Choking (pulmonary aspiration)

Now that I’m old, I choke way more than I used to—mostly when drinking something and swallowing incorrectly. The liquid starts to head toward my lungs (via my trachea), instead of toward my stomach (via my esophagus). Because breathing and swallowing occur in the same space, swallowing requires extremely precise coordination with breathing. Failure to coordinate results in choking.

Swallowing involves over 20 muscles of your mouth, throat and esophagus, and all are controlled by nerves in your head. Your tongue pushes the food toward the back of your throat and also prevents food going back into your mouth; your soft palate blocks the food from going into your nasal cavity; vocal folds close to protect the airway to your lungs; your larynx (voice box) is pulled up and the epiglottis (a leaf-shaped lid) covers the entry to the trachea (windpipe). This last part is the most important step: the epiglottis keeps food from going into your lungs.

Choking is a common effect of aging. Like everything else, the muscles in your mouth get flabby, including your epiglottis, the flap that keeps food from going down your trachea. We also have less saliva, which adds to the problem. In young people, the normal time for a single swallow, is about one second; it can be twenty percent longer in older people, so the airway has to be protected longer. 

One solution is to tuck your chin down when drinking, rather than raising your chin up. Tucking tilts the epiglottis backward to help prevent food going down your windpipe. I can never remember to do that.

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Embodied cognition

Embodied cognition is the theory that our entire body—not just our brains—shape our knowledge and understanding of the world. From the standpoint of evolution, abstract thought is less than 100 thousand years old, whereas the sensory and motor portions of our brains—those necessary for survival—have been at work for a billion years. As one researcher said, “the deliberate process we call reasoning is, I believe, the thinnest veneer of human thought, effective only because it is supported by this much older and much powerful, though usually unconscious, sensorimotor knowledge.”

Researchers have performed lots of experiments to demonstrate this theory. For example, if you're holding a warm cup of coffee, you're more likely to judge a person as trustworthy than you would if you're holding a cold cup of coffee. If you squeeze a soft ball while looking at a gender-neutral face, you are more likely to perceive the face as female than you would while squeezing a hard ball, in which case you would perceive the face as male. When you think about the future, you're more likely to lean forward, but if you think about the past, you'll probably lean back.

One interesting aspect of embedded cognition is that we think and talk in metaphors because metaphors are based on the physiology of emotion. When we’re angry our skin temperatures and heartbeats rise. Thus, we describe someone as being “boiling mad” or doing a “slow burn.” Some of the metaphoric language comes from physical interactions during our first several years of life. We equate up with control (“I have control over him”) and down with being controlled. We equate affection with warmth (“I’m warming up to her”). 

Engineers who work with artificial intelligence are trying to figure out how to construct robots so that they, like us, can learn from their environment. As Alan Turing wrote in 1950, “ …it is best to provide the machine with the best sense organs that money can buy.” Good luck with that.

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

Why we’re living longer

 In 1880, average life expectancy in rich countries was 40 years. In 2018, in the U.S., it was 78.5 years. (Life expectancy is the average number of years a newborn would live if prevailing mortality rates remained unchanged.) In a sense, we have been granted an extra life: an added 40 years.

Because of the Covid pandemic, we’ve been made acutely aware of the ways in which pathogens can sicken and kill us. But it has been ever thus. We fail to appreciate the fact that we’ve been living longer because feats of human ingenuity followed by public health measures have been protecting us from these microscopic invaders.

For example, in London, a physician by the name of John Snow traced cholera deaths to a neighborhood water pump, proving that contaminated water, not foul air (“miasma”), caused the illness. Although Snow wasn’t able to identify the specific contamination agent—later identified as a bacterium—he was the first to study the pattern of deaths in the neighborhoods and thus to pinpoint the culprit. In other words, he was the first epidemiologist. His discovery led to improved sanitation facilities in London.

Discoveries by Pasteur and other scientists continued our forward progress. Antibiotics, blood transfusions, and similar medical interventions have saved millions of lives. But we owe the lion’s share of our extra life not to individualized medicine but to public health measures such as sewers and clean water, pasteurization, chlorination, and vaccines. We should be more grateful.

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

The hospital business

 At least a fifth of America’s hospitals are now run for profit. Private-equity investment in health care has tripled since 2015. Nevertheless, hospitals are closing at the rate of about thirty a year. What's wrong with this picture?

The idea of hospitals turning profits is somewhat recent. The oldest hospital—co-founded by Benjamin Franklin—opened in Philadelphia in 1795. Care was free (costs were covered by philanthropy and taxes). The cost of hospital care rose significantly after the second World War, partly because of the development of expensive procedures and partly because the government began to offer tax breaks for employers who paid for their workers’ health benefits. In 1965, after Medicare and Medicaid came into being, the number of insured Americans grew to more than sixty percent of the population. To capitalize on the boom, for-profit hospitals sprang up and more than seven hundred for-profit insurance companies were offering medical coverage. 

Since 2008 American hospitals have been involved in more than a thousand mergers and acquisitions, resulting in large, powerful health systems that influence both the price of hospital care and the reimbursement rates paid by private insurers. Last year sixty-six billion dollars was spent on acquisitions, a situation that has led to increased price hikes and unnecessary procedures. 

For hospitals, the most lucrative business comes from privately insured patients seeking specialized care. If your hospital is in an area where relatively few privately insured patients reside, it may be doomed. Where I live, the conglomerates have taken over. My hospital is currently undergoing a $360 million dollar renovation. Looks like business is good.

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