Cartoon II for the holidays

"Don't bother."

Cartoon I for the holidays

"You should start taking probiotics now, before we discover that they don't make any difference."

Gaining weight in old age

Over the past five or so years, I’ve put on about ten pounds. I don’t mind so much. Like my mother-in-law used to say, “what’s so great going to happen to me if I get thin?” However, I do mind that the waistband of some of my pants has become too tight. Even so, I’m certainly not going to diet.

The latest research shows that people who restrict their eating are more likely to engage in stress eating. Moreover, unlike intuitive eaters, who eat when they’re hungry, dieters exert mental effort to control their intake. According to psychologists, this effort to restrain eating can increase negative emotions. Dieters—including people who simply watch what they eat—are more likely to suffer from depression, low self-esteem, disordered eating and overall psychological distress than intuitive eaters. In contrast, intuitive eaters have more positive moods, greater body appreciation, and overall life satisfaction. Food deprivation, they say, seems to play a role in creating the very mental conditions that lead people to want to self-soothe with food. 

Research has also shown that the notion of being “addicted” to sugar is bogus. Sugar addiction is the idea that sugar activates the reward centers of our brains, making it irresistible. In fact, it’s the dieters whose brains are significantly activated in response to sweet foods. The brains of intuitive eaters are unfazed by sugar.

I don’t know why I gained ten pounds. My diet and activity haven't changed over these past years. If anything, I eat less. I always thought that old people sort of waste away, getting thin and frail. I’ll just hang around and wait for that to happen. 

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

Heart attack triggers

Both my parents died of heart attacks; my father at age 79, my mother at 85. Both deaths were sudden. The other day, I came across an article in the Harvard Medical School newsletter about factors that trigger heart attacks. According to the newsletter, sudden stress is the primary culprit. Stress activates the sympathetic nervous system, which is responsible for the body’s fight-or-flight response. The sympathetic nervous system sends hormones into the bloodstream that can cause a sudden surge in blood pressure or make the heart beat faster and harder. The hormones may also cause the sudden formation of a blood clot, a tear in a blood vessel, or a wild heart rhythm.

According to research, the most important triggers include heavy physical exertion, severe weather, anger, natural disasters, war, sexual activity, air pollution, and infection. Some of these triggers are not surprising. As to disasters, researchers in New Jersey found a 49 percent increase in heart attacks within a 50-mile radius of the World Trade Center immediately after 9/11. But here’s a surprising trigger listed as the top one in the newsletter: waking from sleep. Before waking up your body prepares for a new day by trickling stress hormones into your bloodstream, making your small blood vessels constrict, your heart beat faster, and your blood pressure rise.

As it happens, my father died after getting up to go to the bathroom. My mother died after she finished giving a speech—a stressful activity, I presume.  I’m 83 as I write this. Like you, I’ve experienced plenty of these triggers, including shoveling snow, earthquakes, smog, and all the rest (although not anger so much). I can avoid most of these triggers, but I do plan to continue getting up in the morning. Living dangerously!

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

The latest on stents

Here’s the latest on stents (those little wire cages inserted into blocked coronary arteries): if you’re having a heart attack, a stent (or bypass surgery) can be lifesaving. Otherwise, they have not proven to prolong life or prevent heart attacks. That is, if you’ve had procedures in a non-emergency situation that show some blockage in your arteries and/or if you have angina (chest pain), inserting stents into those arteries is not more beneficial than drugs at keeping you from heart attacks or death. (Stents do help with chest pain, but about a third of patients with stents develop chest pain again within 30 days to six months of the stent insertion and end up receiving another stent.) The drugs include statins—of which I disapprove—aspirin, blood pressure meds, and, in some cases, meds that slow heart rate (beta blockers).

This is not the first time that studies have come up with this result, but the newest study was longer and more thorough, putting earlier skepticism to rest . It followed 5,179 participants for three and a half years. All patients had moderate to severe blockages and most had a history of chest pain. They were randomly assigned to get only the “medical therapy” (drugs mentioned above); or “intervention” (stents or bypass surgery). Of those thousands of people, 145 people who’d had the intervention died compared with 144 who’d had only the meds. The number who had suffered heart attacks were also about evenly divided between the two groups.

These results, as with the results of earlier studies, are consistent with the current understanding of heart disease, namely, that narrowed arteries can usually be found throughout the arterial system, and docs can’t predict where in this system a problem might occur. Researchers no longer believe that “clogged pipes” cause heart attacks. Rather, heart attacks occur when a trigger, such as anger or physical exertion, causes damaged arteries to release blood clots that block the flow of blood to the heart. So just calm down and take it easy.

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

Your virome

Scientists are learning more and more about our microbiomes—the 100 trillion bacteria, fungi, viruses, and protozoa that live on and in our bodies. They can do this because advances in genome sequencing allow them to determine an organism’s DNA. But they don’t know much about the viruses that live in our guts—in fact, 99 percent of gut viruses are unknown to science. To try to make some headway into this dearth of information, some scientists studied the gut viruses of ten people for over a year. They learned two things: 1) gut virus populations are stable; 2) gut viruses are person-specific (your gut viruses are not like my gut viruses).

They surmise that some viruses are better for your health than others, but—for now—they don’t know which viruses may be good and which may be bad. They do know that most of the viruses in our guts are bacteriophages—viruses that infect bacteria, replicate inside them, and kill them. I suppose those may be good ones. Maybe not. (See an earlier post for an example of bacteriophages at work, killing disease-resistant bacteria.)

The more scientists study our gut microbiomes, the more they are discovering ways in which these microscopic organisms affect our health. Recently, drug regulators in China approved a drug to treat Alzheimer’s disease. The drug adjusts the gut microbiome such that inflammation-causing amino acids from gut bacteria no longer irritate the brain. A neurologist at the Alzheimer Center Amsterdam remarked “These results advance our understanding of the mechanisms that play a role in Alzheimer’s disease and imply that the gut microbiome is a valid target for the development of therapies.” Maybe they should have been studying guts all along instead of brains.

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

Fungi may spur the growth of pancreatic cancer

Scientists are learning more and more about how the trillions of organisms that inhabit our bodies—bacteria, fungi, viruses, protozoa—can affect our health, both for better (help you digest food) and for worse (make you ill). New research is looking at the link between a fungus by the name of Malassezia (shown below) and pancreatic cancer. Malassezia is typically found on the skin and scalp and can cause skin irritation and dandruff. Some studies have linked the fungi to inflammatory bowel disease.

As far as the pancreas is concerned, researchers found that Malassezia was present in extremely high numbers in samples from pancreatic cancer patients. In fact, it appears that the fungi may drive the growth of tumors by way of a cascade of events involving inflammation and the immune system. Researchers discovered that in mice and humans with pancreatic cancer the fungi multiply 3,000 times more than in healthy tissue. The fungi can also make pancreatic tumors grow bigger. 

The more scientists learn about the microorganisms that inhabit our bodies, the more they concur that a tumor’s “microenvironment” is just as important as the genetic factors driving its growth. As one researcher remarked, “We have to move from thinking about tumor cells alone to thinking of the whole neighborhood that the tumor lives in.”

These new findings may spur new developments in treating people with pancreatic cancer. For one thing, the presence of the fungi can serve as a biomarker for who might be at risk. At some point, anti-fungal treatments can be tried. In mice, an antifungal drug got rid of the fungi and kept tumors from developing. However, nobody is ready to begin administering anti-fungal treatments to people. The interaction between microbes and their hosts is very complex, and anti-fungal medications can have side effects. More experimentation is needed before pancreatic cancer patients will reap the benefits of this research. It sure sounds promising to me.

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

Re-growing cartilage like a salamander

About three years ago, bending my right knee became painful. An MRI showed that my meniscus (cartilage) was “shredded.” Over about a year and a half, I had two or three cortisone shots in my knee that reduced the inflammation. The pain eventually went away. About nine months ago, I went back to the doc because, again, it hurt to bend my knee. I assumed it was the same knee. But when I checked the earlier MRI report, I was surprised to discover that it was not the same knee that had caused the earlier problem. What had once been my bad knee was now my good knee.

Conventional medical “wisdom” says that meniscus tears don’t get better and surgery is often recommended. But my once-bad knee is now fine! Maybe I re-grew some cartilage. A new study has shown that humans can re-grow cartilage in a manner similar to what a salamander can do when it re-grows missing limbs. The science has to do with the production of new collagen proteins and is rather complicated. At any rate, as one researcher said, “…this study provides compelling evidence that there are many similarities in human and salamander limbs.”

I also came across an article by Richard Bedard who, in his 40s, was told by four different doctors that his bad knees would never get better. He wouldn’t take no for an answer and began a “research odyssey.” He found several studies that proved that cartilage can indeed regrow, as shown in “before” and “after” MRI images. He started a program to heal his knees, which he doesn’t reveal because he’s written a book Saving My Knees. His conclusion: “My own experience showed me that rehabilitating damaged cartilage is a long, trying process. The condition of this tissue changes very, very slowly. But change it does—both better and worse. Today, after a recovery that took almost two years, my knees feel fine.” I guess I have to buy the book and get to work on my left knee.

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

Eat red meat?

New research has shown that eating red meat isn’t bad for you. After three years of study, a group of 14 researchers in seven countries concluded that eating red meat doesn’t increase your risk of cardiovascular disease or cancer. The research included data on four million study participants. I have always maintained that eating red meat isn’t harmful and for years have been infuriated by the substitution of chicken and turkey for beef and pork in sausage and similar products.

I am newly convinced, however, that the planet would be better off without beef cattle. Here’s why:

• Agriculture consumes more fresh water than any other human activity, and nearly a third of that water is devoted to raising livestock.
• One third of the world’s arable land is used to grow feed for livestock.
• Livestock (mostly cattle) are responsible for 14.5 percent of global greenhouse-gas emissions—a result of the methane they generate as a by-product of their digestive systems.  If cows were a country their emissions would be greater than all of the EU and behind only China and America.
• Every four pounds of beef you eat contributes to as much global warming as flying from New York to London.

One viable solution, besides becoming vegetarian or vegan (not an option in my house) is to eat plant-based fake beef—a relatively new product available in “ground beef” form (pictured to the left). Four companies are currently producing this product, at least one of which, I understand is much like the real thing. In fact, Burger King is selling fake meat burgers made by the Impossible Foods company. I understand you can buy the “beef” at the market. I’ll try it as soon as I can find it here in the Santa Cruz Mountains.  

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

Acid reflux, etc.

I had no interest in this topic until I witnessed a rather alarming episode when I was visiting an old friend and some of her family. We were at a restaurant and my friend had eaten about two-thirds of her salmon burger when she experienced pain between her shoulder blades. Soon after, she turned pale, had a vacant look in her eyes, broke out in a cold sweat, her hand shook, she threw up, and briefly passed out. It seemed to us she might be having a heart attack or stroke, so her daughter called 911 and my friend was hauled off to the hospital in an ambulance.

At the hospital, she immediately began to feel better. Her heart, blood pressure, and blood sugar were all fine. The doctor told her she had esophageal reflux, which astounded all of us. He assured my friend that her symptoms were consistent with that disease. For one thing, if she’d had a stroke, she certainly wouldn’t have recovered so quickly. The pain she experienced had triggered a cascade of the symptoms we observed. (People often experience pain in their chests from acid reflux; in my friend’s case, the pain was in her upper back.) After an hour or two the doctor discharged her and she was quickly her normal self.

Months prior to this event a doctor had told her she had acid reflux, but she pooh-poohed this idea—as I would have. I thought that with acid reflux a bit of stomach acid leaks into your esophagus but that it was no big deal. I’ve learned that it can be a big deal because of the damage it can do to your esophagus. In my friend’s case, the injury to her esophagus occasionally caused internal bleeding and anemia. As you can see in the illustration below, the leakage is a result of a faulty sphincter muscle between the stomach and esophagus.

The terminology used for this condition can be confusing: Acid reflux is a rather common condition that can range in severity from mild to serious; gastroesophageal reflux disease (GERD) is the chronic, more severe form of acid reflux; heartburn is a symptom of acid reflux and GERD.

Even though my friend would have been fine had she not gone to the hospital, we’re glad she did. We all learned a lot.

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

Carpal tunnel syndrome

Because one of my daughters has had surgery for carpal tunnel syndrome—plus additional surgeries on her hands—I was drawn to an article inThe Daily Beast that reported on a ten-minute surgery for the ailment (small incision in palm; snip a tendon [!]). As I was reading about symptoms I was brought up short. Whoa! That’s what I have! The symptoms include tingling and numbness in the hand, usually affecting the thumb, index, and middle fingers; perhaps also a burning or pins-and-needles sensation. The discomfort frequently occurs at night, mostly because the way the sufferer positions his or her hands.

I’d been having these symptoms for a couple of months and assumed it was a pinched nerve—perhaps in my shoulder or neck (my shoulder had been hurting). I’d have the symptoms nearly every night, sometimes with severe pain in my lower right arm. Getting up and walking around seemed to help. Sleeping on my side was impossible, so I began to sleep on my stomach. Sometimes I’d have the symptoms just sitting in a chair and reading. Massage, chiropractic, and acupuncture didn’t help. 

Your carpal tunnel is a narrow, rigid passageway composed of ligament and bones at the base of your hand. It houses tendons as well as the median nerve, which runs from the forearm into your hand. The tunnel is a rather tight space. Carpal tunnel syndrome develops when the median nerve, which passes through the tunnel, gets compressed within the tunnel—usually by irritated tendons that swell or thicken. It’s that compression on the nerve that causes the pain.

Medical people don’t precisely know the causes of the disease: perhaps genetic, or injury to the wrist, or mechanical problems with the wrist joint, fluid retention, development of a cyst, and so forth. I certainly don’t know why I got it at the age of 83. But once I figured out my problem, I’ve been able to avoid the discomfort just by paying attention to what my hands are doing. I now sleep on my side again, but I place my wrists in a neutral position, making sure not to curl my hands under the pillow. Apparently, wrist braces also help, which I might try. For sure, I don't want a tendon snipped.

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

Sued by your hospital? You’re not alone

The Carlsbad Medical Center in New Mexico has sued nearly 3,000 people since 2015 and more than 500 through August of this year. (One of those who was sued was a county judge!) If the bills are not paid, the hospital garnishes patients' wages and put liens on their homes. Likewise, Methodist Le Bonheur Healthcare in Memphis filed 8,300 lawsuits in the past five years, including some against their own employees. In Virginia, hospitals filed more than 20,000 lawsuits over patient debt in 2017 alone. These are all charges still owed after their insurance has paid the hospitals. 

Many are in one-hospital towns where there’s no competition. They can charge whatever they want. In Carlsbad, for example, the medical center charges five times more than Medicare would have paid for the same services. One employer in Carlsbad discovered that it would be cheaper for one of its workers to travel to Hawaii for a gall bladder operation—including airfare for two, and seven-day island cruise—than to get the procedure at the local hospital.

In 2018, more than one in four consumers nationwide were reported to credit bureaus for unpaid debt. Of those, more than half were the result of medical bills. One survey of women with breast cancer found that a third of those with health insurance had been referred to bill collectors; among those without insurance, the number rose to 77 percent. Overall, two-thirds of all bankruptcies and nearly half of all foreclosures in America today are related to medical costs.

Eighteen percent of the US economy ($3.5 trillion) is tied to health care, up from 5 percent in 1960. In 1999, medical expenses consumed 14 percent, on average, of American’s take-home pay. Now it's 31 percent of our take-home pay. I can think of better ways to spend my money.

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

Waste not. Want not

We don’t waste much food at our house: we eat all our leftovers; I pay no attention to “use by” dates; we scrape mold off food and eat what’s left, and so forth. This doesn’t make us sick; just makes for a robust immune system. Besides, some of my best meals are made from leftovers. Such habits have nothing to do with a world view. We’re just old fashioned “waste not want not” people. But I recently learned that food waste is a big contributor to climate change. About a third of food produced and packaged for human consumption is wasted. All the thrown-out food goes into landfills where it rots and gives off methane gas that is roughly 25 times more harmful than carbon dioxide. Plus there’s the waste of the land as well as trillions of gallons of water and vast amounts of fossil fuels required to grow and bring all this food to market.

A grocery store chain of 900 stores in Finland has undertaken a program to thwart food waste. Food that will reach its expiration date at midnight goes on sale at a 60% discount at 9:00 that evening. One man bought two pounds of shrink-wrapped pork tenderloin for $4.53. I’d do that in a heartbeat. A restaurant, also in Finland, serves only food made from past-due ingredients donated by grocery stores and bakeries. Because the donations vary, the restaurant chefs have no idea what they’ll be making until they walk into the restaurant’s kitchen. In the US, the Center for Biological Diversity gave nine out of ten supermarket chains a C grade or lower on food-waste issues. Only Walmart did better. Buying in bulk to save money also contributes to waste (think Costco). Fortunately, half-gallon-size bottles of bourbon never go bad.

Now I’m wondering about our compost pile where our vegetable waste goes. Is it giving off methane? Maybe not. The gophers have done a pretty good job of covering it with dirt.

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

The microbiome on my hand

After more than a year, I finally got back the results from the swab I sent to American Gut, a non-profit research group that studies people’s microbiomes—mostly the gut stuff. I’d swabbed my hand and sent the sample because I’d had an open wound on my finger that kept getting bigger instead of smaller—a situation that lasted about two months before it finally healed. Flesh eating bacteria, I was sure!

Anyhow, the results were not helpful, mostly because they didn’t identify the bacteria down to the species level. If you remember your biology, animal taxonomy goes in the following order: kingdom, phylum, class, order, family, genus, species. The lab results drilled down only as far as genera (the plural word for genus). I was astonished, though, that I had a list of over 170 different bacteria genera living on my hand—this would amount to thousands of different species. The genus staphylococcus was the tenth most abundant of my genera and was doubtless the cause of my problem. (As I said in an earlier blog staphylococcus epidermis is a common skin bacteria that normally causes no problems, but occasionally goes rogue and causes infection.)

Even though the results weren’t helpful, I did a little research on the skin microbiome and found some factoids based on studies of thousands of samples:

•  Your hand microbiome is in a state of constant flux and is affected by your age, handedness and gender, as well as by the products you use, your co-inhabitants and pets.
•  Women have a more diverse bacterial population than men; also, the bacterial composition of female hands is significantly more like their mobile phones than that of men.
• The bacterial composition on the hands of healthy people is different from those who are immune-compromised; oral antibiotics impact the hand microbiome.
•  As a rule, hand washing doesn’t change the microbial diversity on your hands.
•  Pet ownership increases the overall diversity of bacteria on your hands. Your hand microbiome is more like your own pet’s paws than that of a pet in another household.
• A home becomes colonized with its occupant’s microbiome, such that light switches, for example, harbor the same bacteria as your hands. Thus, objects can be identifiable to their owner—an alternative to human DNA in forensic analyses.

Get used to it. Your hands are loaded with thousands of bacteria and they leave tell-tale traces for forensic experts!

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

Patient advocate extraordinaire

Many, if not most, of us have served as advocates when a loved one has become ill. We have searched for answers on the internet, questioned doctors, stayed by the bedside in the hospital, and did our best to make sure he or she is being cared for. I just finished a book recommended by my friend Laura called The Perfect Predator: A Scientist’s Race to Save Her Husband from a Deadly Superbug. Talk about being a patient advocate!

The author, an epidemiologist, and her husband are vacationing in Egypt. He becomes terribly ill and is taken by ambulance to a rather dingy clinic near Luxor where he is diagnosed with pancreatitis. From there, he’s airlifted to Germany and from there to their home-base hospital in San Diego. They find his body is infected with an antibiotic-resistant superbug (Acinetobacter baumannii). In fact, the bacteria have colonized his whole body. None of the 12 antibiotics they give him has any effect. The hospital is keeping him alive with all the equipment you can imagine. Months go by. His organs are shutting down and he’s near death.

His wife and author of the book, Steffanie Strathdee, begins searching the internet for anything that might save her husband and comes across a paper on phages—viruses that attack bacteria. (A single drop of water can harbor a trillion phages. They’re everywhere: in soil oceans, and our bodies.) In Europe and the US, a few labs are doing research on phages in anticipation of the time when more and more bacteria become resistant to antibiotics. The Navy’s lab is one of these. Steffanie begins contacting the labs and enlisting the help of the scientific community in San Diego. The labs are willing to help, but they must first find the specific phage that attacks her husband’s bacteria (sewage treatment plants are good sources).

In a nail-biting sequence of events that involve the labs, the hospital, the FDA, shipments of the patient’s bacteria, experimentation with different phages, couriers, and so forth, phages are shipped. Once the phages arrive in San Diego, the scientists must figure out where to administer them and at what dosage. To make a long story short, after nine months in the hospital, the phages did their job attacking the bacteria and the patient lived. Here are the phages attacking a bacterium.

Following the success of this experiment, the study of phages has been ramped up and the therapy has been used on a few other patients (Steffanie’s husband was the first in the US). Next time it could be you or me.

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

A near death experience (not mine)

Every now and then I read about someone’s near death experience. I think they’re interesting. Those who have experienced such a thing seem to have a number of things in common: the sensation of floating over their bodies and viewing the scene around them; spending time in a beautiful, otherworldly realm; meeting spiritual beings and/or long-lost relatives and friends; recalling scenes from their lives; feeling a sense of connectedness to all creation as well as a sense of overwhelming, transcendent love; and finally being called, reluctantly, away from the magical realm and back into their own bodies. Most people are profoundly changed afterward and may have trouble fitting back into everyday life. 

I watched a TED talk given by Anita Moorjani, whose near death experience struck me as particularly interesting, mostly because of her recovery from her illness. She’d had lymphoma, which is cancer of the lymph system, and had tumors all over her body. Her organs were shutting down and she was hours away from death. She was in a coma. Her family was gathered around waiting for the end. On the verge of death, she had otherworldly experiences similar to those described above. She returned to life. Within five days, her tumors had shrunk 70%; after five weeks she went home, completely cured. She believes her cure was because of what she learned in the clutches of her near death experience:

• Love yourself; value yourself; don’t allow others to control you and don’t control others.
• Live life fearlessly.
• Incorporate plenty of humor in your life (see last week’s post!)
• Be aware that life is a gift and not a chore.
• Be yourself and embrace your uniqueness.

That advice isn’t particularly novel or earth shaking, but perhaps if you don’t value yourself, are afraid all the time, and so forth, such revelations can truly turn things around for you.

Scientists have tried investigating near death experiences—looking into the idea that a conscious mind can exist apart from a living body. While they’ve come up with a number of theories, such experiences remain a mystery as well as controversial, although many scientists, including Erwin Schrödinger, one of the fathers of quantum physics, believed such a thing. In the words of one scientist, “It’s a catalyst for growth on many different levels—psychologically, emotionally, maybe even physiologically.” Too bad that you have to be near death to reap such benefits. Maybe something to look forward to?

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

Laughter as medicine

Remember Norman Cousins? He was a journalist, professor at UCLA, and author of many books, including Anatomy of an Illness as Perceived by the Patient: Reflections on Healing. This was a long time ago, but I just remembered it. In 1964 he was diagnosed with ankylosing spondylitis, a degenerative disease causing the breakdown of collagen. He was in constant pain and given the prognosis of only a few months to live.

As a professor, he had conducted research on the biochemistry of human emotions, which he believed were the keys to success in resisting and fighting illness. He decided to fight his disease with laughter (along with lots of vitamin C). For his laughter program, he’d watch the TV show Candid Camera and comic movies. "I made the joyous discovery that ten minutes of genuine belly laughter had an anesthetic effect and would give me at least two hours of pain-free sleep," he reported.  He lived for 25 more years.

Laughter has since become a legitimate field of study (called gelotology). A related field, psychoneuroimmunology, examines the complex interactions between the nervous and immune system.  It is now well documented that human emotions interact with the mind and body in complex and powerful ways that impact our health. As far as laughter goes, it profoundly affects a number of physiological processes:

• Alters heart rate, blood pressure, sweating, and sleep patterns. including increasing blood flow.
• Decreases levels of stress hormones.
• Activates the brain's natural dopamine reward pathway in the brain.
• Increases the production of antibodies, which are important constituents of the immune system.
• Increases endorphins, the body’s natural painkillers. 

If only our orange clown would make us laugh instead of cry.

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

Withdrawing from painkillers

Travis Rider, a bioethicist at Johns Hopkins, was in a motorcycle accident that mangled his foot. To save it and make it semi-workable, he had six surgeries over a period of months. One of the surgeries consisted of removing flesh from his thigh to plug up a hole in his foot. As you can imagine, he was on lots of pain medicines—every type imaginable, but mostly opioids. 

After several weeks of being home, he wanted to get off the opioids and began calling various doctors about getting off them. They didn’t have a clue and didn’t want to be bothered by him. He called the pain management people at various hospitals with the same result. One doctor, off the top of his head, suggested that Travis cut his dose by quarter every week. Travis did this, and became horribly sick (nausea, sweating, chills, shaking, sleeplessness, depression) to the point of considering suicide. He says, “A whole slew of doctors gave me a medication that they weren’t willing to manage.” He stuck with the withdrawal for four weeks, after which he began to feel better, but “every moment in those four weeks was the worst moment of my life.”

Then he began doing research. Among other things, he learned that at most you shouldn’t taper off the meds faster than 10% a week and perhaps far less. He also learned that doctors receive little or no training in treatment of pain. Many doctors even lack the basic knowledge of when to prescribe opioids and have no idea how long it takes for a person to become dependent. (You can become dependent in as little as two weeks.) Many were taught to give opioids to anyone in pain. To make matters worse, doctors are motivated to keep patients pain free: they and their hospitals get higher ratings and they’re also financially rewarded by drug companies for prescribing pain meds. In his research, Travis also learned that opioids can increase sensitivity to pain, a condition called hyperalgesia.

He also says if he’d just been warned about the tortures of withdrawal he would have been prepared and been less despondent. Because his final surgery occurred after he’d gone through withdrawal, he was reluctant to take opioids for the pain, saying “I was more scared of withdrawal than I was of the pain.”

I think we've all experienced the ease with which doctors prescribe opioids. We had a bunch of unused opioids in our medicine cabinet until a neighborhood boy stole them. That's one solution, I guess.

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

I want this insurance!

Some self-insured companies are using “medical tourism” to save money while providing excellent care at accredited foreign hospitals. Here’s an example: an employee of Ashley Furniture Industries needed a knee replacement. Her company arranged for her to go to Galenia hospital in Cancun for the surgery and to stay at the Sheraton hotel next to the hospital for ten days while she was undergoing post-op physical therapy. A highly trained orthopedic surgeon from the US traveled to Cancun to perform the operation. Here are the highlights:

• The orthopedist stayed less than 24 hours and received $2,700—three times what he would have received from Medicare.
• The surgery in Mexico cost $12,000. The average cost in the US is $30,000 but is often double or triple that amount.
• The standard charge for a night at Galenia hospital is $300. In the US the average cost is $2,000 a night.
• The implanted knee device costs $3,500 at Galenia. The cost for the same device in the US is  $8000.
• The patient paid no co-pay or deductible. In fact, she received $5000 from her employer and all her travel costs were covered.

Ashley furniture has sent about 150 of its employees to Cancun or Costa Rica, saving the firm $3.2 million in health costs since 2016. Even after paying for the medical services plus the incentive payments, the company pays about half the cost it would pay for care in the US.

Following the treatment at Galenia, the patient had this to say: “It’s been a great experience. Even if I had to pay, I would come back here because it’s just a different level of care—they treat you like family.”

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Remember thalidomide?

In the 1950s and early 60s the drug was given to pregnant women as a cure for nausea. Unfortunately, it caused severe birth defects in their children, most notably truncated or missing limbs. Because of the dire consequences of this drug, in 1962 the government enacted the Kefauver-Harris amendment to the Federal Food, Drug and Cosmetic Act, which requires drug makers to satisfy the F.D.A. that their products are safe and effective before they go on sale. (I was kind of blown away by the fact that, before 1962, drugs could be sold without any data to support their claims of efficacy.)

Anyhow, the more than 100,000 drugs already on the market needed to be reviewed. To streamline the process, if the drugs’ components had been deemed to be safe and effective, they could be used under specific conditions without further review. But about a third of the drugs have still not undergone the final review process. That is, hundreds of over-the-counter drugs have not yet been determined to be safe and effective. Sunscreens are one of these.

Beginning in 1997, scientists discovered that oxybenzone, the chemical that filters out UV rays, does not stay on the surface of the skin but is absorbed. It has been found in urine and breast milk. (The CDC found that 97 percent of sunscreen-users’ urine samples contained the chemical.) At the same time, there’s never been any indication that sunscreen chemicals are harmful to humans, and evidence has shown that sunscreen can prevent skin cancer. Still, because sunscreens have not been studied (too many variables!), we don’t know about long-term effects—whether sunscreen use, for example, plays a role in infertility or anything else.

I use sunscreen on my nose sometimes to prevent it from getting any redder than it already is. I’ve had plenty of skin cancers and am plagued by actinic keratosis, which are supposedly pre-cancerous (but have never turned into cancer). Even so, I rarely use sunscreen, mostly because of the bother. My husband has never used it and has never had skin cancer or actinic keratosis. Perhaps a study is called for.

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Diets and supplements for cardiovascular health: Not

Long-term trials (277 of them) on 992,000 people have pretty much shown that adhering to special diets and taking supplements are of no benefit to your cardiovascular health:

• Low fat diets, including avoiding saturated fats, doesn’t help heart health. (I’ve been saying that all along.)
• Eating a Mediterranean diet is also not beneficial. What’s the big deal about “whole grains” anyhow?
• As a rule, supplements, including fish oil, vitamins, and antioxidants, don’t help much. Apparently folic acid helps people in China, where there’s a deficiency. On the down side, the study did find that taking calcium with vitamin D increases the risk of stroke, probably because these supplements increase clotting and hardening of the arteries.
• Reduced salt helped a few people, but was certainly not beneficial across the board. Some people are sensitive to salt; others are not. As doctor Eric Topol says, “maybe salt restriction really is beneficial for some, but we haven’t defined the people yet that would drive that.”

People are different. I have a friend who passes out if she eats strawberries; another who becomes ill by eating onions; another who is allergic to artichokes. Certain cancer medicines help some people but not others. All medicines affect people differently. Then there are your gut bacteria, which vary a great deal among people and which affect not only your physical health but also your mental health. Unfortunately, researchers haven’t nailed down ways to determine what foods or medicines are either beneficial or toxic to you specifically. For now you’re stuck with trial and error.

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We’re stuck with superbugs

Superbugs are bacteria that have become resistant to antibiotics. Bacteria become resistant because their rapid rate of reproduction (every twenty minutes) makes possible a high number of random genetic mutations. Thus, an antibiotic may kill plenty of bacteria, but not those whose mutations have rendered them immune to the drug.  The most well known of these is Methicillin-resistant Staphylococcus aureus (MRSA). MRSA originally appeared in intensive care units, among surgical patients, causing pneumonia and bloodstream infection from catheters. Now it’s become more widespread outside of hospitals. Other bacteria have also become resistant to antibiotics.

Some statistics:

• It costs $35,000 to treat MRSA; chance of death is over 20 percent.
• The number of people dying each year from resistant microbes is at least 1.5 million.
•  Antibiotics from human and animal waste end up in our drinking water, which makes for even more drug-resistant bacteria.
• Farm animals are routinely fed low doses of antibiotics; over 70 percent of medically important antibiotics in the US are sold for use in farm animals.

Drug companies are not knocking themselves out to discover new antibiotics—it’s not commercially attractive to them. We need to conserve those viable antibiotics we have. In other words, limit unnecessary use. Good luck with that.

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The benefits of friluftsliv ("open air life")

According to a wealth of studies, spending time outdoors has lots of health benefits:

• lower stress;
• decreased blood pressure;
• reduced risk of asthma, allergies, diabetes, and cardiovascular disease;
• improved mental health;
• increased life expectancy.

The trick was to figure out how much outdoors time is required to reap these benefits. A study that examined about 20,000 people in Britain (2014 to 2016) found that those who spent about two hours a week outdoors had better health and sense of well being than people who didn’t get out much. 

Interestingly, the findings showed that less than two hours per week (60 to 90 minutes) wasn’t enough, and more than two hours (five hours) didn’t offer additional health benefits. It’s also interesting to note that, in the study, the two-hour threshold was the same for all types of people: men and women, older and younger, different ethnic groups, rich and poor. Researchers haven’t figured out the exact causes of the benefits.

Apparently, more and more doctors are prescribing time outdoors to their patients. In Sweden, people are serious about friluftsliv, a Norwegian term that means “open air life.” In fact, firms even get tax breaks for providing the infrastructure and incentives that encourage their employees to enjoy friluftsliv. In South Korea, the government is establishing dozens of “healing forests” for its citizens.

I spend about twelve hours a week out of doors: about four of those are gardening and the rest are golfing. I just hope the stress of hitting bad shots doesn’t offset the benefits of being in the open air.

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Poisonous generic drugs

Mahatma Gandhi helped start the generic drug industry by urging his friend—a chemist—to copy Western drugs as a way to bring affordable medicine to India’s masses. Thus, the friend, Khwaja Abdul Hamied, reverse-engineered drug formulas and founded a company, Cipla, in 1935. The company prospered and, in the early 2000s, for example, provided HIV drugs to millions of people in Africa at a cost that was about 4 percent of Big Pharma’s price. Cipla is still a (mostly) trustworthy manufacturer of generic drugs, but many others are not. In fact, many manufacturers are producing drugs that are harming and sometimes killing patients. For example, in 2007 scores of kidney patients across the United States died from allergic reactions to the blood thinner, heparin. The heparin, which was manufactured in China, was contaminated.

In the US, imports from India make up 40 percent of all the generics we use; 80 percent of the active ingredients in both generic and brand-name medications come from India and China. In other words, they’ve merged with Big Pharma. I suppose this wouldn’t be so bad if the drugs were pure. But they’re not.

The FDA is supposed to regulate the industry by inspecting production and testing facilities and by exhaustively checking records. But inspection visits are rare and, until recently, the manufacturers are given plenty of notice before inspectors arrive, giving corporate officers time to destroy failed quality test results and fabricate documents that show successful tests. Some plants have even built fake production and testing areas that are kept pristine just for inspection purposes.

FDA inspectors avoid taking drugs made overseas. As a Ghanian creator of a drug verification program noted, “All medicines are poisonous. It’s only under the most controlled conditions that they do good.” Ack.

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Noise pollution

In 1949, buses in Washington DC installed a system to play radio programs (mostly music) in their buses and streetcars—conveyances owned by The Capital Transit System, a privately-owned public utility. At least two riders, Franklin Pollak and Guy Martin, were seriously annoyed by this turn of events—so annoyed, in fact, that the Public Utility Commission of the District of Columbia were forced to hold a number of hearings, in which they concluded that “the playing of radio programming was not inconsistent with public convenience, comfort and safety.”

Pollak and Martin appealed the decision, and the case ended up in the Supreme Court, which  concluded that the radio programs did not violate the First Amendment’s protection of Freedom of Speech (programs didn’t include objectionable propaganda) and also did not violate the Fifth Amendment (people in public transit were not guaranteed a right of privacy equivalent to that in a person's own home or vehicle). Justice Frankfurter chose not to participate in the case because he felt he couldn’t be objective: he believed himself to be a victim of music in the transit system. Justice Douglas dissented, arguing that playing music to a captive audience was contrary to the concept of liberty under the First Amendment and contrary to privacy under the Fifth Amendment.

You go justices Frankfurter and Douglas! I’m with you! Why must I be subjected to someone else’s choice of music everywhere I go? We can’t escape it. Where’s the liberty in that?

OK. It’s a pet peeve of mine. But noise pollution has serious effects on people: hearing impairment, tinnitus, hypertension, heart disease, changes in the immune system (most of these are stress related). Apparently, our sympathetic nervous systems are adversely affected by chronic noise. Someone has come up with the statistic that there are 10,000 deaths per year as a result of noise in the European Union.

Noise pollution is also a serious problem for animals. Example: researchers who were studying stress levels in whales, noticed that their stress levels dropped in mid-September 2001. The reason? A temporary pause in ocean shipping that followed 9/11.

Don’t even get me started on noisy restaurants.

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Hyperacusis: when sounds are painful

Every Fourth of July I conclude that I’m overly sensitive to loud noises. The parade in our small town always starts with fire engines, which I dread because of their sirens. The sound is painful to me and I cover my ears. (It bothers my half-deaf ear most.) I look around and nobody else is covering their ears. I recently learned of a condition called hyperacusis, but my problem is probably not that, unless it’s an extremely mild case. If I did have hyperacusis, the sound of running water might cause ear pain, as is the case of one sufferer.

Hyperacusis is a hearing disorder in which sounds are amplified in a painful way. Even the mildest environmental sounds can cause pain. I read about the case of a young man who was working in a noisy restaurant when his problem started. It got so bad he had to quit his job and move home with his parents. He describes the pain as “raw inflammation” and says that it includes pressure on his ears and temples and tension in the back of his head. He wears the kind of earmuffs people wear in shooting ranges. His family doorbell has been disconnected.

Information on Wikipedia lists notable people who have the condition. The majority are musicians. The most common cause is overexposure to loud noises. People can also get it as a result of diseases such as Lyme disease or from head injuries or from drugs. It is often accompanied by tinnitus—ringing or buzzing in the ear. Experts don’t know exactly why hyperacusis occurs. Theories include a malfunction of the ear’s protective hearing mechanisms, damage to a portion of the auditory nerve, a problem with the central processing system, or a malfunction of the facial nerve. It’s a rare disease but is increasing in occurrence.

I know that I wouldn’t be able to attend Jazzercise class without earplugs. I don’t see how people stand the loud music. I guess they’ve gotten used to it.

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Corporate medicine exploits doctors and nurses

Danielle Ofri, a physician at Bellevue Hospital and New York University writes that “corporate medicine has milked just about all the ‘efficiency’ it can out of the system. With mergers and streamlining it has pushed the productivity numbers about as far as they can go. But one resource that seems endless—and free—is the professional ethic of medical staff members.” What she’s saying is that most doctors and nurses are committed to doing the right thing for their patients and that the system takes advantage of them. Demands on them keep escalating “without a commensurate expansion of time and resources,” yet they continue uphold their professional ethics—sometimes at great personal cost—and try not to stint and caring for their patients. The nurse doesn’t take a lunch break; the doctor squeezes in the extra patients; evenings and weekends are dedicated to catching up with medical records, and so forth.

Here’s what’s happening:

• Primary care doctors spend nearly two hours entering information into the computer for every hour of direct patient care.
• Patients are sicker than in the past: more chronic conditions; more illnesses to treat; more medications to handle.
• Burnout levels among doctors are at new highs and increasing; doctors and nurses commit suicide at higher rates than in almost any profession.
• There are now roughly 10 administrators for every doctor. (From 1975 to 2010 the number of health care administrators increased 3,200 percent).

What are those administrators doing? I suppose a lot of them are entering the codes used by insurance companies. She doesn’t say, but they don’t sound like they do much good for the medical staff.

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Forget testing for vitamin D

We need vitamin D because it increases our intestinal absorption of calcium, magnesium, and phosphorus and makes our bones strong. We get most of the vitamin through a synthesis that occurs on our skin. The synthesis is a complicated process involving a chemical that resides in our skin combined with exposure to the sun (ultraviolet light). (Vitamin D is found in only a few foods, such as egg yolks, oily fish and milk fortified with vitamin D.) Because many people have little exposure to sunlight, especially those living in northern areas in the winter, some investigators became concerned that large swaths of the population were not getting enough of the vitamin.

In 2007, one influential doctor published a paper asserting that blood levels of vitamin D below 29 nanograms per milliliter of blood leads to an increased risk of cancer, autoimmune disease, diabetes, schizophrenia, depression, poor lung capacity and wheezing. (He’s also published books.) Word got around and soon “there was a vitamin D bandwagon,” in the words of Mayo Clinic doctor. Doctors began incorporating vitamin D tests into the general evaluation of patients. Commercial labs immediately began describing levels of 20 to 30 nanograms as insufficient (and many continue to do so). The number of blood tests for vitamin D among Medicare beneficiaries increased 83-fold from 2000 to 2010. Among those with commercial insurance, testing rates rose 2.5-fold from 2009 to 2014.

In the meantime, a number of scientists performed multiple studies to verify the doctor’s claim, which turned out not to be true. After conducting many trials with thousands of test subjects, scientists found that those who took vitamin D supplements were no better off than those who took placebos. After reviewing the studies, the Institute of Medicine prepared a report stating that there’s no benefit for healthy people to have blood levels above 20 nanograms of vitamin D per milliliter of blood. After becoming convinced that the tests weren’t necessary, one doctor tried to discourage her patients from being tested. But, she said, “people were used to vitamin D monitoring, like with cholesterol. They wanted to know what their number is.”

There’s no reason to be tested for vitamin D, even if you live in Maine. It’s just another unnecessary test.

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Why we fell behind in health care

We (the U.S.) devote much more of our economic resources to health care than any other nation, yet our health care outcomes aren’t better for it. In 1980, this wasn’t the case. At that time we were spending about the same as other countries and our life expectancy was also about the same. But by the mid-2000’s we were spending more than other countries and were at the bottom of the life-expectancy pack. What happened?

According to the experts, the oil price shocks of the 1970's hurt economic growth, straining countries’ ability to afford health care. At the same time, high inflation contributed to growth in health care spending. Unlike other countries that had constraints in place to control spending, constraints in the U.S. were negligible. It all goes downhill from there.

• Other countries put limits on health care spending whereas we rely on market forces. Because of this, prices for health care goods and services are much higher in the US. What’s more, when we have periods of rapid growth, health care markups also grow rapidly.
• In the U.S., medical facilities become ensnared in a “medical arms race,” in which they compete by investing in the latest technologies, which, by the way, don’t necessarily translate into better outcomes.
• The US has higher health care administrative costs than other wealthy countries. It’s because we have so many insurers, each requiring different billing documentation.
•  The U.S. spends less on those at the bottom of the economic ladder, even though the most efficient way to improve overall health is to focus on that population. In 1980 we spent 11 percent of our GDP on social programs, excluding health care, while members of the European Union spent an average of about 15 percent. In 2011 the gap had widened to 16 percent versus 22 percent. 

Ideas anyone?

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Medicare for all

In one hospital, Medicare pays $17,000 for a knee replacement. The same hospital can get $37,000 for the same surgery on a patient with private insurance. The RAND corporation recently gathered information on about a third of the hospitals in the US and studied four million insurance claims. Overall, prices for hospital care average 2-1/2 times more for private insurers than for Medicare.

This study is the first to reveal such disparities on a large scale. Hospital rates are normally closely held secrets between insurers and hospitals. Businesses that contract with insurance companies have no idea what their insurers are paying hospitals. But because the costs are so steep, many businesses off-load more of the expense onto their employees through higher premiums and deductibles. The expense of paying for employees’ health care has depressed wages and entrepreneurship. One textile manufacturer moved more than 1,000 jobs out of the country because it couldn’t afford to pay for insurance for its workers. This is becoming increasingly common.

What’s more, the trend toward consolidation among hospitals have spurred higher costs. They become more powerful systems that can demand ever-higher prices. Many are flush with money. In Colorado, which has the biggest disparity, hospitals are building new facilities and buying physician practices, even though their existing hospitals are only two-thirds full.

The health care industry makes up 18 percent of the nation’s economy and is one of the nation’s largest employers. In fact, it’s the biggest employer in at least a dozen states. Medicare for all (or some form of that) would cost jobs—maybe two million of them. But as one Stanford physician-economist says, the first casualties of a Medicare for all program would be the “intermediaries that add to cost, not quality.” These would include the armies of administrators, coders, billers and claims negotiators. Plus there would be far less need for drug and device sales representatives who ply their trade office to office and hospital to hospital. Few people would mourn the end of $35 million annual compensation packages for insurance executives or the downsizing of companies that have raised insulin prices to 10 times what they are in Canada.

As the president of Physicians for a National Health Program says, “you don’t need insurance companies for Medicare for all. You need hospitals.” The point of a health care system is to treat patients, not to buttress the economy.  

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I’m still fuming

The other day I read a case study about a woman who was being treated for ulcerative colitis. She was prescribed sulfasalazine (a combination of a sulfa drug and aspirin). She got desperately ill: very high fever and rash, so she went to the hospital and was put into intensive care. They did blood work and whatnot and discovered that she had bone marrow suppression, meaning a decrease in production of red and white blood cells. They were pretty sure she had leukemia, but it turned out she was allergic to sulfasalazine.

The reason I’m still fuming is that a couple of years ago my husband was being treated for colitis (not the ulcerative kind) and was prescribed a drug called budesonide (he didn’t think sulfasalazine was working). A few days after taking the drug, his extremities became painful and very weak. He could hardly move. He didn’t stop taking the drug until he could get ahold of the doc, who said to stop it, but didn’t say it was causing his symptoms. To try to figure out what was causing his symptoms he went to his GP, his gastroenterologist, a neurologist, and a rheumatologist. They all had different theories. He had a colonoscopy plus a muscle biopsy. The results showed nothing.

All along I’d been saying his symptoms were caused by the budesonide. But no one paid any attention to me, of course. (Although when I spouted my theory to the neurosurgeon who did the biopsy, she said, “It’s the reason I don’t take pills” and walked off.)  I even found an FDA-related “adverse effects” web site in which people reported the same effects from budesonide as my husband’s. I recommend that you look at it.

It took my husband about a year to recover. By the way, he takes sulfasalazine to control his colitis and I’m still fuming.

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