Specialists aren't so special

Here’s what one doctor, a specialist, has to say about our health care system: it is  "...a colossal network of unaccountable profit centers, the pricing of which has been controlled by medical specialists since the mid-20^th century…Each specialist performs the procedures that generate income for them, then passes the patient along. …They are corrupting our health care system.”

As to specialist societies, such as the American Association of Orthopedic Surgeons, another specialist says, “In the United States, physician specialty societies advocate not only for a higher volume of procedures for their members, but also for higher reimbursement per procedure.” In essence, specialists determine the services that are covered by insurance and the prices charged for them.

Both the physicians I have referenced (one at California's Permanente Medical Group, the other at New York's Mount Sinai Health System) believe we overvalue doctors who operate on people and undervalue the physicians who keep us off the operating table in the first place—our primary care physicians. The United States ranks first in the world in the proportion of specialists to generalists. In fact we have a national shortage of primary care physicians. Both the doctors believe that more resources and training should go for education and training of primary care physicians and that we should also pay them more. At the moment, they make less than half as much money as specialist.

In Switzerland, which ranks second in the world for health care quality, about 12 surgeons perform all total joint surgeries for the nation’s eight million residents. Because of this, they have about five to ten times the experience and expertise of their US counterparts. The US, with forty times the population of Switzerland, has about 5,000 surgeons who perform this procedure—which is more like one joint surgeon per 64,000 people compared to one per 650,000 in Switzerland.

As we all probably know by now, our health care system is the most expensive in the world yet ranks last out of 11 developed countries. Something is wrong with this picture.

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Paltrow's placebos

Gwyneth Paltrow sells stickers called Body Vibes. You stick them on your upper arms to “promote healing,” “rebalance energy frequencies,” “smooth out physical tension and anxiety,” and “boost cell turnover” (do you want your cells to turn over?).  For $60, you can get a pack of ten! Here are a few:

Paltrow says the healing power of Body Vibes came from NASA space science, using the “same conductive carbon material that NASA uses to line spacesuits…using a biofrequency that resonates with the body’s natural energy fields…” NASA debunked the claim, stating that spacesuits “do not have any conductive carbon material lining.” But the stickers work! Users say they feel better!

This, of course, is an example of the placebo effect, which is actually a rather complicated business and can be triggered in different ways. One has to do with your expectation that you’re going to feel better. Your expectation triggers the release of endorphins—natural pain-relieving chemicals. This endorphin release occurs even when you take a real painkiller. Studies show that painkillers such as morphine are markedly less effective if you don’t know you’re taking them—that is, the expectation is part of the pain relief effect.

Studies have also shown that people can learn to enhance and suppress their own immune systems—a kind of Pavlovian response. And the state of our minds also affect our health. Researchers found that, during a severe flu epidemic, depressed people who had the flu were sicker for longer periods than people who were not depressed. There’s no shortage of examples of the placebo effect, including sham surgeries that recipients were certain made them well.

As one placebo researcher remarked, “I think it’s connected to systems that generate emotional responses. It’s a window into ways in which psychological factors can affect brain and body factors that are related to health.” It’s that old mind over matter business. But I don’t know, I’d find it hard to put my faith in those stickers.

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Men acting hormonal

Apparently the sales of testosterone supplements are on the rise—from 1.3 million four years ago to 2.3 million now. I guess men think it will make them more vigorous or something. I don’t know about that, but many studies have shown that when men take testosterone they make impulsive—and often faulty—decisions. Even without an extra boost of testosterone, men tend to be more confident than women about their intelligence and judgments. They believe their decisions and solutions are better than they actually are and are less likely to see flaws in their reasoning.  One reason that testosterone leads to overconfidence is that it inhibits activity in the region of the brain (orbitofrontal cortex) that’s responsible for self-evaluation, decision-making, and impulse control. Those are not areas that you want to inhibit.

To study men’s tendency to be over-confident compared to women, college students taking final exams rated their confidence about each answer on a five-point scale, with one for a “pure guess” and five for “very certain.” Men and women both gave themselves high scores when they answered correctly. But when they’d answered incorrectly, women tended to be hesitant, but men weren’t. Most checked “Certain’ or “Very certain” even when their answers were wrong.

Also, compared with women, men tend to think they’re much better than average. They’re also less willing to collaborate. In one study, in which some women took testosterone and others took a placebo, the women who took testosterone were more likely to ignore the input of others and relied more heavily on their own judgment, even when they were wrong.  

In another study, 140 male traders were given either testosterone or a placebo. In an asset trading simulation, men with boosted testosterone significantly over-priced assets compared with men who got the placebo. They also were slower to incorporate data about falling values into their trading decisions.

Apparently, Donald Trump has had his testosterone measured--not normally part of a routine checkup, partly because nobody knows what an ideal testosterone level might be. The range is very wide. Trump’s is mid-range. Perhaps he takes supplements. I hope not.

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Is a fecal transplant right for you?

Sorry. You can’t get one unless you’re at death’s door with a gut colonized by clostridium dificile, a bad bug (bacterium). That’s the only condition under which the FDA authorizes fecal transplants. In case you can’t figure it out, a fecal transplant is the transfer of “stool” from a healthy donor to an unhealthy recipient. In a hospital setting, people with healthy innards are donors.

Of course, you could always do it yourself, as plenty of desperate people do. Case in point: an athletic woman, who is a research scientist, had “bad stomach” issues and chronic fatigue. She had been on a year-long regimen of broad-spectrum antibiotics to combat a serious case of Lyme disease. But the regimen had killed the good bacteria in her colon and, she learned, had allowed the growth of pathogenic bacteria. Because she couldn’t find a doctor who would give her a fecal transplant, she did it herself, using a six dollar enema kit from the drugstore (“not fun,” she says). For a donor, she enlisted a fellow athlete. “Within two months I was a new person,” she reports. “I had no more fatigue. I could ride my bike hard three days in a row, no problem.”

Of course the Web has all kinds of information on do-it-yourself fecal transplants. For example, a Web site called PowerofPoop provides instructions and even helps connect people to potential stool donors. The HBO show, Vice, did a segment on them, which you can watch on You Tube. If you’d like to have your poop analyzed and at the same time contribute to science, go to the American Gut Project Web site. They’re a citizen science project. As their site says, “You get some cool information about the microbes that call your body home while supplying us with priceless data…about the connections between our microbes and our health.” I might do it.

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