Showing posts with label emergency medicine. Show all posts
Showing posts with label emergency medicine. Show all posts

12 June 2020

Where Have You Gone, Edgar Sengier?


Edgar Sengier was a Belgian engineer who operated a mine in the then-named Belgian Congo at the early 20th century. His employers, the Union Minière du Haut Katanga, initially mined copper, but at some point the firm discovered a vein in a settlement called Shinkolobwe that yielded two substances of astonishing purity. One was radium, a radioactive element which was so infamously used in the dials of wristwatches, with horrifying results. The other? Well, let’s just say that when Sengier’s people informed him how Substance #2 could be used, the world was on the brink of World War II. French scientists wanted Sengier’s ore, but then France was swallowed by Germany. Sengier quietly packed half his stock—about 1,000 tons of this mysterious ore—in barrels and had them shipped to a warehouse in Staten Island, New York. The barrels sat idle for two years. Nine months after Pearl Harbor, Col. Kenneth Nichols—No. 2 in command of the Manhattan Project—paid a visit to Sengier’s New York office, asking if it was true the firm had located ore that could be processed into U-235. The Belgian engineer smiled. “I’ve been waiting a long time for your visit!”

"Where can I get U?" — Actual text message from Col. Kenneth D. Nichols, circa 1940.
(Atomic Energy Commission file image)
That, in a nutshell, is how the US and not Hitler ended up with a critical stockpile that ensured its success in the race for the bomb. Sengier, a man who went down in history simply by waiting for others to catch up to his foresight, popped into my head this week when I interviewed someone about the US’s medical preparedness for our protracted Covid future.

The fellow on the phone was an exec at a major international firm that manufactures medical supplies. (Yes, I am intentionally being vague.) Not ventilators. Not masks or gowns. But nearly everything else a medical office or hospital needs to do its job. By one estimate, this firm produces more than half of a specific medical tool used on the planet.

The corporate headquarters are based in the US, but operates factories over the globe. The execs have been largely quarantined at home for the last three months, but the firm has been running their assembly lines the whole time, tweaking how they do business to keep employees safe and the endless stream of supplies coming. In some cases, they have actually re-routed employees from areas of the business with low demand—making, say, kits for various types of elective surgeries—to areas with high demand.

Moving employees like this is easier said than done. For example, they arranged visas for employees to travel 100 miles from their homes and places of work in one Asian nation to another nation across a border. “ Commuting” was deemed impractical, so the firm is putting these folks up in hotels in the second nation so they can work in shifts. Anything to meet demand.

“First, every hospital in the world needed supplies,” the exec told me. “So we ramped up production to meet that demand. And when we caught up with that, then the federal governments of various countries started contracting with us directly to beef up their national stockpiles. So now we’re doing that.”

For another writing project, ages ago, I interviewed a former military doc who told me that most military stockpiles he’d seen were always in need of upgrading or replacement. Supplies expire and go bad. Medical tech, especially, becomes obsolete or deteriorates sitting unserviced in warehouses, waiting for a use date that never comes. No one wants to have product sitting around in a warehouse. But it’s what you do if you want to be prepared. You rotate in, you rotate out. If you're organized, that is.

But what was troubling our biotech executive the day we talked?

“There’s one country that hasn’t asked us to stock their national stockpile yet,” he told me, his voice dropping. “A big one. Can you guess which one that is?”

I didn’t have to guess. Both of us are Americans, and we both chuckled awkwardly at the same time. And then the naive little man inside me piped up: “Couldn’t you do it on your own? Just make ‘em and store ‘em somewhere?” Even before the words were out of my mouth, I felt stupid. This is why I’ll never be a businessperson; I cling too much to hope.

“Can’t,” the exec said. “We have enough trouble keeping up with demand as it is. And we’re sure as hell not gonna do it for free.”

Duh. Logical me understood that completely. But naive me, writer me, fought against it. And my brain kindly coughed up the name of that Belgian engineer.

To be sure, Sengier’s firm was paid. So far as I’ve been able to determined, they supplied the US with 4,200 tons of uranium, and plutonium as well. (The price for the uranium was $1 a pound. I have not located a price for the plutonium, enriched at Hanford.) After the war, Sengier received the Medal of Merit from the US, its highest civilian honor, and other accolades—Honorary Knight Commander, OBE, from the UK, the Legion of Honour from France, five distinct medals from Belgium alone—from nations grateful that he’d kept that uranium out of the hands of the Nazis.

Sengier (center) receives his medal from Manhattan Project director General Leslie Groves (right).
(Atomic Energy Commission file image)

And yes, we can spend days debating the wisdom of creating those first nuclear weapons. I have had those conversations. My wife spent seven years writing a nonfiction book about the Manhattan Project, and for seven years the faces and voices of the few surviving chemists, engineers, and rank-and-file workers she interviewed were in my mind nearly every day. We can also spend an equal amount of time talking about the exploitation of Africa’s natural resources and its people by centuries of colonizers.

But...

Those bombs, and the ones that followed them, were tools of death, but medical supplies are tools of life. Call me crazy, but US stockpiles have been known to dwindle. And it dismays me to learn that Sengiers are apparently in short supply.

19 April 2016

Back Pain Attacks Writers and Readers



Do you love books? Reading them, writing them, anything to do with them?
And have you ever had back pain?

Chances are high that you said yes to both books and back pain. This is a site for mystery lovers, after all, and approximately 84 percent of adults get low back pain at some time in their lives.⁠1 ⁠2 So you and I are not alone.

(Wouldn’t that make a great birthday card? Happy 18th birthday! Party hard, because now you have an 8 out of 10 chance of hurting your back!)

So listen. I’m an emergency doctor who loves books. I decided to tackle this sucker by writing THE EMERGENCY DOCTOR’S GUIDE TO A PAIN-FREE BACK, which releases Thursday, April 21st.

Obligatory disclaimer: I am a doctor, but I’m not your doctor, so you have to go see your own health care  practitioner. All I can do is give you helpful advice on treatment and prevention.

I pored over research articles. I read other books and considered both traditional and integrative approaches, including acupuncture, yoga, and diet. What struck me is that some people want to give advice without anchoring it on research, so I’m proud to say that I included studies written right up until January 2016.

The other thing that struck me was that a lot of fact-based books were super dull, so mine is short, funny, and full of cartoons and pictures because hey, life is short.

Here are three tips for readers and writers:

1. You don’t have to be a book lover to get back pain. Even sitting all the time doesn’t automatically cause back pain⁠ 3, although it does predispose you to other problems (coronary artery disease, diabetes, breast and colon cancer ⁠4…I know! I’m full of good news today!). So try to get up and move throughout your day.

2. After you go see your doctor, you may well get diagnosed with non-specific low back pain. More than 85 percent of the time, we don’t find a particular cause.5 I consider that good news, because you don’t want the herniated disc, fracture, infection, or cancer. You want to get better. Fast. And to do that…

Kathleen can do it. So can you!
3. “Don’t tell me I have to exercise,” groaned more than one writer-friend on Facebook.
Yes, I’ve got triple good news for you. You do have to exercise once you get over your initial agony, or to prevent it in the first place. Exercise and education reduce your risk of a back pain episode by 25 to 40 percent, as shown in a 2016 meta-analysis by Dr. Daniel Steffens and colleagues at the University of Sydney. They considered 21 randomized control trials of 30,850 people.6

There’s no hard evidence on which type or amount of exercise is best. “It seems to matter less exactly what type of exercise you do than that you do it in a regular way,” said Dr. Timothy S. Carey, a physician at the University of North Carolina at Chapel Hill, who co-authored a commentary on the mega-study by Steffens.

So choose exercise that you like, and do it. Cardio, core, strength training, flexibility, and working your upper and lower limbs were all included in that mega-study.

Since we’re all busy, I developed a three-pronged exercise program where you can even work on your strength and flexibility in bed, at work, and while watching TV. My program is meant to be accessible to everyone. Look at my friend Kathleen. She’s a senior citizen, and she’s hitting it hard. With my book!

Click cover to preorder e-book now for a special price of $5.99 (regular price $9.99).
Direct Amazon.com link here.
Bottom line: most of us will get back pain sooner or later. As someone who loves words, you’re already at at advantage to prevent it through education. Keep reading and start moving, and you'll save your energy for more fun stuff like cat detectives and hard-bitten thrillers.


1 Deyo RA, Tsui-Wu YJ. Descriptive epidemiology of low-back pain and its related medical care in the United States. Spine. 1987; 12:264.
2 Cassidy JD, Carroll LJ, Côté P. The Saskatchewan health and back pain survey. The prevalence of low back pain and related disability in Saskatchewan adults. Spine. 1998; 23:1860.
3 Chen SM, Liu MF, Cook J et al. Sedentary lifestyle as a risk factor for low back pain: a systematic review. International Archives of Occupational and Environmental Health. 2009 Jul, 82(7): 797-806
4 Lee I, Shiroma EJ, Lobelo F et al. Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. The Lancet. 380(9838): 219-229
5 Deyo RA, Weinstein JN. Low back pain. N Engl J Med 2001;344: 363-70
6 Steffens D, Maher CG, Pereira LS, et al. Prevention of Low Back Pain: A Systematic Review and Meta-analysis. JAMA Intern Med. 2016 Jan 11:1-10. doi: 10.1001/jamainternmed.2015.7431.