Your marriage and your health

Back in the 80s, scientists at Cal Berkeley began a laboratory study of married couples (not like Kinsey, I might add). The couples, who had been married at least 15 years, were asked to talk for 15 minutes about their days, followed by another 15 minutes in which they were told to rehash areas of ongoing contention in their relationships—in other words, to argue. All sessions were recorded on video. The couples also completed detailed questionnaires about their health. Every five years, for at least 20 years, the couples returned to the lab and repeated the drill: discussion, argument, health report.

In studying the couples’ interactions, scientists examined facial expressions and voices, taking note of the emotions shown by the test subjects during arguments. For example, when angry, people’s eyebrows lower, their eyes widen, lips compress, and voice volume increases. The researchers then compared the subjects’ emotions with their health questionnaires. Here is what they learned:

Over the years, spouses, especially husbands, who seethed with anger while arguing were much more likely than calmer spouses to report symptoms of cardiac problems, such as chest pain or high blood pressure. Spouses who stonewalled (refused to respond) were more prone than others to develop muscular problems such as back pain. Interestingly, angry spouses rarely developed back pain and stonewallers rarely reported cardiac symptoms. People whose main response to conflict was sadness or fear did not report many cardiac or musculoskeletal problems at all.

I don’t know whether the fear/sadness people developed some characteristic health problems. I wasn’t willing to pay $11.95 to get the full journal article (Emotion, May, 2016) to find out. My guess is that their health issues were all over the map.

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

Sweat as an emotions barometer--and more

Not long ago, I was taking care of my daughter who was recovering from complicated surgery on her hand. I was also helping with the dog walking. I noticed that my feet were often sweaty during my stint—slipping around in my flip-flops. Though the weather was hot, I knew that sweating on the soles of my feet happens under stress because this has happened to me before. Apparently I was more nervous about this care-taking activity than I was conscious of.

The kind of sweat glands on your feet, as well as everywhere else on your body, are called eccrine sweat glands. (A second kind, called apocrine, are mostly limited to your armpits and anus area. I’m sticking with eccrine sweat glands in this post.) Sweat glands, which are controlled by your nervous system as well as hormones, are particularly numerous on your feet, palms, face, and armpits. (Our palms have around 370 sweat glands per square centimeter.) For our primitive ancestors, having lots of sweat glands on their hands and feet increased friction and enhanced grip—part of the fight or flight mechanisms. Sweat also cools our skins, reduces body temperature, allows us to get rid of excess water and electrolytes and helps to protect our skin from bacterial colonization.

Because it is derived from your blood plasma, sweat is 99 percent water, but also contains sodium, chloride, and other elements. When all of your sweat glands are working at maximum capacity, you can lose more than three liters per hour. But you normally sweat about a quart a day. You may be one of those who gets muscle cramps after sweat-inducing exercise. This is generally the result of losing electrolytes (sodium, etc.). I understand that drinking two-and-a half ounces of salty pickle juice almost instantly relieves the cramping. If you try this, let me know if it works.

Sweat is odorless. It’s the interaction with bacteria that causes the odor. Deodorants work by killing the bacteria on your skin. Antiperspirants, which are classified as drugs, block the top of your sweat glands and plug them up (doesn’t sound like a good idea to me). You may have noticed, as I have, that polyester clothes are stinkier than cotton. That’s partly because polyester is less absorbent than cotton, a characteristic that helps promote odor-causing bacteria. But it also promotes a different type of bacteria than cotton—the kind that degrades fatty acids and amino acids into “malodorous compounds,” as one researcher explains it. Malodorous I don't want to be. I'm sticking with cotton.

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

Your ambulance service may be owned by private equity firm

Private companies now represent about 25 percent of all ambulance providers. Because of the 2008 financial crisis, many municipalities have struggled to pay for basics and have turned to private equity firms to provide ambulance and fire-fighting services. Thus, when you dial 911, you may be interacting with private equity

Private equity firms invest money from wealthy individuals and pension funds. Because these firms are primarily skilled in making money, not providing services, studies have shown that some have used cost cutting, price increases, and litigation to improve their bottom lines.

Private equity investors swept into the ambulance business with high hopes (“tremendous growth potential,” as one investor stated). But it didn’t always play out as they had hoped and several have gone bankrupt. To keep afloat, some firms fell back on a time-tested moneymaking strategy: cutting costs. In many cases this meant fewer ambulances and staff, slower response times, failed heart monitors, ambulances breaking down, shortages of supplies, and much more. At one company, emergency workers were forced to supply needed medications by swiping supplies from hospitals. In fact, they were pressured by their supervisors to raid hospital supply carts. As one worker who swiped supplies said, “There’s only a couple of things that terrify paramedics. Being without your critical medications is one of them. I make no apologies.”

I’ll bet you thought that your government supplied your local ambulances. I did, so I looked it up and discovered that in my county (Santa Cruz, California) the service is provided by a contractor called American Medical Response, which, I discovered, was acquired in 2011 by a private equity firm, Clayton, Dubilier & Rice. In the next county, Santa Clara, services are provided by Rural/Metro, a company that went bankrupt in 2013. (It was paying hundreds of thousands a month in fines for things such as failing to have three ambulances at the ready and for responding too slowly to emergencies.) In 2015 it was purchased by Envision Healthcare Holdings, the parent company of American Medical Response, which, as I mentioned, is owned by Clayton, Dubilier and Rice. It’s all horribly Byzantine.

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

Exercise as medicine

It’s long been known that working out is good for the brain, but, until recently, scientists didn’t know why. It turns out that when we work out our muscles produce a protein called cathepsin B, which promotes the production of new brain cells. In the studies that resulted in this finding, the people (and mice) were running on treadmills. I don’t know if a less rigorous workout would lead to this brain-enhancing effect. I hope so.

But there are plenty of health benefits that don’t require running. I recently came across an analysis of 305 randomized controlled trials (340,000 participants) showing how exercise can be almost a “miracle cure.” Here is a sampling of the conclusions:

• Osteoarthritis of the knee: improves both pain and function.
• Rheumatoid arthritis: increases aerobic capacity and muscle strength.
• Heart attacks: reduces all-cause mortality by 27 percent and cardiac mortality by 31 percent.
• Heart disease: as good as drugs in preventing mortality.
• Diabetes: helps control blood sugar.
• Depression: improves symptoms.

You can reap these benefits by exercising (moderate intensity) 30 minutes five times a week. Walking or bicycling can do the trick; even vacuuming and lawn mowing. The idea is to get your heart rate between 110 and 140 beats per minute. I have an Apple watch with a heart rate counter (which I generally ignore). But today at Jazzercise I paid attention, and found that I got a high reading of 129, though more often it was around 108.

Commenting on the “meta analysis” of the benefits of exercise, editors at the British Medical Journal noted that, while exercise isn’t really a miracle cure, it is nevertheless “the best buy for public health.” I wish that lying on the couch and reading (a favorite pastime) had similar health benefits.

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

Hip replacement profiteering

A couple of years ago, I thought I might need a hip replacement. My left hip hurt a lot, especially walking upstairs. Turns out it was “only" bursitis, which is bad enough. I’m glad for that. Hip replacement devices are way overpriced and sometimes dangerous. Yet the market for them is enormous: In 2011, more than 645,000 hip replacements were performed in the US. Undoubtedly, they do improve the lives of many people. But their profit margins are unconscionable. 

An artificial hip costs about $350 to manufacture. But hospitals pay an average $4,500 to $8,000 for the device. In the case of one manufacturer, Medtronic, the overall cost of making its products is about 25 percent of what it sells them for, yielding a gross profit margin of about 75 percent.

After purchasing the device, the hospital then marks up the price for sale to the patient. The cost of implant procedures vary according to where you live. Overall, the cost averages $30,000. It’s cheapest in Birmingham, Alabama ($11,327) and highest in Boston ($73,987)—a 313 percent cost variation. In Boston, though, you could get a replacement for as low as $17,000. I guess you have to shop around. But if you live in the Fort Collins-Loveland area of Colorado, shopping around won’t do much good: in that area, the average cost is $55,686.

Plus, there are the kickback shenanigans. That is, device manufacturers pay doctors to use their products. In 2007 the five major device manufacturers paid over $200 million to about five hundred orthopedic surgeons.

Finally, safety can be an issue. In most devices, the ball (at the top of the femur) is metal and the metal socket is lined with plastic. One company developed a device that eliminated the plastic, making it metal on metal. It was purported to last longer than the older devices. But it was poisoning people. Small particles of cobalt and chromium were coming off the device and entering the bloodstream.

If you’re getting a hip replacement, there’s probably not much you can do about the cost. But in selecting a model, go for the tried and true.

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