Your big toe

I’ve recently seen a few articles about feet, especially the big toe. Is that a new thing?  Dr. Courtney Conley, who specializes in foot and gait mechanics, says that “Toe weakness is the single biggest predictor of falls when we get older.” Really?! Apparently, gripping the floor with your toe flexors is crucial in maintaining balance. (The flexor muscles are those you use to curl your toes down.) One study assessed the feet of 312 men and women aged 60 to 90, looking for bunions and other toe deformities. In 12 months, 107 people had fallen. The fallers showed significantly less strength in their toes and were more likely to have bunions and other deformities.

In addition to balance, we use toe muscles for propulsion when walking. If toe strength is compromised, everything up the chain is more vulnerable—ankle, knee, hip, and spine. Lack of toe flexor strength is implicated in bunions (hallux valgus) and lesser toe deformities, such as hammer toe (raised toe knuckle).

The big toe gets special attention. Your big toe initiates propulsion when we walk. Lack of big-toe extension (pointing the toe up) can cause gait dysfunction and can even be a limiting factor in getting up off the floor unassisted as we age. One expert says that, when pointing your big toe up, the angle should be about 50 degrees (photo). 

You can determine your toe dexterity by trying to lift your big toe while keeping your other toes flat on the ground and vice versa. Being able to move your toes independently, even a small amount, is a sign of healthy feet. One physical therapist says your toes can be agile enough to play the piano. Right.

You can do exercises to strengthen your toes, such as, while sitting, placing all five toes of one foot on a folded towel, then pressing your toes down (don’t grip) and raising your heel.

I have bunions and one hammer toe, but I’m not a faller! I tried a series of toe exercises. They’re probably worth doing, but they’re a drag to do. As to the photo: impressive! I can’t even come close.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Administrative waste in health care

This from The Journal of the American Medical Association: The cost of health care is “the largest sector of the US economy and 29% of net federal outlays.” Here are some more of their points:

• For people with employer-based insurance, health insurance premiums represent 25% of the median family household income before having to pay thousands of dollars more to use their health insurance.
• The US spends almost twice the average on health care and administration than the 37 other countries who belong to the Organization for Economic Co-operation and Development (OECD).
• The US spends approximately 10 times more on administrative expenses than any other OECD country. Two-thirds of these costs are related to transactions or billing costs and insurance-related costs.
•  In the US, a primary care physician spends $20.49 to receive payment for a service that generates approximately $100 in revenue.
•  In medical practices, the time spent trying to get prior authorization from insurance companies is equivalent to the annual working time of 100,000 registered nurses.

The authors want the Trump administration to fix the problem.

Bonus factoid: 29% of doctors in the US weren’t born here.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Earworms

In case you didn’t know, earworms are fragments of songs that stick in your head. I have earworms most of the time and have no idea how my mind chooses certain tunes. Once it was a fragment of a hymn! “Killing Me Softly” is a recent earworm of mine. Why that? It turns out that scientists have actually studied earworms! Psychologists call them “involuntary musical imagery” that can produce some insights into how memory works—how associations with music trigger memories or how mood is associated with memory.

One group of scientists conducted a huge survey by asking radio listeners to call the station and report on their current earworm and why they had it. From this data, the scientists determined the most common triggers for earworms. Unsurprisingly, the most common trigger is having heard the song recently, but other experiences can trigger an earworm, such as seeing a license plate with letters that bring a song to mind. Mood is also a trigger. Sadness, for example, might be associated with a certain song. Earworms are more likely to occur when your mind is wandering—when you’re not focusing on something.

Scientists also discovered that earworm songs tend to be in a certain tempo range—around 124 beats per minute (two beats per second), which is generally faster than non-earworm songs. That tempo, they say, aligns with our body rhythms—the speed at which we like to move or dance. Also, earworm melodies tend to go up and down in a regular pattern, which may help us recall the song more easily.

What if you’re tired of your earworm and want it gone? You can switch to a different song, or you can chew gum vigorously. Because chewing involves the same nerve signals you use to mentally sing the song, gum chewing interferes with your mental singing—provided you’re not chewing to the beat of the music.

I don’t mind my earworms, but now I’m back to my Killing Me Softly earworm, which has become tiresome. Alas, there’s no gum in the house.  

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

RFK Jr. and the F.D.A.

But first, a word about measles: You undoubtedly know about the recent measles outbreak in Texas in which one child died, and that Kennedy, an anti-vaccine activist and newly appointed head of Health and Human Services, noted that the outbreak is “not unusual.” In fact, the outbreak is unusual. Until a few weeks ago, someone hadn’t died of measles in this country since 2015.

According to the CDC, before a vaccine became available in 1963, an estimated 3 to 4 million people in the United States were infected each year. Each year, an estimated 400 to 500 people died; 48,000 were hospitalized; and 1,000 suffered encephalitis (swelling of the brain). Since the arrival of the vaccine, endemic spread of the virus was declared eliminated. Of course, we old people were not vaccinated. As a result of my measles infection, I lost half the hearing in my left ear. (Measles can damage the nerve fibers in the inner ear.)

While scientific experts agree that Kennedy’s wacky ideas could pose a danger to human health, they also contend that the F.D.A. needs to change. (At the same time, they also say that the agency should have more resources and authority—not less—and that the FDA is the most important public health agency we have.) Here are the changes they recommend:  

• Stop relying so much on industry funding. Almost half of the F.D.A.’s budget comes from “user fees” in which pharmaceutical and medical advice companies pay the F.D.A. to review their products—an obvious conflict of interest. (The government should pay.)
• Crack down on employee-industry connections. The F.D.A. commonly hires people employed by drug or device companies and, in reverse, F.D.A. employees leave the agency to go work for these companies. Advisory committee members may also have close ties with the industry. More conflict of interest.
• Close loopholes in the approval process. While experts generally agree that the F.D.A.’s approval process for new drugs and vaccines is rigorous, some worry that such rigorous standards aren’t enforced across other divisions, most notably medical devices, food additives, and supplements.
• Break the F.D.A into two agencies, one focused on food and the other on drugs.

Happily, Dr. Martin Makary, who will head the F.D.A., seems well qualified. As one F.D.A. watcher noted, “It could have been way worse.” Fingers crossed.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.