The hospital business

 I just finished a book called The Hospital, by Brian Alexander. Here are a few things I learned:

• Health is our nation’s largest industry—a $3.6 trillion enterprise. Doesn’t that strike you as out of whack?
• From 1998 through mid-2019 The US experienced 57.6 percent inflation for all goods and services above the 1998 baseline. Hospital services rose over 200 percent.
• Manufacturers of products used in hospitals have merged to become oligopolies, such that they dominate the market and can raise prices with impunity. One manufacturer of saline bags raised its price by 100 percent in 2019.
• Drug companies raised their prices by 26 percent from 2017 to 2018, and some way more than that. Insulin medications ballooned by 500 percent, from $35 to $300 per vial.
• Manufacturers of products such as joint replacements have paid orthopedic surgeons “consulting fees” of between tens and hundreds of thousands of dollars per physician, in return for their brand loyalty.
• Merging hospitals into conglomerates doesn’t result in increased efficiency and reduced rates. Just the opposite. In Colorado, for example, a hospital conglomerate increased its rates such that its profits rose from $538 per patient to $1,518. The hospitals use the money to pay big salaries, store the money in cash hoards, and invest it.

Sorry—I could go on and on. There is no end to this stuff.

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Too little; too late

 Below are excerpts from emails sent to my sister from a friend diagnosed with cancer. Comments in brackets [ ] are my sister's:”

“As you well know, the Healthcare system is broken. I can't get a biopsy for 2 weeks and I can't see an oncologist until I get one and then it will be another week to 10 days before they can see me. A little discouraged but I'm determined to accept what is available on this little mountain!

I'm still trying to get an appointment with the oncologist. [She never could.] The medicine my Primary prescribed is keeping the cough under control if I remember to take it before the coughing spasm hits.

Physically, I'm reasonably comfortable, but this has been a medical care nightmare! Hours and hours on the phone chasing down an order for a biopsy. Finally got a date confirmed on Monday--it's next Thursday. [She died on Friday.] I am now using oxygen full time, still have temp (going to Urgent Care today). I've had it for weeks. Aranda [her doctor] is useless. I need to make sure I'm clear before the biopsy.

I already have cancelled my eye appointment and the endoscopy. Waiting to ask the oncologist about the heart specialist and the booster shot.

I am doing ok. I am so grateful for the meds that keep my cough at bay. Sleeping and eating are still a challenge but I'm managing. And the breathlessness is increasing incrementally. (I'm grateful I can still find words. I dread losing them and my ability to talk and sing!)”

 I have nothing to add.

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

Sunscreens that kill good bacteria

I don’t use sunscreen, mostly because I’m too lazy, but also because I figure it’s too late. I’ve had basal cell skin cancers, but no melanoma (the serious kind). Even so, I don’t use sunscreen. (Neither does my husband, who has had no skin cancer.)

Anyway, I just learned that sunscreen products commonly include a chemical called nano-titanium dioxide (TiO2), a product that kills good bacteria on your skin. The good bacteria include a common strain of Staphylococcus epidermis. You don’t want to kill these bacteria. Richard Gallo, Distinguished Professor and the Founding Chairman of the Department of Dermatology at the University of California, San Diego tells us that “This unique strain of skin bacteria produces a chemical that kills several types of cancer cells but does not appear to be toxic to normal cells.” So—sunscreens kill bacteria that kill cancer. “There is increasing evidence,” Gallo says, “that the skin microbiome is an important element of human health. In fact, we previously reported that some bacteria on our skin produce antimicrobial peptides that defend against pathogenic bacteria such as Staph aureus.”

Perhaps not all sunscreens contain nano-titanium dioxide, but you can’t tell which have the chemical and which don’t. According to the National Institutes of Health, sunscreen producers are not required to list the ingredients. Thus, they report, consumers “…are unable to switch to an alternative because it is unknown to them which alternative does not contain the experimental material.” Because sunscreen ingredients are not labeled, The NIH calls the use of use of TiO2-containing sunscreens a “societal experiment.” (Incidentally, the International Agency of Research on Cancer (IARC) has categorized TiO2 as a potential human carcinogen.) At least I’m not an unwitting participant in an experiment.

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

Autism rates continue to rise

 I was shocked to learn that about 1 in 44 children has been identified with autism spectrum disorder. The statistics come from data collected in 2018 by the CDC and recently analyzed. The report focused on the prevalence of autism among eight-year-olds. In 2009, the CDC’s data showed the number to be 1 in 110. That is a shocking increase. I remember when nobody had ever heard of autism. It seems like not that long ago. The disorder was first described in 1943 by a psychiatrist at Johns Hopkins who found eleven children with what he called a unique condition. (By the way, this was well before vaccines were commonplace. The idea that autism is caused by the MMR vaccine has been thoroughly refuted by studies all over the world.) 

The latest thinking is that the disorder is caused by a malfunctioning immune system, either because of infections acquired by the pregnant mother, or acquired by the child after birth, or both. Andrew Zimmerman, a scientist working at Johns Hopkins, found that brain tissue from deceased autistic people showed dramatic evidence of inflammation (the brain has it own resident immune cells). When checking the spinal fluid from living autistic people, he also observed markers of inflammation. Betty Diamond, head at the Center for Autoimmune and Musculoskeletal Diseases at The Feinstein Institutes for Medical research notes, “The immune system must be understood, not just as a defense against microbial invasion, but also as a sensory organ that informs the brain.” 

What’s more, as I discussed in an earlier post, children with autism have lower diversity of microbiota in their intestines as well as a nearly-depleted strains of helpful bacteria—conditions that can affect brain development. Kevin Becker, a geneticist at the National Institutes of Health says, “Something environmental is causing the rise, and it seems to parallel asthma and autoimmunity,” which is also on the rise. Broadly speaking, autism follows the same epidemiological patterns as asthma. One bit of data: if a mother has an autoimmune disorder, the chances of her child having autism increased nearly nine-fold.

This is an enormously complicated subject. Basically, it appears that the rise in autism is caused by inappropriate inflammation which in turn, some think, is caused by “environmental factors.”  No one really knows what those environmental factors might be.

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

Cartoon for holiday II

 

"You should relax less."