Cartoon for the holidays

 

 "Something's just not right--our air is clean, our water is pure, we all get plenty of exercise, everything we eat is organic and free-range, 

and yet nobody lives past thirty."

Strength training

 I used to go to Jazzercise once a week, a fitness program that included both aerobics and strength training. The program shut down during Covid. To compensate, I signed up for Jazzercise on Demand, an online program. It’s $25.00 a month, but worth it for me because I use it consistently twice a week (although my sessions are only ten minutes long). The photo below is an accurate depiction of what I do, using five-pound weights and my iPad (not a TV). It’s strength training.

Silver Sneakers is also an option. It’s an exercise program for seniors, offered as both in-person classes and online. It’s free (mostly) for Medicare Advantage subscribers (but not through Original Medicare). A friend of mine uses this and likes it a lot. The image below is from the Silver Sneakers website.

According to experts, just 20 minutes of strength training twice a week, or 10 to 15 minutes three times a week brings significant long-term rewards, including a 10 to 20 percent reduction in your risk of mortality, cardiovascular disease and cancer. (I don’t see how you can reduce your risk of mortality, but that’s what my source, the British Journal of Sports Medicine, said.) At any rate, I do it to maintain strength. 

Strength training is particularly valuable for people with diabetes, as one journal reports: “Our findings showed that muscle-strengthening activities were associated with a 17% lower incidence of diabetes. Because muscle-strengthening activities increase or preserve skeletal muscle mass, which has been identified as the major tissue in glucose metabolism, a clear dose–response association can be established.” 

What's not to like?

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

Government Dietary Guidelines and diabetes

 The Government Dietary Guidelines are skewed toward carbohydrates, a position that exacerbates the rise in Type 2 diabetes in this country. I’d guess that most of us don’t pay much attention to these guidelines (I never have), but the guidelines directly influence food policy across federal agencies, state and local government, food manufacture, labelling, food programs within schools and hospitals, and recommendations by doctors and dieticians. The current guidelines include 10 percent of calories as sugar and three servings of refined grains daily.

A third of Americans 65 and over have diabetes. The number of diabetic people under the age of 20 grew by 95 percent from 2001 to 2017.  Diabetes means having excess glucose (sugar) in your blood. Carbs raise blood sugar levels. As blood sugar levels increase, the insulin-producing cells in the pancreas release more insulin. Eventually these cells become impaired and can't make enough insulin to meet the body's demands. The result: diabetes.

A double-blind clinical trial compared the government’s diet against a typical American diet. For the experiment, the typical diet had lots of refined grains, saturated fat, and sugar, while the government diet contained more fruits, vegetables, and whole grains. Half the trial participants followed the government diet for eight weeks and half followed a traditional diet, which included 3-1/2 additional servings of refined grains per day, including cake and candy. At the end of the trial, markers for diabetes and heart disease showed no difference in both groups. (A seven-year trial came to the same conclusion.)

Here's the thing: 95 percent of the U.S. Dietary Guidelines Committee have conflicts or interest with the food or pharmaceutical industries. A total of more than 700 conflicts of interest were found on the 2020 Dietary Guidelines Advisory Committee and more than 50 percent of the committee members were connected to 30 industry actors or more. Kellogg, Abbot, Kraft, Mead Johnson, General Mills, and Dannon had the most frequent connections. While you can ignore the guidelines, federal programs are required by law to follow them.

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

Antidepressants

 I was surprised to learn that, before Covid, 1 in 8 Americans was taking an antidepressant drug. That number rose by 18.6 percent in 2020. Zoloft, an antidepressant drug, is now the 12^th most commonly-prescribed drug in the U.S.

Most psychiatrists believe that the drugs do help most people who take them. But there’s some controversy about why and how they work. The most commonly prescribed antidepressants are selective serotonin reuptake inhibitors (S.S.R.I.s), such as Zoloft, Prozac, and Celexa. These drugs prevent neurons from sucking up the neurotransmitter serotonin, allowing more of the chemical to float around in the brain. Other antidepressants cause an increase in other brain chemicals, such as norepinephrine and dopamine. This is the “chemical imbalance” theory of treatment.

Studies show that depressed people don’t have less serotonin than people who are not depressed. Researchers are now looking at other causes. For example, studies have shown that depressed people have less volume in their brains’ hippocampus, an area that’s important for regulating mood. Studies have also shown that chronic stress can cause the loss of connections (synapses) between cells in the hippocampus and other parts of the brain. This type of research indicates that antidepressants work in part by helping the brain form new connections between cells

For people with treatment-resistant depression, ketamine and psychedelic therapy has shown promise in helping the brain create new connections more efficiently. Ketamine, like psychedelics, induces a “dissociative experience” (a trip). Studies have shown that within 24 hours of the first dose, the lost connections start to regrow.   Apparently these interventions improve depression scores in roughly 60 percent of the people who try them. However, they’re seen as riskier and more invasive than antidepressants.

I've never suffered from depression, a situation I attribute to dumb luck.

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

Sleep apnea

Sleep apnea—more accurately, obstructive sleep apnea—is a condition in which your breathing stops during sleep for longer than 10 seconds and at least five times per hour. This condition occurs because something is blocking your upper airway, such your muscles or tongue. Here are the symptoms:

• Snoring that's interrupted with periods of quiet; snoring that resumes with a loud sound as breathing starts again.
• Morning headache
• Frequently falling asleep during the day.
• Depression; being easily irritated; difficulty remembering things.

The people I know with sleep apnea use a CPAP (continuous positive airway pressure) machine that provides a constant flow of air to help keep their airways open. If you have the condition, it also helps to avoid drinking alcohol or taking sedatives—behaviors that relax your muscles. If you do use a CPAP machine, I hope it's not made by Philips Respironics. The foam used inside those machines contain potentially cancer-causing particles that blow into the mouths and noses of users. After years of ignoring reports of cancer and other ailments, those machines have now been recalled.

One test of sleep apnea is called the Epworth Sleepiness Scale, which determines your level of daytime sleepiness.

0-10 is normal; 11-14 is mild; 15-17 is moderate; 18 or higher is severe. If you scored 11 or higher, you may have a problem. Studies have shown that people who have sleep apnea and who use the CPAP machine improve their scores..

I fall asleep during educational TV; never while talking to someone or when stopped in traffic while driving! I scored four on the sleepiness scale.

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

Medicare Advantage rip-offs

Medicare Advantage is a private sector alternative to traditional Medicare. The government pays Medicare Advantage insurers a set amount for each person who enrolls, with higher rates for sicker patients. By developing elaborate schemes to make their patients appear as sick as possible, the insurers get more money from the government. 

To maximize their profits, insurance companies employ firms to help them come up with money-making opportunities. A whistleblower uncovered an email that was sent by an insurance company executive to one of these consulting firms. It says, “You mentioned vasculatory disease opportunities, screening opportunities, etc with huge $ opportunities. Let’s turn on the gas!”

 Most of these private insurance companies, including ours, have been accused of fraud. Eight of the 10 biggest Medicare Advantage insurers have submitted inflated bills. For example, our insurer, Anthem (now called Elevance Health) pays more to doctors who said their patients were sicker. Executives at United Health Group told their workers to mine old medical records for more illnesses. When the workers couldn’t find enough, they were sent back to try again. 

In some of the schemes, patients are diagnosed with diseases that they don’t actually have. For example, one patient was diagnosed with bipolar disorder—which he didn’t have--giving Anthem an additional $2, 693.27.  Doctors and nurses have been pushed to document a range of diagnoses, including vertebral fractures, pneumonia and cancer they lacked the equipment to detect. And so on.  

Advantage companies also use deceptive marketing practices in order to sign up new customers. For example, they have posed as the IRS and other government agencies. They also prey on vulnerable people with dementia and cognitive impairment. Many people say they were enrolled in plans without realizing it.

In 2020, such fraudulent diagnoses cost the government $12 billion—enough to cover hearing and vision care for ever American over 65.

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

Medicare vs. Medicare Advantage

I’d been under the mistaken impression that Medicare Advantage is a supplement to Medicare. I haven’t paid attention. It’s not. (You probably know better.)

Original Medicare—is federal health insurance for people 65 or older, some younger people with disabilities, and people with end-stage renal disease. It helps cover—

• Hospital, nursing facility, hospice, and home health care (Part A).
• Services from doctors and other health care providers; outpatient care; home health care; medical equipment such as wheelchairs; many preventive services, such as screenings, shots, and “wellness” visits. (Part B)

You can join a separate drug plan (Part D).

You usually pay 20% of the Medicare-approved amount after you meet your deductible. You can buy supplemental coverage (Medigap) to help pay out-of-pocket costs.

You can use any doctor or hospital that takes Medicare, anywhere in the U.S.

You don’t need a referral to see a specialist.

Medicare Advantage (Part C)

Medicare Advantage is a private sector alternative to traditional Medicare. The government pays Medicare Advantage insurers a set amount for each person who enrolls, with higher rates for sicker patients.  You can choose from 38 Advantage plans offered by private insurers such as Humana, CVS Health, Kaiser Permanente, and Cigna. These plans are “bundled,” meaning they include Part A, Part B, and usually Part D (a drug plan). Often you can also include vision, dental and hearing—one stop shopping.

Most Advantage plans allow you to go only to contracted providers— in-network providers. You may need to get a referral to see a specialist.

Researchers who have tracked Advantage users compared with similar patients in the same counties or ZIP codes, have found that 10 percent are less likely to enter the highest-quality hospitals, 4 to 8 percent are less likely to be admitted to the highest quality nursing homes and half as likely to use the highest-rated cancer centers for complex cancer surgeries. This, or course, shows the limitations of in-network and prior-authorization requirements.

Four of the five largest Advantage insurers have been accused in court of fraud, as I’ll discuss next week.

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

Pigeons detecting breast cancer

Pigeons can detect breast cancer in microscope images as well as humans. Apparently, pigeons have excellent visual systems, similar to or better than ours. For one thing, they sense five different colors as opposed to our three.  Humans have receptors for green, blue, and red. The combinations of these three colors produce all the colors we can perceive, whereas pigeons can also detect ultraviolet and polarized light. Pigeons can distinguish letters of the alphabet, misshapen pharmaceutical capsules, and paintings by Monet versus Picasso. Also, pigeons don’t mentally fill in gaps, like we do, when an expected shape is missing.

To identify cancer cells, 16 pigeons received two weeks of training, which consisted of presenting them with magnified images of possible breast cancers.

They would identify a growth as benign or malignant by pecking one of two answer buttons. A correct identification earned them a pigeon pellet. Once trained, the pigeons’ average diagnostic accuracy reached 85 percent. But when the selections of four pigeons were pooled (“flock sourcing”), diagnostic accuracy reached 99 percent—what would be expected of a pathologist. What they weren’t good at was locating suspicious tissue densities that can signal malignant potential on a never-before-seen image.

While it is unlikely that pigeons will be playing a role in patient care, researchers believe the findings can help develop more effective training methods for budding clinicians. What would they use for rewards?  Potato chips? Hershey’s kisses? Money?

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

Constipation saga (not mine)

 The New York Times published an article that begins, “To maintain continence, the puborectalis muscle chokes the anal canal. The sling of tissue is supposed to release during defecation. Mine has not been doing that.” Her constipation has been going on for over a year. Here are some of her efforts at finding a cure:

• At least nine over-the counter medicines, such as Miralax, Benefiber, Squatty Potty, and Dulcolax.
•  At least twenty-four foods and supplements, such as psyllium, flax seeds, prunes, ginger, dandelion, sea moss, and slippery elm.
•  Colonic massage, fleet enemas, acupuncture, and perianal splinting (involves the fingers).
• A gastroenterologist, who tells her to avoid cruciferous vegetables and prescribes various medications, none of which work.
• An x-ray of her intestinal tract that reveals “considerable stool material in the descending colon as well as the rectosigmoid region.”
• A YouTube video by a masseuse who explains how to heal constipation with love, and who holds up a piece of paper that says, “I allow life to flow freely through me.” Put one hand on your heart, she says, and ask yourself: “How true does this affirmation feel?”
• A colorectal specialist whose test shows “a reversed rectal anal gradient — I squeeze when I should push. I leave with instructions for an exercise called ‘anal winks.’”
• The Gastrointestinal Motility Disorder Center where she receives pelvic floor biofeedback therapy and is told to “synchronize Kegel contractions with the rise and fall of an animated dolphin as it undulates across a monitor that is connected to the wire in my anus.”
•  A proctologist who administers anal Botox.

The author doesn’t say if she’s been cured.

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

Diabetes

 As you know, there are two types of diabetes: Type 1, in which the immune cells destroy the pancreatic cells that synthesize and secrete insulin; and Type 2, in which pancreatic cells still produce insulin, but its effectiveness is compromised. Type 1 used to be called “juvenile” diabetes, and Type 2 was called “adult-onset” diabetes. Here’s something I didn’t know: adults can get Type 1 diabetes and children can get Type 2 diabetes.

 Anyhow, in the past, people used to be treated with cow insulin because there was no source of human insulin. But a lot of people were allergic to cow insulin. A scientist by the name of Arthur D. Riggs figured out how to use recombinant DNA technology to convert bacteria into factories that produce human insulin. He made his discovery while working at the City of Hope National Medical Center in Duarte, California. In order to produce the human insulin, Riggs partnered with scientists at the biotech company Genentech. In 1982, the FDA approved a human insulin product called Humulin.  

 The partnership made Genentech and Dr. Riggs rich. But Dr. Riggs declined the opportunity to make even more money working in the for-profit sector. After his contract with Genentech ended, he returned to City of Hope full time, living in the same modest house for fifty years. He died this year at the age of 82. He donated $310 million to City of Hope, most of it anonymously.

 The price of insulin has nearly tripled over the last fifteen years. A single vial of Humalog (a fast-acting insulin) cost $21 in 1999. In 2019, it cost $332—an increase of more than 1,500 percent. In Canada, the price didn’t budge. The difference is that in the U.S., there’s neither a real free market nor government price controls for insulin. Instead, there’s an oligopoly of three drug companies—Eli Lilly, Novo Nordisk, and Sanofi—that appear to set prices in sync. In other words, price fixing. I’m sure this is not what Dr. Riggs had envisioned.

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

Vaccinations

 The New York Times recently reported that, as of September 6^th, more than 700 children in Zimbabwe have died from measles and more than 6,500 people have been infected with the virus. In New York state, some people have contracted polio, mostly with flu-like symptoms, but one man has become partially paralyzed. Researchers are finding polio virus in the wastewater. This, of course, is because of the decline in vaccinations.

 I believe in getting vaccinated--at least for some diseases. My kids had all the recommended vaccinations. As for myself, I’m not sure which vaccinations I’ve had. Not the measles vaccination, which wasn’t developed until 1963. I caught the measles as a child and, as a result, lost fifty percent of my hearing in one ear. I remember having to stay in bed in a darkened room so that my eyes wouldn’t be affected also. Polio vaccine wasn’t available until the late 1950s. Happily, I didn’t get that disease, but many people I know are crippled because of it. A man in our golf group was left with a droopy eye. In fact, he can’t close it. I assume I got the polio shot as soon as it was available.

 I’ve also probably been vaccinated for smallpox, which was the first vaccination to be developed, beginning in 1796. Worldwide, smallpox had a mortality rate upward of 50%. Thanks to vaccinations, which were widely distributed in the 1940s, smallpox was eradicated in the U.S., such that routine vaccinations for that disease were discontinued in 1972. I’ve probably also been vaccinated for diphtheria, tetanus and pertussis (whooping cough), all of which were available by the late 1940s. But I think that’s all I’ve had—except for the Covid vaccine, of course. Nowadays, there are 14 vaccines recommended for children.

 Many vaccines are now recommended for adults. You can see all of them on a CDC website. It lists seventeen vaccinations you can get—too long and complicated for this blog post. I won’t be getting any of them. Not that I’m opposed. I just don’t worry about it.

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

A New Book: Don't Worry About It: Health Advice You Can Ignore

 I’ve written a new book, called Don’t Worry About It: Health Advice You Can Ignore. You can get it on Amazon. It's a compilation of some of the posts I've been writing since 2015. 

Here’s the blurb I wrote about it: 

People worry unnecessarily about many aspects of their health—such as their cholesterol, blood pressure, and salt consumption. Don’t Worry About It provides evidence-based information to reduce that worry. It refutes much of conventional advice, not only regarding medical treatments but also regarding everyday health concerns, such as eating food past its “sell by” date, getting enough sleep, and losing weight. What’s more, it explains how to limit your interactions with our health care system—an enterprise that routinely turns healthy people into patients through pointless office visits, useless tests, overly strict guidelines, dubious medications, and misguided advice. In our current climate of increasing frustration with our health care system, Don’t Worry About It offers timely encouragement for trusting your body to keep in balance.

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

The big business of blood plasma

If you donate blood, you can donate whole blood, or you can donate just plasma, the yellowish liquid that makes up half of blood volume. The idea of donating just plasma confused me until I learned that donation centers use a process called plasmapheresis. This process uses two lines, one that removes about a pint of blood and another that sends just the cells and platelets back into the body. In between, a machine separates the plasma from the rest of the blood ingredients. Because your body replenishes plasma within 48 hours, you can donate (or sell) up to twice a week.

Hospitals use plasma in transfusions to treat burns and liver failure, relying on donors who are not paid. Biopharmaceutical companies use it to manufacture life-saving drugs. Plasma that is used for medications does not need to be labeled as either voluntary or paid. Because of the high demand for plasma, there’s been a boom in for-profit plasma centers across the U.S. Two thirds of these centers are owned by one of three companies: CSL Plasma, Grifols, and BioLife. The centers are typically located in low rent strip malls.

The thousands of people who sell (“donate”) their plasma to these companies can make five times the federal minimum wage in the 90 minutes it takes to donate. The rates vary, but usually range between $50 and $75. Sellers can increase their earnings with bonuses for referrals, rewards programs, and incentives for those who donate twice a week. A study in Cleveland found that plasma sellers reported at least a third of their income that month came from their “donations.” They spent their earnings on gas, rent, phone bills, food, and student loans. If you’ve had Covid and your blood contains the Covid 19 antibodies, you could make as much as $200 in a single visit. Some people have intentionally tried to contract the virus in hopes of upping their income.

Americans supply two-thirds of the world’s blood plasma. It’s not hard to guess the source of that supply.

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

How overturning Roe v Wade impacts doctors

 When Roe v. Wade was overturned by the Supreme Court, I didn’t give much thought to its impact on doctors, but the impact is huge, particularly in some states. It used to be that, in dire medical situations, aborting a fetus was standard of care. Now, however, a doctor can land in prison for six years if a prosecutor disagrees with the decision to abort. Doctors must now think like lawyers. Lawyers are now on call to help doctors determine whether a woman would have died without getting an abortion. As one physician said, “We’re no longer basing our judgment on the clinical needs of the woman, we’re basing it on what we understand the legal situation to be.”

 In some places, the fallout looks like this:

•   “Do we wait until the fetus is definitely dead, or is mostly dead good enough?”
•  “How much bleeding is too much?”
•  In Texas, oncologists say they now wait for pregnant women with cancer to get sicker before they initiate treatment. Normally, the standard of care would be to abort the fetus rather than allow treatments that damage it.
•  Forensic nurses who care for sexual assault victims in the emergency room say they would no longer provide morning-after contraception for fear it would be considered an abortion drug.
•  A neonatologist worried about the liability for declining to resuscitate a fetus judged no longer viable.
• In Texas, women had to wait an average of nine days for their conditions to be considered life threatening enough to justify abortion. While they waited, they suffered serious health consequences, such as sepsis and hemorrhaging. One required a hysterectomy.
•  Doctors at one hospital declined to perform an abortion on a woman who arrived with a stillborn fetus.

 You get the idea.

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

The dangers of “demon rum”

 I like having an alcoholic drink every evening—either wine or a cocktail. For some reason, I am unable to consume more than one drink. It just doesn’t appeal. For this reason, I’ve never been concerned about my alcohol consumption. But lately, new reports are emerging about alcohol’s deleterious effects—even the small amounts I drink.

 In the past, researchers have argued that modest drinking (up to 14 drinks a week) protects the heart. This conclusion was based on the fact that moderate drinkers have less heart disease than those who drink heavily or those who abstain. Now, however, they conclude that light to moderate drinkers tend to have characteristics that decrease their risk, such as smoking less, exercising more, and weighing less.

 The latest research, as reported in the JAMA Network Open, says all drinking confers the risk of heart disease. This conclusion comes from the analysis of data collected in the U.K. Biobank, a repository that holds genetic and medical data of nearly 400,000 people. According to this research, the health risk is small if you have an average of seven drinks a week. (Whew! That’s my average.) Actual risk depends on whether you have other conditions, such as diabetes or obesity. In general, however, their data showed that a typical middle-aged person who did not drink had an estimated 9 percent chance of having coronary heart disease, while a person who had one drink a day had an estimated 10.5 percent chance—a small increase. However, after that amount, the risk increases quickly. In Canada, new guidelines conclude that you shouldn’t drink more than two drinks a week. Every drink over six a week, they say, causes a dramatic escalation in disease risk.

 Other studies report that alcohol consumption increases the risk of atrial fibrillation, brain shrinkage, breast cancer, liver disease, and mental disorders. As to brain shrinkage, one journal concludes: "The brain tends to shrink physiologically with age. Heavy alcohol consumption seems to exaggerate this shrinkage...Fortunately, alcoholic brain damage is known to be, at least in part, reversible." Death is not. In the U.S., deaths caused by drinking exceeds 140,000 a year.

 In these studies, researchers consider a standard drink to be 3.4 ounces of wine, 12 ounces of beer (3.5% alcohol), or one ounce of spirits that is 40% alcohol by volume. Based on these rather miniscule amounts, my weekly average is probably more than one drink a day. Four ounces of wine is only half a cup! I’m going to have to think about this, although, for me, it’s rather late in the game.

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

Weird wiring

At the beginning of the pandemic lockdown, my friend Betsy started sending weekly messages to friends as a way for us to stay connected. Two years later, she’s still at it. The messages include TV and book recommendations, beautiful photos, cartoons, and other interesting tidbits. Here’s something she sent recently that is a read head scratcher. I’d seen this years ago but had forgotten about it. It’s something you must try!

1. While sitting in a chair, lift your right foot off the floor and make clockwise circles.
2.  Now, while doing this, draw the number ‘6’ in the air with your right hand. Your foot will change direction!

 Here's an explanation from the Internet: "The left side of the brain cannot manage two opposite movements in the same moment, so the brain combines the movement to a similar motion. When you switch to the left foot, there is no problem because the right side of the brain controls your foot movement, while the left side can focus on drawing the number 6."

Makes you wonder how someone came up with this.

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

Medical personnel behaving badly

 My sister, who is closing in on 88, had been having unexplained bouts of fatigue. To diagnose this situation, her GP recommended some tests at the Cardiovascular Diagnostic Center of Dignity Health. After a two-week wait my sister arrived for her appointment. Here’s her report:

“Don and I entered through a large automatic door to find an enormous glass room buzzing with staff. Nearby were a myriad of chairs filled with waiting clients looking as confused as I was. I approached the wide desk, manned by several harried people, and told them why I was there. They sent me to the second floor. This required a ride on an elevator whose buttons were so obscure we couldn’t find them.

Eventually we found our floor and were directed down a long hallway (while I’m thinking of heart patients more feeble than I). We came to another huge, glassed area with a bleak, sterile atmosphere. Again, we had to trek down a long hall past another crowd of people in chairs before arriving at a reception cubicle behind glass.

Then began the sign-in. I was required to sign in while I stood at a computer that I couldn’t make work properly. Don assisted and finally—with the help of a man in one of the chairs—we managed. Behind her glass and desk, the impatient receptionist gave me an ID bracelet and ordered me to wait. We sat for a while, and I was then ushered down another hall by a tech.

The tech looked me over, including at my walking stick, and she and her partner agreed that they wanted an OK before administering the stress test on a treadmill. They consulted a doc down the hall who didn’t emerge from an office, and that invisible person decided the stress test wasn’t safe for me. They sent me home.”

Update: My sister’s GP received an email from the Dignity people. The message said, “Patient refuses to get on the treadmill.” My sister was appalled and I am furious. They never even asked if she wanted to give it a try! Plus they lied! I wonder if she'll get a bill. Grrrr.

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

How big pharma deceives us

 Most of the information in the post comes from posts I wrote in 2015. You have likely never read those posts or have forgotten the information, which, by the way, comes from a book written by Marcia Angell, the former editor in chief of The New England Journal of Medicine. She says, among other things, that the pharmaceutical industry has become “a marketing machine to sell drugs of dubious benefit.”

Here are some of the ways big pharma deceives:

Over charging. The cost of the drug is unrelated to the costs of research and development, as they would have us believe. Instead, the costs, which are continually rising, are based on what the public is willing to pay.

Manipulating research findings to make drugs look good. As much as 90 percent of published medical information—the kind of information that doctors rely on—is flawed, according to the world’s foremost expert on the credibility of medical research.

Rewarding doctors to promote their drugs. Companies spend more than four billion dollars nationwide in payments to doctors as incentives for attending industry-sponsored conferences, as well as for promoting their drugs at the conferences.

Rewarding doctors to prescribe their drugs. The rewards to doctors range from meals to generous honoraria for speaking at conferences. As a rule, the doctors who prescribe the most are rewarded the most.

Promoting old drugs as new. Most of the new drugs approved by the FDA are “me too” drugs—old drugs whose molecules have been only slightly altered so they can appear as new. They are more expensive but no more effective than the old models.

Passing off their professionally written articles as the work of academics. Drug companies pay professional writers to produce academic papers according to the companies’ specifications then reward the academics for adding their names to them.

Passing off marketing as “education.” The so-called “education” programs come out of drug companies’ marketing budgets, which, collectively in 2001 amounted to $19 billion. By masquerading marketing as education, big pharma can evade legal constraints on marketing activities.

Let's hope new legislation has some impact on this behavior.

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

Forget your annual checkup (redux)

This was the title of my second blog post, published on January 10, 2015. You probably never saw it. Here’s a revised version:

I had my last annual checkup in 2002. On that occasion my doctor informed me that my cholesterol was high. I’m not worried about mine and don’t believe in taking cholesterol-lowering drugs. Because I didn’t want to argue, I simply never went back for another checkup. It turns out, eliminating annual checkups is probably a wise decision for most of us.  

You probably get annual checkups because you think they might prevent you from becoming ill. I used to think that also. But I have since learned that reputable medical organizations agree with my stance. For example, one of the recommendations of the Society of General Internal Medicine’s “Choosing Wisely” campaign is “Don’t perform routine general health checks for asymptomatic adults” [my italics]—asymptomatic meaning you feel fine. Regularly scheduled general health checks, according to this group of doctors, “have not shown to be effective in reducing morbidity, mortality or hospitalization, while creating a potential for harm from unnecessary testing” [my italics again]. This conclusion was the result of studies that included nine trials of 155,899 patients.

After examining the records of 182,000 people from 1963 to 1999, the Cochrane Collaboration, an international group of medical researchers, came to the same conclusion. So did the United States Preventive Services Task Force — an independent group of experts making evidence-based recommendations about the use of preventive services. The Canadian guidelines have recommended against these exams since 1979.

Plenty of doctors say the same thing. For example, Dr. Ezekiel J. Emanuel, oncologist, and a vice provost at the University of Pennsylvania, says, “from a health perspective, the annual physical exam is basically worthless.” Dr. Michael Rothberg, a primary care physician and health researcher at the Cleveland Clinic, tries to avoid giving physicals. "I generally don't like to frighten people, and I don't like to give them diseases they don't have. If you get near doctors, they'll start to look for things and order tests because that's what doctors do." Dr.Ateev Mehrotra at the Harvard Medical School says annual physicals are a waste of money, costing us about $10 billion a year, which is more than we spend on breast cancer.

I've now gone for 22 years without an annual physical exam. Works for me.

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White hair returns to brown!

 Slow news day.

Here’s an interesting article I read in the New England Journal of Medicine: A 51-year-old man with chronic myeloid leukemia had been tread for a year and a half with a medicine called nilotnib, a “tyrosine kinase inhibitor.” When he visited the oncology clinic for a routine follow-up, the medical personnel were surprised to see that his normally white hair (photo on left) had returned to the brown of his younger self.

During the same period, he had not started any other new medications and had used no hair-coloring products. Other than his hair returning to brown, the scientists saw no other changes in his hair, skin, or "mucosal pigmentation." Molecular testing showed a “deep molecular response,” which sounds impressive although I’m not sure what it means.

Don’t try this at  home.

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Inhalers make climate change worse

 Many people use inhalers to treat asthma and chronic obstructive pulmonary disease, conditions that are often exacerbated by the effects of climate change, principally smoke from wildfires. It turns out that inhalers themselves contribue to climate change.

Metered-dose inhalers, which are commonly used in the U.S., use hydrofluorocarbon aerosol propellants to help deliver medication into the lungs. These types of propellants are greenhouse gases that trap heat and carbon dioxide. In 2020, Americans used roughly 144 million metered-dose inhalers—the greenhouse gas equivalent of driving half a million cars for a year.

Incidentally, in 1987 the Montreal Protocol outlawed the ozone-depleting propellant called HCFC (hydrochlorofluorocarbons; note the extra chloro). When pharmaceutical companies switched to the newer propellant, they patented the new formulation, after which inhaler costs skyrocketed.

Dry-powder inhalers, such as those used in Sweden, are an effective alternative to the aerosol propellant type used by most people in the U.S. Unfortunately, some inhaled dry-powder medications are not yet available in the U.S., or they are not covered by insurance. Government agencies, insurers, and hospitals can help by creating a demand for nonpropellant inhalers, a move that would help persuade pharmaceutical companies to bring more of them to market.

Fortunately, pharmaceutical companies are now developing metered-dose inhalers using new propellants that have virtually no global warming effects. If and when they're brought to market, we can probably expect an extravagant price hike.

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Blood pressure for the “old old” (those over 85)

 A journal called Clinical Interventions in Aging, includes an article titled “Appropriate blood pressure for the ‘old-old- (85 years and older).” The author states, “treating hypertension in patients over the age of 85 years, ie, the “old-old,” presents a challenge that is different from that encountered when treating any other age group.” Some in the medical field believe that, for this group (my cohort) the target should be less than 140/80, a target that this author says, “encourages aggressive treatment simply to meet a specific metric.” “Aggressive treatment,” of course, means medications. Besides, this author says, “a study from the University of Leiden in the Netherlands has reported that high blood pressure is “associated with resilience to physical and cognitive decline.”

In the Leiden study, researchers followed 572 85-year-olds for 3.2 years, measuring their blood pressure, their activities of daily living (ADL), and their cognitive scores using the standard Mini-Mental State Examination (MMSE). Their conclusion: “At age 85, higher systolic blood pressure was associated with lower ADL disability scores and higher MMSE scores”—a good thing. Researchers from Oxford, in studying the Leiden data concluded: “lower systolic blood pressure in the oldest-old taking antihypertensives was associated with higher mortality and faster decline in cognitive function.”

In 2003 Dr. Claudia Kawas, a neurologist and professor at UC Irvine, came across previously ignored health records of more than a thousand residents of a retirement community in California. The records consisted of lengthy surveys, taken in 1981, about the residents’ health and lifestyles.  In studying the records, her team found that 1,900 of the original survey takers were still alive and in their 90’s or older. The researchers tested about 1,600 of this still-alive group for a variety of health indicators. Among other things, their findings revealed that having high blood pressure reduced their chances of dementia.

One difficulty with all of this is that I couldn’t find how the researchers defined high blood pressure. Here’s the standard definition: Normal is 120/80; pre-hypertension is 120-139/80-89; stage 1 hypertension is 140-159/90/99; stage two hypertension is 160/100. The article in the New England Journal of Medicine ends with the following: "My final point is that a study from the University of Leiden in the Netherlands has reported that a systolic blood pressure of 180 mmHG is associated with resilience to physical and cognitive decline in patients with pre-existing disability." He doesn't say which "pre-existing disability."

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My adventure with blood pressure meds

Prior to my two knee replacement surgeries, I’d never taken medications to reduce my blood pressure. I didn’t worry about it. The few times I’d had my blood pressure taken in a doctor’s office it was always high—the “white coat effect.” When I take my blood pressure at home, it hovers somewhere in the 125-145 range—sometimes lower, sometimes higher. As I feared, at my pre-surgery appointment, my blood pressure was 190 over something, a number that alarmed the medical personnel and led them to require my local doctor—whom I hadn’t seen in 20 years—to give the go-ahead for my surgery.

At my doctor’s office, as I predicted, my blood pressure was also very high. I needed some kind of intervention that would make it possible for me to have the surgery. My doc prescribed a medicine that combines lisinopril and hydrochlorothiazide. Lisinopril relaxes the blood vessels; hydrochlorothiazide, a diuretic, reduces blood volume. I started taking that medicine—what I call the “combo” drug.

One morning prior to my surgery, I felt a little light-headed and took my blood pressure. It was 87 over something. Whoa! Normal is supposedly 120 (systolic) over 80 (diastolic). (Systolic is the highest arterial pressure just after the heart contracts; diastolic is the minimum pressure during relaxation.) Thinking that the combo drug was overkill, I asked the doc to give me a prescription for just the diuretic, which he did (12.5 mg dose).  

Returning to my doctor’s office, my blood pressure was low enough that he gave the go-ahead for the surgery. To make sure my blood pressure was reasonable prior to my surgery, I took the combo drug for two days before going in, but in between surgeries I took just the diuretic. Prior to the second surgery, I took the combo drug again, just to make sure they didn’t kick me out. After that, I continued taking just the diuretic.

Three weeks after my second knee replacement, I quit taking any blood pressure drug. Since then, I’ve been taking my blood pressure twice a day. As before my surgery, it has stayed mostly in the 125-145 range. That seems OK to me. I relayed this information to my local doctor and he agreed.

It seems to me that an old person shouldn’t be expected to have the same blood pressure as a young person. I’ve started researching this. It appears that nobody really knows what the target should be for  for people my age (85). Some say 150/80. Some say more, some say less. I’ll say more about this next week.

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“Time restricted feeding”

Most of us associate the term “circadian rhythm” with the internal clocks that regulate when we go to sleep and wake up. In fact, your whole body operates on an internal clock. For example, during the day, your pancreas increases its production of insulin, which controls blood sugar levels, then slows it down at night. Similarly, your gut’s “clock” regulates the daily ebb and flow of enzymes, the absorption of nutrients and the removal of waste. Even the bacteria that comprise your gut microbiome operate on a daily rhythm. It turns out that daily rhythms are programmed in our DNA, such that in every organ, thousands of genes switch on and off at roughly the same time every day.

According to a growing body of research, our bodies do best when our eating patterns align with our circadian rhythms. Satchin Panda, a professor at the Salk Institute and an expert on circadian rhythms, argues that people improve their metabolic health when they eat their meals in a daily 8- to 10-hour window, taking their first bite of food in the morning and their last bite early in the evening. Researchers also recommend that you eat a big breakfast and small dinner. That’s because your blood sugar control is best in the morning and at its worst in the evening. You also burn more calories and digest food more efficiently in the morning.

Except for the big breakfast, this “time restricted feeding,” as it’s called, is easy for me. But what about people, such as night owls, whose circadian rhythm seems to be different? I think the researchers have more work to do.

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Asbestos in baby powder

 I’m watching a show about the cosmetics industry called Not So Pretty. The first episode deals with asbestos in cosmetics. Because asbestos occurs in the same geologic formations in which talc is mined, it often turns up in cosmetics. Also in baby powder. I never bought baby powder because I could never figure out what you were supposed to do with it. Apparently, lots of people use it liberally.

Johnson & Johnson, the maker of baby powder, is featured in the first episode of the show. Some women who had used the powder for years began to die of mesothelioma, a lung cancer, and also ovarian cancer (apparently some women use the powder on their privates). In autopsies, researchers discovered asbestos in the lungs of those who’d died of mesothelioma. As reported in one scientific journal, “Through many applications of this particular brand of talcum powder, the deceased inhaled asbestos fibers, which then accumulated in her lungs and likely caused or contributed to her  mesothelioma as well as other women with the same scenario.… In recent years, more than 10 women developed mesothelioma and their only source of asbestos exposure was the use of one brand of talcum powder.” In the  image below, the straight rod is asbestos. 

Lawsuits ensued. Despite proof to the contrary, Johnson&Johnson steadfastly maintained that their baby powder contained no asbestos. In fact, in-house documents as early as the 1970s revealed that company executives were aware of asbestos liabilities. Beginning in 1971, tests from different labs found asbestos in the baby powder, but Johnsons & Johnsons never reported the findings to the FDA. What’s more, they didn’t remove their product from U.S. markets until 2019. The product is still sold in other countries.

Johnson&Johnson is not a nice company, vaccines or no vaccines.

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Shorter hospitals stays=more money for hospitals

Back in the day, hospitals received insurance payments for each day you were in the hospital. This method of billing created an incentive to keep you in the hospital for prolonged stays. The more days in the hospital, the more money the hospital made. Now, hospital stays are based on a code system called diagnoses-related group (DRG). Every diagnosis has a code attached to it. That code signifies the amount insurers will reimburse the hospital.  

Specialists in the hospital have a binder that lists the DRG codes, how much the hospital is reimbursed for each code, and the maximum number of days the payment covers. These specialists review your chart to create the highest billing code that will match a diagnosis. For example, you may have come to the hospital with non-threatening “angina pectoris” (chest pains), a diagnosis that brings the hospital $5,221 in revenue.  By upgrading the diagnosis to “acute myocardial infarction with cardiovascular compromise,” the hospital would receive $15,731. The hospital is reimbursed for this amount whether you stay two days or ten days. Thus, the shorter your hospital stay the more profitable your admission is for the hospital. Hospitals also have specialists whose job it is to get you out of the hospital as fast as possible, sometimes harassing your doctor or family members.

Of course, getting kicked out of the hospital quickly isn’t necessarily a bad thing. You are probably better off at home, away from bad bugs, bad food, and interrupted sleep. Plus, you’re helping your hospital make more money! 

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