvinced and for a moment I entertained the idea of asking if they were having an issue with unsolicited deliveries of poo, but thought better of it.

She checked my insurance provider and address (as I assume this would alter the routing of the package) and then said she needed to step into the back for a moment. I asked if I could get a receipt for the stool sample for my records and she starred at me with a mixture of mild annoyance and disbelief. Finally, after several minutes she agreed to take possession of the item.

Ironically, the common treatment for a bacterial infection caused by anti-biotics is really, really potent anti-biotics. Due to her age, the medicine had to be compounded by hand and they flavored it with mango to cover the taste. My daughter has always been a trooper when it comes to medicine, but one drop of this initiated immediate dry-heaves. We began to suspect she was not a fan of the mango flavoring and I thought about asking them if they could remix it with cherry.

Finally I decided to test it myself and placed a small amount on my tongue. It quickly became apparent that the flavoring was irrelevant since all I could taste was sadness. It was like licking a rusted car bumper while watching someone eat a mango on television. It took Listerine to remove final remnants from my taste buds and my daughter watched all of this with what I interpreted as smug satisfaction. I was much more patient with her after that.

Thursday, December 10, 2015

Guns in America

As much as a person can assess their own political bias, I will attempt to do so here. I do not hunt. It is not because I find the practice abhorrent or offensive and I certainly have nothing against eating delicious animals. It is simply a pastime I have no interest in (like water polo or Celine Dion concerts). I grew up with guns in the house, both of my parents have carry permits and I got my mom a gift certificate to the shooting range for a mother’s day gift. I even enjoy shooting a handgun when I get the chance. That being said, I do not currently own a gun and probably will not in the foreseeable future.

From a political perspective I would call myself a moderate (which for some reason has become dreadfully unfashionable as of late). I greatly admire George H. W. Bush and believe him to be the best president of my lifetime, but have voted for both Republicans and Democrats in Federal elections. I often find myself aligned with the fiscal policy of Republicans and the social policy of Democrats but not always. 

There has been much debate about guns, shootings, and safety and I find it very difficult to find objective data on which to base my own opinion. I have tried to do so here. I mainly focused on two ideas that always seem to get people riled up.     

Idea 1 – Higher rates of gun ownership deter and reduce crime overall – On the surface, there is certainly empirical evidence to back this up. Most notably, the gun homicide rate is down 49% since its 1993 peak, while gun manufactures have enjoyed unprecedented levels of gun sales over the past decade. This is certainly enough to explore a correlation so I found a 2013 PEW research study that looked at the issue more closely.

At its 1993 height, the United States averaged 7.0 homicide deaths per 100,000 people. That dropped dramatically until it was only 3.8 per 100,000 in 2000. Since then it has fluctuated some (it is currently at 3.6) but has not seen any more dramatic shifts over the past decade despite unprecedented levels of gun sales. The United States currently has more guns than citizens and we lead the world in per-capita civilian ownership of firearms (Serbia and Yemen register a distant second and third).The same study also showed that while record numbers of firearms have been purchased under the Obama administration, the percentage of households that own guns has been declining since its 1973 peak of 49% (it is around 43% now).
What that tells is that the record sales under Obama indicate the boom is largely the result of existing gun owners purchasing more firearms rather than people purchasing their first firearm. To put it another way, the biggest number of civilian firearms in American history are controlled by a minority of the populace. While that is not inherently good or bad, it makes a connection between increased gun sales and decreased gun homicides rather dubious. To quote the PEW research study:

Compared with other developed nations, the U.S. has a higher homicide rate and higher rates of gun ownership, but not higher rates for all other crimes.

The truth is that gun sales are up and gun homicides are down but there does not seem to be a direct correlation. There is still no consensus among researchers as to why the gun homicide rate was so high in the early 90’s or why it dropped so dramatically after 1993, but every ideology is more than willing to take credit. Gun advocates will tell you it is because gun ownership is an effective deterrent and gun control pundits will point to socio-economic factors and the implementation of the Brady bill. There is no real consensus as to why people were less prone to shooting one another in 1994, but if my experience was any indication it was because they were all too busy playing Super Metroid.

Idea 2 - Higher rates of gun ownership deter or reduce mass shootings specifically - As of yet, I have been unable to find any evidence to back this up. There has also been much parsing of the idea that we average a mass shooting every day. Gun advocates would tell you that the results are misleading because they do not utilize the FBI’s definition (who only count the incident if 3 or more victims die. This means that if the gunman is a sub-par marksman and shoots 40 people at a mall but only 2 die from their wounds the incident wouldn’t make the cut.)

To be fair, many gun control advocates are misleading when it comes to the mass shooting frequency as well. Obama was wrong when he indicated that this sort of thing did not occur in any other industrialized nations. It does. Furthermore, the best per capital statistics I could find that included other industrialized nations found the United States did NOT lead the world in rampage shooting deaths or injuries per capita (that distinction belongs to Norway.)

That being said, the United States averages 10 times more per capita gun deaths (both homicide and suicide) than Great Brittan and Australia (countries decried by the NRA for their “draconian” gun restrictions.) In fact, we rank just under Mexico by most metrics.

Playing devil’s advocate, it would make perfect sense that a county with less guns would see less gun deaths, but would that effect the overall murder rate? For that, we would look at the per capita intentional homicide rate. The US still averages over 4 times the murder rate of Great Brittan and Australia regardless of how the homicide was committed. Going one step further, there are several memes that simply cite “violent crime” rates and claim that the United Kingdom (while it may have less murders) has more violent crimes per capita than the US.

On the surface that is true, but only because Great Brittan considers any “crime against a person” as a violent crime while in the US we only count murder and non-negligent homicide, forcible rape, robbery and aggravated assault. For instance; harassment, statutory rape, or even possessing a knife are considered violent crimes in Great Brittan so there is no real way to compare apples to apples since we categorize that data so differently.

If we stick with the comparisons of Great Brittan and Australia, the study showed that between the years of 2000-2014, Great Brittan had 1 mass shooting with 23 total victims (killed and injured) and Australia had 2 mass shootings with 9 total victims. During that same period, the United States had 133 mass shootings with 992 total victims.

The other problem with the mass-shootings-every day crowd is that they rely on aggregate news reports and not centralized research sources. This wouldn’t be such a disingenuous critique by gun advocates if the NRA hadn’t spent so much effort preventing reliable statistics from existing.

In 1995, the CDC spent $2.6 Million on gun research. The NRA accused the CDC of advocating for gun control and in 1996 the $2.6 Million was removed from the CDC’s funding by a Republican congressman. It was only restored after the following provision was added to the CDC appropriations bill:

None of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention may be used to advocate or promote gun control.

While the provision did not technically outlaw research, it created a model that predicated funding on how the resulting data would be used. The CDC got the message and there were practically no studies done on firearms, gun deaths, or injury preventions until 2013 when President Obama ordered them to resume it. They have yet to do so for fear of Congressional retribution. The National Institute of Justice (an arm of the Department of Justice) averaged over 5 gun studies a year in the early 90’s but from 2009 to 2013 conducted none.

Almost every year, groups of scientists and doctors signed letters calling on the CDC to resume research on effective ways to reduce gun violence. One of the signees, a criminology professor at the University of Pennsylvania, stated that he could “see no upside to ignorance.” The NRA contends that the Center for Disease Control should not handle firearms statistics lest gun ownership be equated to a “disease.” Let’s just say that the same CDC department studies motor vehicle safety and the NRA has not yet expressed concern that the Federal government will ban or confiscate anyone’s Ford Focus.

Gun control advocates are wrong when they indicate that gun deaths are skyrocketing or that no other industrialized nation experiences mass shootings. Guns do not make people violent, but they are the weapon of choice for violent people. They can also be used by law-abiding citizens for sport or protection.

We also have a second amendment that, like all of The Constitution is open to interpretation.

A well regulated Militia, being necessary to the security of a free State, the right of the people to keep and bear Arms, shall not be infringed.

Some interpret this as being two mutually exclusive ideas: A well regulated Militia is necessary for the security of a free state. In addition to militia-members, the right of [anyone] to keep and bear arms [for any reason they wish] shall not be infringed.

Others would see the first half of a sentence as a qualifier for the second. Since a well-regulated militia is necessary to the security of a free state [the right of militia members specifically to keep and bear firearms] shall not be infringed.

Bottom Line: Residents of Great Brittan and Australia are far less likely to be murdered in general and murdered by guns specifically. This solidly refutes the idea that more guns among citizens = less homicide. However, removing guns from a population does not remove anger, hatred, or violence. It simply limits the expression of those emotions to less advanced weaponry.

Regardless of how you feel about gun rights, we need standardized nationwide data on gun safety and gun deaths before we make any decisions on regulation. If the NRA truly believes that a wide interpretation of the Second Amendment keeps law-abiding citizens safer, then they should have no reason to fear the data such studies would produce or spend millions lobbying against the CDC’s ability to compile it.

                 Politifact mass shooting statistics