Hospitals & Asylums 








November 2014

By Anthony J. Sanders


Balancing the federal budget is a self-inflicted pain in the OASDI, be sure to sit on a soft cushion when doing calculus all day long, but at least the 3% of GDP deficit inspired me to correct my mathematics regarding the optimal OASDI rate of 10.1% OASI and 2.3% DI until 2018 when the demographics change to 10.2% OASI and 2.2% DI. Balancing the budget is mostly a matter of OMB accurately accounting for agency budget requests, accepting the $495 billion military and $1 trillion medical spending limit without review until FY2020, and reorganizing to better account for Acts Affecting a Personal Financial Interest off-budget.  Other Defense – Civil Programs, Allowances, and Undistributed Off-setting Receipts rows must be abolished and deleted from the on-budget table so OMB ceases to confuse the public debt with the decadent accounting of off-setting receipts involved in the operations of the Treasury, for which considerable retroactive debt relief may be due.  The $60.1 billion Premium Tax Credit and Cost-sharing reductions treasury program needs to be immediately abolished. It will be necessary to redress the cruel ~$666 a month social security overpayment decisions, ruled illegal by the Senate Social Security Caucus in 2011, with underpayment determinations compensating the theft victims with the restoration of their original benefit amount, back-payments for the time their benefits were subjected to illegal retroactive garnishment and base wage boost >$700 to the $1,000 per person ideal begged by the author, up to $2,400 a month for retired and disabled workers with dependent family or partner/caregiver, to compensate for the use of Section 204(b)(c) of the Social Security Act (42USC§404), the Theft of Government Funds 18USC§666 and the Treasury under 31USC§329 and limit the time a beneficiary can earn between $600 and $699 a month to 42 months before they are automatically given $700 a month (Revelation 13:10).


An Act is needed this December 2014 to assure DI beneficiaries a decent COLA that won’t be reduced to 80% of scheduled benefits in 2016 because the DI trust fund is exhausted, To eliminate the maximum taxable limit on the Disability Insurance (DI) FICA tax calendar year 2015 increasing revenues, from $117.3 billion to an estimated $156 billion barely enough for costs of $151 billion at the current 1.80% rate, and from $149.9 billion to $199.4 billion at the optimal rate of 2.30% going down to 2.20% in 2018.  To amend the DI tax rate from 1.80% to 2.30%, from 0.90% to 1.15% for employees and from 0.90% to 1.15% for employers under Sec. 201(b)(1)(S) of the Social Security Act 42USC(7)II§401 without increasing the overall 12.4% OASDI or 15.3% OASDI and Hospital Insurance (HI) tax-rate under 26USC(A)(2)§1401. To amend the OASI tax rate from 10.60% to 10.10%, from 5.30% to 5.05% for employee under 26USC(C)(21)(A)§3101 (a) and from 5.30% to 5.05% for employers under 26USC(C)(21)(A)§3111 (a).  To abolish the OASI income cap on contributions and tax the rich the full 12.4% OASDI FICA tax in FY2016, raising >$250 billion annually in new revenues, requiring the Social Security Administration (SSA) to pay >$55 billion for SSI and >$11 billion SSA administrative costs $70 billion 2016, off-budget, and receive a guaranteed 10 percent of profits in surplus of expenditures, to save in the OASI and DI trust funds at a ratio in equilibrium with the beneficiary population whereby the large OASI trust fund should bear primary responsibility for an account deficit, so as not to deplete the smaller trust fund; with interest income OASDI combined may not need to raise taxes again for the rise in expenses 2030-2050 and possibly increase the tax rate around 2070 as costs rise to 13.58% of taxable payroll in 2090, and share the remainder of profits with the General revenues to insure the 75 year horizon against poverty and reasonable federal deficits until about 2030.


Diabetes mellitus edition of Gastroenterology HA-6-11-14


Gastroenterology has been edited to better understand of diabetes mellitus.  On some Native American reservations 60% of the population has diabetes. In the United States an estimated 23.6 million children and adults, 7.8% of the population, have diabetes. While an estimated 17.9 million have been diagnosed with diabetes, 5.7 million people (or nearly one quarter) are unaware that they have the disease and another 57 million have pre-diabetes. An estimated 177 million people are affected by diabetes world-wide, the majority by type 2 diabetes. Two-thirds live in the developing world.  The rate of new cases of diabetes has increased by about 90 percent in the United States over the past decade. From 1995 to 1997, newly diagnosed cases of diabetes were at 4.8 per 1,000 annually. Between 2005 and 2007, that number rose to 9.1 per 1,000 people.  An estimated 90 percent to 95 percent of the new cases are type 2 diabetes.  Diabetes and pre-diabetes have skyrocketed among the nation’s youth, jumping from 9 percent of the adolescent population in 2000 to 23 percent in 2008.  Despite the minute size of the islets of Langerhans the endocrine pancreas is responsible for a disproportionate amount of morbidity and mortality.  Diabetes mellitus ranks among the top ten causes of death in Western nations.  The number of new cases of Diabetes mellitus has nearly doubled in the past fifteen years since the atypical antipsychotic and antidepressant Olanzapine (Zyprexa), known to cause both diabetes and fatal diabetic episodes when mixed with alcohol, was marketed in 1994 by Eli Lilly & Company, the U.S. manufacturer of insulin.  It is hypothesized that injectable insulin is vulnerable to drug counterfeiting and injections, particularly several times a day, are more dangerous than the oral route, wherefore clinical studies are recommended to see if patients with Type I diabetes respond well to oral diabetes medications used in the treatment of Type II diabetes. There are two types of diabetes type I and II.  Insulin-dependent diabetes mellitus (IDDM) also called Type I diabetes, juvenile onset and ketosis-prone diabetes.  Juvenile onset diabetes accounts for 10 to 20% of all cases of idiopathic diabetes.  Non-insulin dependent diabetes mellitus (NIDDM) also called type II diabetes and adult onset diabetes accounts for 80 to 90% of all cases.  Type II diabetes is divided into obese and non-obese types and third rare form, known as maturity-onset diabetes of the young (MODY) that manifests as a mild hyperglycemia and is transmitted as an autosomal dominant trait.  A clinical study found that 50% of people diagnosed with Type I juvenile onset diabetes were dad within 22 years of diagnosis.  Chronic hyperglycemia is a major contributing factor towards almost all possible complications with diabetes including kidney failure, blindness, diabetic neuropathy, and heart problems. Morning fasting glucose levels range from 70 to 99 mg/dL, pre-diabetes from 100 to 125 mg/dL and diabetes 126 mg/dL or higher.  Ketone testing is an important part of monitoring in type 1 diabetes. It is a tool that is often also used in pregnancies that are complicated by diabetes.  If the reading is below 0.6 mmol/L you are in the normal range. If the number is between 0.6 to 1.5 mmol/L is in this range ketones are present in the blood, which may develop into a problem if not treated. Readings above 1.5 mmol/L indicate a greater risk for developing ketoacidosis (DKA). Hemoglobin A1c refers to the final product of several chemical reactions that occur in the bloodstream as red blood cells are exposed to glucose. A red blood cell typically lives for about three months, so the HbA1c reading provides a report card averaging the prior three months blood sugar levels. The A1C test result is reported as a percentage.  A normal A1C level is below 5.7 percent. 


Insulin is a naturally-occurring hormone secreted by the pancreas. Insulin is required by the cells of the body in order for them to remove and use glucose from the blood. From glucose the cells produce the energy that they need to carry out their functions. Researchers first gave an active extract of the pancreas containing insulin to a young diabetic patient in 1922, and the FDA first approved insulin in 1939. Currently, insulin used for treatment is derived from beef and pork pancreas as well as recombinant (human) technology.  In general, adjust dosage of insulin based on blood and urine glucose determinations and carefully individualize to attain optimum therapeutic effect. Administer into the thighs, upper arms, buttocks, or abdomen using a 25- to 28-gauge needle, one-half to five-eighths inch in length.  Insulin (regular) (i.e., purified pork insulin) generally is given sub-Q in a dosage of 2–4 units, 15–30 minutes before meals and at bedtime no change in dosage usually is required when transferring to human insulin,  .  Rapid Acting Insulin Analogs (Insulin Aspart, insulin Lyspro, Insulin Glulisine) which have an onset of action of 5 to 15 minutes, peak effect in 1 to 2 hours and duration of action that lasts 4-6 hours.  Regular Human Insulin has an onset of action of 1/2 hour to 1 hour, peak effect in 2 to 4 hours, and duration of action of 6 to 8 hours.  Intermediate-acting insulin is absorbed more slowly, and lasts longer.  It is used to control the blood sugar overnight, while fasting and between meals, it includes NPH Human Insulin which has an onset of insulin effect of 1 to 2 hours, a peak effect of 4 to 6 hours, and duration of action of more than 12 hours. NPH (Neutral Protamine Hagedorn) is a longer-acting human insulin that is used to cover blood sugar between meals, and to satisfy overnight insulin requirements. A fish protein, protamine, has been added to the Regular human insulin to delay its absorption. Long-acting insulin is absorbed slowly, has a minimal peak effect, and a stable plateau effect that lasts most of the day and is used to control the blood sugar overnight, while fasting and between meals. Long acting insulin analogs (Insulin Glargine, Insulin Detemir) have an onset of insulin effect in 1 1/2-2 hours. The insulin effect plateaus over the next few hours and is followed by a relatively flat duration of action that lasts 12-24 hours for insulin detemir and 24 hours for insulin glargine.  Novolog or another rapid-acting injectable insulins are self injected about 15 minutes before mealtime. Short-acting insulins such as regular insulin, should be taken 30 to 60 minutes before a meal. Intermediate-acting insulins should be taken up to 1 hour prior to a meal.  Pre-mixed insulins, depending on the product used, premixed solutions should be taken 10 minutes or 30 to 45 minutes before mealtime. Injections of long-acting insulins are not "timed" to mealtime because of their long duration of action. Levemir is taken once or twice a day irrespective of mealtime. Lantus is only administered once a day (and should be administered at the same time each day). Finally, the rapid-acting products can also be taken immediately after a meal (rather than 15 minutes before mealtime). 


Insulin resistance is the hallmark of type 2 diabetes.  Lowering body fat lowers insulin resistance.  The first treatment for type 2 diabetes blood glucose (sugar) control is often meal planning, weight loss, and exercising. Sometimes these measures are not enough to bring blood glucose levels down near the normal range. The next step is taking a medicine that lowers blood glucose levels.  All diabetes pills sold today in the United States are members of six classes of drugs that work in different ways to lower blood glucose (blood sugar) levels: Sulfonylureas, Meglitinides, Biguanides, Thiazolidinediones, Alpha-glucosidase inhibitors and DPP-4 inhibitors. (1) Sulfonylureas stimulate the beta cells of the pancreas to release more insulin. Sulfonylurea drugs have been in use since the 1950s. Chlorpropamide (Diabinese) is the only first-generation sulfonylurea still in use today. The second generation sulfonylureas are used in smaller doses than the first-generation drugs. There are three second-generation drugs: glipizide (Glucotrol and Glucotrol XL), glyburide (Micronase, Glynase, and Diabeta), and glimepiride (Amaryl). These drugs are generally taken one to two times a day, before meals. All sulfonylurea drugs have similar effects on blood glucose levels, but they differ in side effects, how often they are taken, and interactions with other drugs. Meglitinides are drugs that also stimulate the beta cells to release insulin. Repaglinide (Prandin) and nateglinide (Starlix) are meglitinides. They are taken before each of three meals.  Because sulfonylureas and meglitinides stimulate the release of insulin, it is possible they cause hypoglycemia (low blood glucose levels).  Alcohol and some diabetes pills may not mix. Occasionally, chlorpropamide and other sulfonylureas, can interact with alcohol to cause vomiting, flushing or sickness.  Metformin (Glucophage) is a biguanide. Biguanides lower blood glucose levels primarily by decreasing the amount of glucose produced by the liver. Metformin also helps to lower blood glucose levels by making muscle tissue more sensitive to insulin so glucose can be absorbed. It is usually taken two times a day. A side effect of metformin may be diarrhea, but this is improved when the drug is taken with food.  Rosiglitazone (Avandia) and pioglitazone (ACTOS) are in a group of drugs called thiazolidinediones. These drugs help insulin work better in the muscle and fat and also reduce glucose production in the liver. The first drug in this group, troglitazone (Rezulin), was removed from the market because it caused serious liver problems in a small number of people. So far rosiglitazone and pioglitazone have not shown the same problems, but users are still monitored closely for liver problems as a precaution. Both drugs appear to increase the risk for heart failure in some individuals, and there is debate about whether rosiglitazone may contribute to an increased risk for heart attacks. Both drugs are effective at reducing A1C and generally have few side effects.  Acarbose (Precose) and meglitol (Glyset) are alpha-glucosidase inhibitors. These drugs help the body to lower blood glucose levels by blocking the breakdown of starches, such as bread, potatoes, and pasta in the intestine. They also slow the breakdown of some sugars, such as table sugar. Their action slows the rise in blood glucose levels after a meal. They should be taken with the first bite of a meal. These drugs may have side effects, including gas and diarrhea. 


A new class of medications called DPP-4 inhibitors help improve A1C without causing hypoglycemia. They work by preventing the breakdown of a naturally occurring compound in the body, GLP-1. GLP-1 reduces blood glucose levels in the body, but is broken down very quickly so it does not work well when injected as a drug itself. By interfering in the process that breaks down GLP-1, DPP-4 inhibitors allow it to remain active in the body longer, lowering blood glucose levels only when they are elevated. DPP-4 inhibitors do not tend to cause weight gain and tend to have a neutral or positive effect on cholesterol levels. Sitagliptin (Januvia), saxagliptin (Onglyza), linagliptin (Tradjenta), alogliptin (Nesina) are the DPP-4 inhibitors currently on the market in the US.  Because the drugs listed above act in different ways to lower blood glucose levels, they may be used together. For example, a biguanide and a sulfonylurea may be used together. Many combinations can be used. Though taking more than one drug can be more costly and can increase the risk of side effects, combining oral medications can improve blood glucose control when taking only a single pill does not have the desired effects. Switching from one single pill to another is not as effective as adding another type of diabetes medicine.Generic versions of some sulfonylureas are available. These cost less than brand-name products and in general are reliable. There is now a generic Metformin (Glucophage).  To save more money, ask for the largest tablet strength suitable for the dose needed. One 500-mg tablet, for example, often costs much less than two 250-mg tablets, and can be split. Diabetes pills aren't perfect, but they can help to lower glucose levels for many people with type 2 diabetes.  All diabetes pills can interact with other medicines. Any sulfonylurea or meglitinide can cause blood glucose levels to drop too low (hypoglycemia).  Metformin or the glitazones rarely cause hypoglycemia unless taken with insulin stimulators (sulfonylureas or repaglinide) or insulin injections. Acarbose or miglitol, taken as prescribed, does not cause hypoglycemia. However, hypoglycemia can occur when acarbose or meglitol is taken in combination with other diabetes medications. For pancreatic cancer diagnosed as insuloma Diazoxide inhibits release of insulin and has a peripheral hyperglycemic effect, a benzothiadizine diuretic should be given with diazoxide.  Propranolol and glucocorticoids have also been used. Without any demonstrated improvements with combination therapy 5-FU alone is the most appropriate chemotherapy choice for pancreatic cancer.


Since antiquity, diabetes has been treated with plant medicines. Recent scientific investigation has confirmed the efficacy of many of these preparations, some of which are remarkably effective. Only those herbs that appear most effective, are relatively non-toxic and have substantial documentation of efficacy were covered by Holistic online, most of the rare ones were corroborated by Reader’s Digest.  Onion (Allium cepa) and garlic (Allium sativum) have significant blood sugar lowering action. The principal active ingredients are believed to be allyl propyl disulphide (APDS) and diallyl disulphide oxide (allicin), although other constitutents such as flavonoids may play a role as well. The additional benefit of the use of garlic and onions are their beneficial cardiovascular effects. They are found to lower lipid levels, inhibit platelet aggregation and are antihypertensive. So, liberal use of onion and garlic are recommended for diabetic patients. Experimental and clinical studies have demonstrated the antidiabetic properties of fenugreek (Trigonela foenum-graecum) seeds. The active ingredient responsible for the antidiabetic properties of fenugreek is in the defatted portion of the seed that contains the alkaloid trogonelline, nicotinic acid and coumarin. A decoction of the leaves of the blueberry (Vaccinium myrtillus) has a long history of folk use in the treatment of diabetes. In Europe, it is used as an anti-haemorrhagic agent in the treatment of eye diseases including diabetic retinopathy. Asian ginseng is commonly used in traditional Chinese medicine to treat diabetes. It has been shown to enhance the release of insulin from the pancreas and to increase the number of insulin receptors. It also has a direct blood sugar-lowering effect.  A recent study found that 200 mg of ginseng extract per day improved blood sugar control as well as energy levels in Type 2 diabetes (NIDDM).  Bilberry may lower the risk of some diabetic complications, such as diabetic cataracts and retinopathy.   Stevia has been used traditionally to treat diabetes. Ginkgo biloba extract may prove useful for prevention and treatment of early-stage diabetic neuropathy. Cinnamon triples insulin's efficiency Barberry - One of the mildest and best liver tonics known. Dosage: tincture, 10-30 drops; standard decoction or 3-9 g.  Pterocarpus marsupium (Indian Kino, Malabar Kino, Pitasara, Venga) tree is the source of the Kino of the European pharmacopeas. The gum-resin looks like dried blood (Dragon's blood), much used in Indian medicine. This herb has a long history of use in India as a treatment for diabetes. The flavonoid, (-)-epicatechin, extracted from the bark of this plant has been shown to prevent alloxan-induced beta cell damage in rats.  Both epicatechin and a crude alcohol extract of Pterocarpus marsupium have actually been shown to regenerate functional pancreatic beta cells. No other drug or natural agent has been shown to generate this activity. Bitter Melon (Momordica charantia) also known as balsam pear, is a tropical vegetable widely cultivated in Asia, Africa and South America, and has been used extensively in folk medicine as a remedy for diabetes. The blood sugar lowering action of the fresh juice or extract of the unripe fruit has been clearly established in both experimental and clinical studies. Bitter melon is composed of several compounds with confirmed anti-diabetic properties. The oral administration of 50-60 ml of the juice has shown good results in clinical trials.  Excessively high doses of bitter melon juice can cause abdominal pain and diarrhea. Small children or anyone with hypoglycemia should not take bitter melon, since this herb could theoretically trigger or worsen low blood sugar, or hypoglycemia. Furthermore, diabetics taking hypoglycemic drugs (such as chlorpropamide, glyburide, or phenformin) or insulin should use bitter melon with caution, as it may potentiate the effectiveness of the drugs, leading to severe hypoglycemia.  Gymnema Sylvestre (Gurmar, Meshasringi, Cherukurinia) assists the pancreas in the production of insulin in Type 2 diabetes. Gymnema also improves the ability of insulin to lower blood sugar in both Type 1 and Type 2 diabetes. It decreases cravings for sweet. This herb can be an excellent substitute for oral blood sugar-lowering drugs in Type 2 diabetes. Some people take 500 mg per day of gymnema extract. 


Book 8 Drug Regulation (DR)


13th Draft To repeal and replace Chapter 8 Gorgas Hospital §300-320, to reduce demand for the 10 billion prescriptions that fuel the $1 trillion global drug market with $600 billion in pharmaceutical sales and $400 billion in illicit drug sales, $160 billion pharmaceutical and $65 billion illicit drug sales in the U.S. in 2001, to better regulate food quality, more than 3,200 pharmaceutical preparations and laboratory pathogens, to refund certified organic tobacco vendors a tax rebate, for 14 years a year for rolling tobacco and 17.5 years a year for small cigars, for each year the excessive excise tax of 2009, to voluntarily recall all antipsychotic and antidepressant drugs, to treat autistic side-effects of antipsychotics with one dose of Cogentin (benztropine) or Symmetrel (Amantadine), to treat hyperactive children is spearmint (Mentha spicata) in equal proportions with lemon balm (Melissa officinalis) to which can be added milky oats (Avena sativa); for mild depression and anxiety St. John's wort (Hypericum perforatum); Valerian root (Valeriana officinalis)  is a more serious nervine for stress, insomnia and anxiety, to require GMO crops and rBGH dairy products be labeled. to limit exclusively for medical use antibiotics in animal feed, pesticides and chemical fertilizers, to market antibiotics and highly safe and effective prescription medicines Over-the-counter (OTC), to append antibiotic warning labels “take one billion probiotic organisms within two hours of taking antibiotics and for two weeks after completing the course”, to append heart medicine labels “salt and sugar free vegan diet and daily exercise, eliminate obesity, high blood pressure, diabetes and angina pectoris, Hawthorne is the Supreme herb for the heart, antibiotics cure endocarditis”, to promote the metronidazole prescription for surgery prevention and manufacture in the USA, to fast track the clinical and animal trials of the antiviral DRACO that might cure the common cold and HIV, to prohibit the sale of Aspergillus niger to improve the respiratory prognosis of African-Americans and promote Sporonox (itraconazole) for the treatment of fungal infections including pulmonary and extra-pulmonary aspergillosis, the primary prophylaxis for leukemia and neutropenic patients, to provide Narcan to methadone consumers, to change the name of the Substance Abuse Mental Health System Administration (SAMHSA) to Social Work Administration (SWA), to abolish the Bureau for Alcohol Tobacco and Firearms (ATF) into an FDA Center for Alcohol, Tobacco and Marijuana (ATM) and DoJ Bureau of Firearms and Explosives (BFE), change the name of the DEA to Drug Evaluation Agency, prohibit DEA international offices and police finance, hire exclusively doctors DEA Administrative Law Judges (ALJs) and transition to the FDA, to reschedule Tobacco I, LSD II and Marijuana III, destroy Dimethoxy-methyl-amphetamine (DOM) stockpiles, and repeal automatically refilled military contracts in DEA Form 222 to reverse the 1,000% annual increase in fatal opiate overdoses since 2001, to transfer the Secretariat of the International Narcotic Control Board (INCB) to the World Health Organization (WHO), to remove Drugs from the name of the Office of Crime (OC), to give Afghanistan 80% of the national and 75% of international opium quota, to stop doctors from receiving kickbacks from pharmaceutical companies, to divert pharmaceutical political contributions to independent candidates, to eliminate mandatory minimum sentencing and reduce sentences for illicit drug possession and trafficking, to make drug addiction treatment safe, accessible and judged by a social worker, MIRROR form; Quiz….1062


Book 10 Armed Forces Retirement Home (AFRH)  


To transfer Chapter 1 Navy Hospitals, Army and Navy Hospitals, and Hospital Relief for Seamen and Other §1-40 to Chapter 10 Armed Forces Retirement Home §400-435.  The Armed Forces Retirement Home (AFRH) houses approximately 1,600 veterans at the U.S. Soldiers’ and Airmen’s Home (USSAH in Washington D.C. and the U.S. Naval Home (USNH) in Gulfport, Mississippi.  At an average age of 76, the largest percentage of residents, 80% are WWII veterans, 30% in Korea and 10% in Vietnam.  The average length of stay is 10.6 years.  The Naval Home was established in the Naval Hospitals Act of Feb. 26, 1811 by Paul Hamilton of South Carolina, secretary of the Navy, under President James Madison.  The charter was to provide a permanent asylum for old and disabled naval officers, seamen and Marines.  The Naval Home was however not officially opened until 1834 after James Fillebrown, Secretary of Commissioners of Navy Hospitals appealed his embezzlement conviction to the Supreme Court in 1833, it was known as the Naval Asylum until the name was changed to the Naval Home in 1880.  The Soldier’s Home was established in 1851, as an asylum for old and disabled veterans.  It was at the Soldier’s Home that President Abraham Lincoln wrote the Emancipation Proclamation.  The Soldiers’ Home began admitting airmen in 1917 and officially changed its name to Soldiers’ and Airmen’s Home in 1972.  The Naval Home was initially funded by contributions from the active force. This contribution was augmented by all fines imposed upon persons of the Navy and was the principal source of monies for the Naval Hospital Fund/Pension Fund. The Pension Fund also received all money accruing from the sale of prizes of war. For nearly 100 years these monies funded the Naval Home.  In 1934, the Pension Fund was abolished by Congress and the proceeds were deposited into the U.S. Treasury. From 1935 until 1991, the Naval Home was funded by Navy appropriations. Today, it is funded by monthly withholding from active duty troops, fines and forfeitures, interest off the Trust Fund and resident fees, to incorporate the oldest and newest HA laws; Quiz…1608