Cartoon II for the holidays

 

Cartoon I for the holidays

 

"I can cure your back problem, but there's a risk
you'll be left with nothing to talk about."

How’s your mobility?

Mobility is not the same as flexibility. Flexibility is the ability of muscles, ligaments, and tendons to passively stretch. Mobility is the joint's ability to actively move through its full range of motion. Good mobility requires flexibility in the muscles and other soft tissues surrounding the joint, but it also requires strength and stability. You can be flexible but lack mobility.

Recent studies have found a correlation between joint health and longevity; also, that people with lower limb mobility are less likely to suffer from falls in their older years. Here are some tests for checking your mobility:

• Neck: (1) Rotate your head right and left, without turning your shoulders. You should be able to turn your head 80 degrees, or just short of your shoulder. (2) Look up: you should be able to gaze directly at the ceiling. Bring our chin down toward your chest. It should be an inch or two away at most. (3) Bend your neck sideways to lower your right ear to your right shoulder. Your ear should be about halfway to your shoulder.

• Shoulders: You should be able to reach your hand behind your back and touch your mid back with your thumb.

• 

  Wrists: Starting at chin level, place your hands together with your palms touching and fingers pointed up. Keeping your palms together and elbows out and parallel to the ground, lower your hands down to your belly button.

• Back: Standing with your feet hip-width apart and keeping your knees straight, slide your fingertip down your thigh. You should be able to touch the outside of your knee. (Do both sides.)

• Hips: Sitting in a chair or lying on your back, pull your knee (left or right) into your chest. Your thigh should touch your abdomen and chest. (Do both sides.)

• 
  Knees: Standing on your left foot, place your left hand on a wall or chair for balance if needed. Use your right hand to bring the heel of your right foot behind you, toward your butt. Your heel should touch your butt. Repeat on the other side.

• Ankles: Facing a wall with your toes touching it, bend your knees and keep your feet flat on the ground. Your knees should be able to touch the wall without your heels rising. If this is easy take one step away from the wall and repeat.

Here’s a link to exercises to improve your mobility. Here's one from an earlier blog of mine for improving your flexibility. Apologies to those who have already seen this information in The New York Times.

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

Guaranteed annual income and health

 I am in favor of guaranteed annual income—or universal basic income, or similar proposals. They’re a form of social security in which a population group receives a regular sum of money, either from a government or from some other public institution, independent of any other income. The idea, in the words of the Stanford Basic Income Lab and Center for Guaranteed Income Research, is to “…facilitate individuals' opportunity, freedom, and resilience to build financial security.” In the United States, about 30 pilot programs have been established and evaluated.

A large body of research has shown that people tend to use the money for essentials, such as rent, transportation and food—also for medical care. In one pilot program, 2800 participants received cash benefits via debit card of up to $400 per month for 9 months. As reported in The Journal of the American Medical Association, researchers found that—compared to a control group—the cash benefits significantly reduced emergency room visits. That’s because people spent money on healthcare—including visits to subspecialists—to forestall such visits.

In another pilot program, 3000 participants in Illinois and Texas received $1,000 monthly for three years beginning in 2020—a 40 percent boost in their incomes. At a time when even Americans with insurance say they have trouble staying healthy because they struggle to afford care, the study results show that basic-income recipients increased their spending on health care services, including visits to hospitals and dentists. (Almost two in five insured Americans report delaying or skipping necessary treatment or medication because of high out-of-pocket costs for health care.)

Studies have not proven that the cash transfers have had a lasting impact on the physical health of the recipients (probably too late). Even so, recipients at least have more resources to seek help when they need it.

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

Physician burnout and shortages

From what I’ve been reading lately, it appears that doctors are increasingly suffering from burnout. In the opinion of Dr. Eric Reinhart, a physician at Northwestern University, burnout is caused in large part by “…our dwindling faith in the systems for which we work.” Definitions of burnout have included emotional exhaustion in response to intensive work, becoming emotionally drained, detachment from and negative feelings toward people they are trying to help, and a sense of helplessness and loss of purpose.

Nearly two-thirds of physicians report that they are experiencing burnout, and are “…finding it difficult to quash the suspicion that our institutions, and much of our work inside them, primarily serve a moneymaking machine.” Examples include hospitals putting profits over people, the use of billing codes that dictate nearly every aspect of medical practice, and the profit motives of insurance and pharmaceutical companies that become intractable barriers to improving patients’ lives. A study of 10,000 family physicians showed that key contributors to burnout also include the need to spend time at home working on electronic health records as well as a lack of a fully staffed support team. 

Now we have a chronic physician shortage. One in five doctors plans to stop practicing in the coming years. In 2021, about 117,000 physicians left the work force, while fewer than 40,000 joined it. According  to projections published by the Association of American Medical Colleges, the United States will face a physician shortage of up to 86,000 physicians by 2036.  

The United States is the only large high-income nation that doesn’t provide universal health care to its citizens. Instead, it maintains a lucrative system of for-profit medicine. Dr. Reinhart supports universal health care. So does The American College of Physicians, which says, in its position paper, that “…the United States needs a healthcare system that provides care for everyone, either through a universal health insurance system, such as the UK NHS, or through a pluralistic system that involves the government and private organizations.” So let’s do it!

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

Itching

I probably shouldn’t have delved into this topic. It’s horribly complicated. I was curious about the fact that I have an itchy spot under my left collar bone (hard to reach!). My little itch is small potatoes compared to the suffering that many people endure.

Dermatology websites list the causes of itching: extremely dry skin; bug bites; skin conditions, such as eczema, hives, and psoriasis; skin cancer; warning signs of diseases, especially of the kidney and liver, and overactive thyroid gland; allergic skin reaction; reaction to a plant or marine life; medication or cancer treatment; nerve problem. Scratching alleviates itch by interrupting it: the pain of scratching creates the pleasure of relief.

One in five people experience chronic itch in their lifetime, often caused by cancer, a skin condition, or liver or kidney disease. (There are no medications for it.) Some unlucky people have a rare disease in which itching can be unrelenting and extreme.

The kind of itching that’s acute (not chronic), and caused by irritants such as poison ivy, is caused by the immune system’s reactions: immune cells secrete histamine that activates the nervous system, making you itch and scratch. Medications, such as steroids or antihistamines, may help in these cases. Some people itch for no clear reason and their bodies don’t respond to steroids or antihistamines.

In 2007, neuroscientists figured out itch-specific nerve receptors that are triggered by substances other than histamines. Some itching—such as that caused eczema—is caused by the body’s secretion of certain proteins (cytokines) that rev up the immune system. In 2017, the FDA approved a drug called Dupixent, which reduces the immune system's overreaction that causes eczema. Apparently, it works. It can be yours for $59,000 a year (retail).

My research yielded nothing in the way of explanation for my little itch--at least nothing definitive. I can live with it.

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 sleep

I never get what is considered a “good night’s sleep,” that is, seven or eight hours uninterrupted. I never sleep more than six hours, and it’s always interrupted, sometimes for more than an hour. It’s no fun, but I don’t worry about it. I figure it’s my normal sleep pattern. But millions of people are becoming preoccupied with obtaining a perfect night’s rest.

That preoccupation is a bonanza for business. The “sleep economy” is worth billions of dollars. Venture capital funding for sleep tech has been steadily rising, from around $400 million in 2017 to close to $800 million in 2021. As one sleep neuroscientist noted, there’s more money going into sleep-related products than ever before.

Here are some examples:

• “Wearables”: Electronic sleep-tracking devices. The latest sleep-tracking gadget, the Oura ring, is a $350 miniature computer that collects data on vitals like heart rate, body temperature and movement.
• Fancy bedding: mattresses with sensors, weighted blankets, adjustable pillows. (The U.S. mattress industry doubled in value from 2015 to 2020, swelling from $8 billion to $16 billion.)
• Other gadgets: Timed lights, eye masks, smart thermostats, cool air fans, bedtime headbands.
• Supplements and such: Melatonin, magnesium, herbal teas, CBD gummies, sleeping pills. (About eight percent of Americans take sleeping pills, such as Ambien).

It seems like the media is fueling this preoccupation, scaring us with alarming adverse outcomes such as diabetes, heart disease, hypertension, and immune system problems. Because of worrying about falling asleep, people become anxious with obsessive thoughts that keep them awake even longer.

Plenty of people do well on less than seven hours sleep: Thomas Edison (three or four hours); President Clinton (five to six hours); Martha Stewart (four to five hours); Jay Leno (five hours). Stop worrying about how much sleep you’re getting. It’s unhealthy.

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

Value of supplemental vitamins (not)

I’ve never taken vitamins, but plenty of people do. According to Johns Hopkins researchers, half of all American adults—including 70 percent of those age 65 and older—take a multivitamin or another vitamin or mineral supplement regularly. Their primary motivation is to prevent disease. The total price tag exceeds $12 billion per year. It’s a waste of money.

The most recent twenty-year study of 390,124 healthy adults, reported by The Journal of the American Medical Association, showed that taking a multivitamin daily was not associated with a lower risk of dying. Other studies have shown similar results:

• Research involving 450,000 people found that multivitamins did not reduce risk for heart disease or cancer.
• A study that tracked the mental functioning and multivitamin use of 5,947 men for 12 years found that multivitamins did not reduce risk for mental declines such as memory loss or slowed-down thinking.
• A study of 1,708 heart attack survivors who took a high-dose multivitamin or placebo for up to 55 months showed that rates of later heart attacks, heart surgeries and deaths were similar in the two groups.

Then there’s this: according to the U.S. Preventive Services Task Force, beta-carotene and vitamin E supplements can be harmful, especially at high doses. Beta-carotene may increase the risk of cancer and the risk of death from heart disease or stroke. Vitamin E may promote tumor formation and may cause nausea, diarrhea, intestinal cramps, fatigue, weakness, headache, blurred vision, or rash. 

Here’s an exception to avoiding vitamin supplements: Because folic acid prevents neural tube defects in babies, experts recommend that women take it before getting pregnant and during early pregnancy. Otherwise, as the director of the Johns Hopkins Welch Center for Prevention, Epidemiology and Clinical Research says, “Pills are not a shortcut to better health and the prevention of chronic diseases. You get all the vitamins and minerals you need from food.”

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

Report of my spine surgery

On September 18^th of this year, at age 88, I had a laminectomy: surgery to remove part of the bone (lamina) that was pressing on my spinal nerves and causing burning pain that ran from my butt to my ankle—basically sciatic pain. I’d had the pain for a couple of years or more, and it kept getting worse. My efforts to fix it myself through stretching and postural changes had no effect; neither did chiropractic and acupuncture treatments or two injections of steroids in my spine.

Of course I’d had an MRI, which showed the problematic area (L4-5). But the surgeon also ordered a series of spine X-rays in various poses. She doesn’t proceed unless the X-rays show a configuration—don’t ask me what—that she deems will ensure success. So, I gave the OK to go ahead. Still, it’s a scary prospect. Although you sometimes hear horror stories about spine surgeries, the people I’d talked to who’d had a similar surgery were enthusiastic.

Under general anesthesia, the surgeon made about a two-inch incision and used a drill to remove the offending bone parts. She also performed a bunch of other procedures to clean everything up. I have a copy of her report. It says things like “There was severe facet hypertrophy, which I drilled down also with the Anspach drill” (photo). The surgery started around 2:00. I was home by 6:00.

The pain relief was immediate and permanent (as of now, anyway). After about a week and a half, I started to gingerly do my regular exercises. At three weeks, I was back at yoga. At four weeks I was golfing. This surgery has changed my life. I no longer plan my days around pain or take any anti-inflammatories, which I’d been taking daily. I’m enormously grateful to my doctor and her skill. Sometimes we need doctors in our lives.

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

Humira: the biggest moneymaker

Humira, a drug produced by AbbVie, is the most lucrative franchise in pharmaceutical history and the top-selling pharmaceutical in the world, generating an annual revenue of $20.7 billion. It’s an anti-inflammatory drug used for autoimmune, rheumatologic, and gastrointestinal diseases. 

Since its approval in 2002, the price has increased about 30 times. By the end of 2016, the list price had gone up 60 percent to over $80,00 a year. One company that directly covers its employees' health claims found that Humira was costing the company well over $70,000 a year for one employee. (In 2020, Medicare covered the cost of Humira for 42,000 patients.)

AbbVie has been able to ward off competitors by employing patent-prolonging strategies, such as filing multiple additional patents on the same drug. For example, they obtained a patent on the autoinjector device and a separate patent for the “firing button.” They also obtained patents on production methods and dosing regimens. (Most, if not all, drug companies employ such methods. In fact, 78 percent of recent new patents were for existing drugs.) In all, a total of 247 patent applications for Humira have been filed in the United States.

Competitors, such as Amgen’s Amjevita, have finally entered the market by developing biosimilar drugs—drugs that are very close in structure and function to a medicine but not an exact copy. In this way they were able to invalidate AbbVie’s Humira patents, enabling them to enter the U.S. market before the technical end of Humira’s monopoly period, which in the United States was 2039.

It will be interesting to see what happens pricewise. A spokeswoman for Amgen said, “We price our products according to the value they deliver.” Huh?

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

A myopia epidemic

Myopia (nearsightedness) has reached epidemic proportions worldwide. By 2050, according to one estimate, half the world’s population will be nearsighted. In the U.S., its prevalence has jumped from 25 percent in the 1970s to 42 percent in the early 2000s.

People with myopia can see an object up close clearly, but at a distance the object is blurred. That’s because, instead of the focus of light landing on the retina, it occurs in front of the retina.

Myopia predisposes people to other eye conditions that can lead to blindness. Higher degrees of myopia are associated with premature cataracts, glaucoma, retinal tears and detachments, and myopic macular degeneration.

Researchers believe the myopia epidemic is the result of children not getting as much outdoor play as in the past. Being outdoors is important because outdoor light enables the visual system to process a variety of light wavelengths and intensities—variety that’s needed for normal eye development and growth. (Studies could not support unequivocal evidence that using digital devices is causing the shift toward myopia.)

In the U.S., myopia hasn’t garnered the same sense of urgency and funding as is the case in other parts of the world. Because we in the U.S. don’t have a nationalized health system, we also don’t have a national database to provide standardized tracking and reporting that would provide good prevalence data for myopia. To attract attention and funding for effective screening, treatment, prevention, and research, experts believe that myopia needs to be recognized as a disease.  

I don’t know whether I’m nearsighted or farsighted. I don’t normally wear glasses. I have a pair for reading, and another pair for distance, which I rarely use, even though they work well. As with most old people, as a child, I spent more time outdoors than kids do nowadays.

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

Antidepressants

During the Covid epidemic, rates of depression and anxiety soared, and many Americans turned to antidepressants to help them cope. Even before Covid, one in eight American adults was taking an antidepressant drug. Zoloft is now the 12^th most prescribed medication in the U.S. (Other examples of antidepressants include Lexapro, Effexor, Celexa, and Prozac.) Eighty percent of antidepressants are prescribed by primary care doctors who have not had extensive training in managing mental illness.

Researchers question how well they work. Some even say they’re barely better than a placebo.  Psychiatrists who prescribe them believe they do help most people who take them. They’re most effective in helping moderate, severe and chronic depression, but they don’t tend to help mild depression. In fact, they don’t work for about a third of the people who take them.

Use of antidepressants assumes the “chemical imbalance” theory of depression: low levels of neurotransmitters in the brain. The most prescribed antidepressants are selective serotonin reuptake inhibitors (S.S.R.I.s), which prevent neurons from sucking up the neurotransmitter serotonin, allowing more of the chemical to float around in the brain. Other antidepressants also increase circulating levels of other brain chemicals, such as dopamine.

Research has shown that people with depression consistently have less volume in an area of the brain called the hippocampus that’s important for regulating mood. The current prevailing theory is that chronic stress can cause the loss of connections (synapses) between cells in the hippocampus and other parts of the brain, potentially leading to depression. Antidepressants are now thought to work at least in part by helping the brain form new connections between cells.

Because I’ve been lucky at never suffering from depression, I was curious about the genetic component. When I went to 23andMe to see about that, I got a notice that said “Discover your genetic likelihood of developing this condition” which I could get by subscribing to their “Premium” package. Maddening. No wonder the company is in trouble.

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

Thalidomide in the U.S.

If you’re old enough, you should remember the epidemic of babies born in the 1960s—mostly in European countries—with shortened limbs and other serious medical conditions.

A German drug company had developed a new non-addictive sedative—a supposedly safe wonder drug. It was the second-best seller in Germany, right behind Aspirin. Active ingredient: thalidomide. People used it to get a good night’s sleep. For pregnant women, it helped with morning sickness. Because the drug was such a big moneymaker in Germany, Merrell, a U.S. drug manufacturer, got a license to make and sell it in the U.S.

On September 8, 1960, Merrell submitted the drug application to the FDA for approval. Because it was already so popular in Europe, Merrell thought it would be a shoo-in for approval. Just let the new girl rubber stamp it. The “new girl” was Frances Kelsey, an MD with a PhD in pharmacology who had joined the FDA a month before the application was submitted. She was in charge of reviewing the clinical trials portion of the application, which was the size of four phone books bound together.

Kelsey had 60 days from the date of submission to respond to the application. If she did not, the drug would automatically be put on the market. To deny it, she had to prove it was unsafe. She was disturbed by the lack of details about the clinical trials, such as the participants’ age, sex, dosages, how long they were on the drug, adverse effects, and so forth. The company had never performed randomized, placebo-controlled studies over a sufficient period of time. In order to reject the application, Kelsey needed data proving the drug wasn’t safe—data she didn’t have.

Fortunately, there’s a loophole allowing reviewers to delay action by calling the application incomplete. You can just ask for more information and stall, which Kelsey did. In the meantime, Merrell was ready to go ahead. Even without approval, Merrell was already distributing the drug to thousands of patients across the U.S. They’d sent millions of thalidomide pills to doctors in so-called clinical trials. They’d already had brochures printed and enough raw material to make 15 million pills. They’d also lined up dozens of sales representatives to start hawking the drug in hospitals.

Kelsey kept stalling. The old-boy network was furious. In November 1961, the shit hit the fan. A doctor in Scotland, as well as other sleuths in Europe, had found a side effect of thalidomide, which was reported in a letter in The British Medical Journal. It turns out that the drug is safe in late pregnancy but harms an early embryo by blocking the development of blood vessels.

Thalidomide had been on the market for four years at this point. Thousands of babies had been affected. In the U.S., the official FDA count was 17 affected babies, nine of them born to mothers who took the samples; eight who had obtained the drug in other countries. But approximately 150 others in the U.S. have self-identified as thalidomide survivors. Absent Kelsey, it could have been much worse.

The scandal led to the Kefauver Harris Amendments of 1962, which required manufacturers to provide data from animal experiments and human trials to prove that a drug is safe before it can be sold. Ya think?

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

B.M.I. is out B.R.I. is in

As you probably know. B.M.I. stands for body mass index, which is the ratio of height to weight. The B.M.I. began as an index developed by Adolph Quetelet (1796–1847), a statistician who studied the distribution of weight in a population—mostly 5,738 Scottish soldiers. It’s been used as a medical screening tool since the 1970s.

I’ve always thought this measurement was problematic. Consider this: Arnold Schwarzenegger, in his prime, was in the “obese” category. So is American Olympic rugby player Ilona Maher. (Muscle weighs more than fat.) A study of 500,000 U.S. adults found that those with a B.M.I. between 25 and 29.9 (“overweight”) had a 5–7% lower risk of death than those with a "healthy" B.M.I. And so forth. For most of my adult life, including now, I’ve been in the “overweight” range.

Because of its obvious shortcomings as a measure of health, it is now being replaced by the B.R.I., the body roundness index. This metric measures how round or circlelike you are to get an estimate of abdominal fat, which is supposedly linked to an increased risk of developing Type 2 diabetes, hypertension, and heart diseases. That’s because fat stored in the abdominal cavity surrounds internal organs such as the liver and contributes to insulin resistance and glucose intolerance as well as high blood pressure and lipid abnormalities.

Apparently, it’s a complicated formula, but you can avoid the math by using a calculator. You’ll need to include more measurements than with a B.M.I. calculator, which looks at only height and weight.

I’m not bothering with it myself. Plus, I’m not sure that I trust this metric either. Just leave me alone.

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

Statistics on the value of exercise

I rarely write about exercise, a topic that gets plenty of coverage elsewhere. However, thanks to a friend, I got some eye-opening information I’d not seen before. The information comes from Euan Ashley, who is a professor of cardiovascular medicine and genetics and data science at Stanford, where he is the Chair of Genomics and Precision Health. (He helped establish the field of medical genomics.)

In a podcast interview with Derek Thompson, he states that “Exercise is just the single most important intervention you can think of for your health.…you name the system in your body and exercise improves it and makes your chance of disease in that system less.” Here are the statistics he offers on the effect of exercise on a variety of diseases:

• 60 percent less likely to have atrial fibrillation.
• 50 percent less likely to have diabetes.
• 70 percent less likely to fracture your hip.
• 50 percent less likely to have colon cancer.
• 25 percent less likely to have breast cancer.
• 25 percent less likely to get depression.
• 70 percent of people who are active in their daily lives report better sleep.

The data is based on a population of more than half a million people who were followed for over ten years. In the interview he doesn’t mention how much exercise or what kind. You have to figure that out for yourself.

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

America's oversized death rate

Our mortality rates from non-Covid causes have been rising for years. Among 18 high-income countries, America’s life expectancy ranks dead last. A million more Americans died each year than would have if our overall mortality matched those of peer countries in Europe.

• In a quarter of American counties, death rates among working-age adults are higher than they were 40 years ago.
• Homicide rates involving a firearm are 22 times higher here than in the European Union.
• The death rate among children grew more than 15 percent between 2019 and 2021, with little of that attributable to Covid.
• For the first time in half a century, all-cause mortality in children ages 1-19 years began to increase, due primarily to homicide, suicide, vehicle injuries, and drug overdoses.
• Our maternal mortality rate is more than three times as high as that of other wealthy countries, and our newborns have the highest infant mortality rate in the rich world.
• Life expectancy among America’s poorest men may be 20 years shorter than their counterparts in the Netherlands and Sweden.

Whatever accounts for this decrease in life expectancy appears to be uniquely American. Something systemic to the U.S. is limiting survival. “Deaths of despair,” such as opioid overdoses, alcoholic liver disease, and suicides, account for some of the increased death rates. But mortality from other causes has also increased, including Alzheimer’s, diabetes, kidney failure, heart failure, vehicle collisions, and firearms. In addition to deaths of despair, experts posit a number of other possible causes for our decrease in life expectancy, including obesity, limited access to health care, health care affordability, loss of social support systems, chronic stress, and an increase in high school dropouts.

On the other hand, it looks like we do pretty well at keeping old people alive: the chances that an American 75-year-old makes it to 90 or 100 are about the same as in other wealthy countries. In the U.S., the trick is to make it to 60.

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

Being left-handed

I am right-handed, but for ten days my right hand was in a cast, so I was forced to use my left hand for everything. Boy was that hard! Even if you’re naturally left-handed—as only ten percent of people are—the engineered world makes it hard to do ordinary things. My sister is left-handed. Here are some of her examples:

• If you approach big heavy doors with a single handle, it’s always on the right, so you must open it with your right hand, or make an awkward crossover.
• At the bank, the pens-on-chains aren’t convenient for the left-handed.
• In the ladies room the drying towels are on the right. So are the nozzles of gas pumps.
• Travel mugs with lids on them don’t work for lefties. If you hold the handle with your left hand, the opening on the lid is on the wrong side.
• “How to” instructions are written for right-handed people.

On the plus side, lefties seem to be overrepresented in terms of special skills and accomplishments. Albert Einstein and Isaac Newton were left-handed. So were Leonardo da Vinci and Ruth Bader Ginsburg. Six of the last 12 presidents were/are left-handed, including Reagan, Clinton, and Obama. Studies have shown that 20 percent of students enrolled in art programs were left-handed, and that left-handed men who attended a year of college are 15 percent richer than similarly educated right-handed men. 

Some researchers theorize that lefties are more likely than righties to use both sides of their brains at the same time. But nobody really knows why the percentage of especially accomplished lefties is unusually high. Maybe it’s from persevering in a world designed to thwart you.

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

The complexity of taste

Taste is a multisensory experience in which smell, texture, and pain receptors all play a role in determining how something tastes.  It’s also a complex process that starts with our tongues, where a variety of sensors in taste buds send signals to our brains. The taste buds are located in the bumps you can see on your tongue.

Depending on their location, your tongue’s taste buds vary in their receptivity to the different tastes we can sense: sweet, salty, sour, bitter, savory (umami), and more recently, fat (“oleogustus”). The taste receptors at the back are most sensitive to bitter taste, those at the tip are most sensitive to sweet and savory tastes, and those on the sides are most sensitive to salty and sour tastes. The bumps on the remaining portions of the tongue don’t contain taste buds. Rather, their rough texture aid in gripping food and transferring it down to the esophagus as well as in cleaning our mouths and spreading saliva. Taste buds also reside on the pharynx, larynx, soft palate, and epiglottis (the little flap that keeps food from going into your bronchial tube). 

Signals sent by taste buds go to other organs besides our brains. Taste receptors are also found in the gastrointestinal tract, liver, pancreas, fat cells, muscle cells, thyroid, and lungs. Receptors in these organs pick up the presence of various molecules, metabolize them, and use them to prepare the organs for work. For example, when your gut notices sugar in food, it tells your brain to alert other organs to get ready for digestion. Taste wakes up the stomach, stimulates salivation, and sends a little insulin into the blood, which in turn transports sugars into the cells.

In 1904 Ivan Pavlov showed that lumps of meat placed directly into a hole in a dog’s stomach would not be digested unless he dusted the dog’s tongue with some dried meat powder to start things off. Looks like he was onto something.

I don’t know what we can do with this information. I just thought it was interesting.

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

My surgeries

 I’m not keeping the doctor away. Unfortunately, by the time you get this, I will have had surgery for carpal tunnel syndrome on my right hand. I will also have turned 88. On September 17^th, I’m having surgery for a pinched nerve in my spine.

As to carpal tunnel, my fingers are numb and I’m losing muscle in my hands (mostly right), and sometimes I have pain at night. Carpal tunnel syndrome occurs when irritated tendons swell or thicken and thus compress the median nerve, which passes through the wrist and on to the fingers. It can be caused by injury to the wrist, genetic predisposition (small tunnel), and other issues, such as an overactive pituitary gland.

The surgery consists of making about a two-inch cut and cutting the carpal ligament to make the carpal tunnel larger. It’s performed with a local anesthetic. I’ll have to wear a splint for ten days.

As to the pinched nerve in my back, it’s caused by a narrowing of the space in my spine where nerves pass through. For me, this results in sciatic pain running from hip to foot on my right leg. I’ve tried physical therapy, acupuncture, and steroid injections into the offending area. None of these methods worked. I’m not a candidate for a procedure (ablation) that uses radiofrequency energy to disrupt pain signals that travel from your spine to your brain. So I’m going to have a laminectomy, which enlarges the spinal canal to ease pressure on the nerves. Or as my neurosurgeon says, she’ll clean it up. This is also minimally invasive and I should go home the same day.

I’m not looking forward to any of this, but I’m tired of having numb fingers and pain in my leg.

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

Finger ratios and you

Look at your hands. Is your ring finger longer than your index finger? Or is your index finger longer than your ring finger? Some scientists believe that the amount of estrogen and testosterone we’re exposed to in our mother’s wombs can influence which digit is longer than the other.  The theory is that a longer ring finger is the male pattern (more testosterone); a longer index finger is the female pattern (less testosterone).

Unfortunately, because scientists can’t safely sample blood from early fetuses, they can’t confirm a correlation between fetal hormone levels and variations in finger lengths. The subject is controversial. Nevertheless, some studies on finger ratios have shown the following:

• Men’s running speed, skiing speed, and football ability are strongly linked to longer ring fingers.  Usain Bolt, “the world’s fastest man,” has exceptionally long ring fingers.
• Financial traders with longer ring fingers made more money than their short-ring-fingered colleagues. They're also thought to be more aggressive, and more likely to take risks.
• Lesbian women tended to have the more masculine (long ring, short index) finger arrangement.
• Women with longer ring fingers did better in a driving skills test than those whose ring fingers were equal to, or shorter than, their index fingers.
• Women who have a longer ring finger have higher grip strength. 

Apparently, genetics plays a role. 23andMe tells me, “Constance, the combination of your genetics and other factors makes you likely to have longer ring fingers than index fingers.” Well, yes and no. On my right hand, my ring finger is clearly longer than my index finger (male pattern). But on my left hand, my index finger is a tad longer than my ring finger (female pattern).

Maybe there’s something to this finger ratio theory. I’m not a very girly girl. I don’t own any jewelry and there are no dresses in my closet.

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

Senior moments

Psychologists divide general intelligence into two categories: crystallized and fluid. Crystallized intelligence consists of the knowledge and skills that accumulate over a lifetime, such as vocabulary, storehouse of facts, and how to do things, such as knitting and skiing. Fluid intelligence consists of our ability to reason, flexibly engage with the world, recognize patterns and solve problems. An emergency room doctor uses fluid intelligence to assess symptoms and make a diagnosis; she uses crystallized intelligence to treat the problem.

Crystallized intelligence accrues over a lifetime and may peak at about age 65 or above. Fluid intelligence tends to peak at about age 20, then decline with age. The rate of decline varies from person to person. Some people, such as ninety-three-year-old Warren Buffet, have managed to retain strong fluid intelligence. Morrie Markoff, who died at the age of 110, remained mentally sharp to the end. (His eighty-two-year-old daughter is donating his brain to science.) But these guys are outliers.

So what about that euphemism “senior moments? We old people—I turn 88 this month—say we’re having a “senior moment” when we can’t remember something. It seems less embarrassing than saying “I can’t remember.” I have lots of those moments. They consist mostly of an inability to remember a name, word, or phrase. Supposedly such moments are normal “age-related memory loss,” probably from decreasing neurotransmitters and brain size. I haven’t been able to find out where that fits in with the crystallized/fluid scheme. Maybe it doesn’t matter.

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

Pharmacy benefit managers: why drugs are so expensive

Pharmacy benefit managers (PBMs) are middlemen who are hired by employers and governments to negotiate prices with drug companies. The three largest PBMs—CVS Health, Cigna, and United Health Group—collectively process roughly 80 percent of prescriptions in the U.S. Each would rank among the top 40 U.S. companies by revenue.

When PBMs negotiate with drug companies, the drug companies start out with a sticker price. The drug companies then agree to reduce prices on brand-name medications by giving rebates to the PBMs. (Generic drugs don’t get rebates.) The PBMs share most of those rebates with employers, but they also pocket a portion for themselves. This adds up to billions of dollars.

But here’s the deal: Because the PBMs demand discounts from the drug companies, the drug companies often increase their sticker prices so they can maintain their profit margins. Thus, the patients’ out-of-pocket costs for that drug go up. Example: Bristol Myers Squibb more than doubled the sticker price of Eliquis, a blood thinner, making it possible for PBMs to deliver big rebates to employers. But because out-of-pocket costs are a percentage of the sticker price, many patients are now paying hundreds of dollars more per year for Eliquis.

Even when an inexpensive generic version of a drug is available, PBMs have a financial reason to push patients to take a more costly brand-name product. The higher the original sticker prices, the larger the discounts PBMs can finagle, the fatter their profits. Employers may prefer brand-name drugs because of the discount. (Employers often can’t understand or control how the system works. It’s complicated.)

PBMs also own pharmacies, such as CVS, including mail-order warehouses. PBMs push or force patients to use these pharmacies. To increase profits, such pharmacies may charge thousands of dollars more than what a drug costs. Example: CVS was charging an employer $138,000 a year for a patient’s prescription—the same drug the patient could buy elsewhere for about $14,000.

Finally, in 2018, PBS companies established subsidiaries—group-purchasing organizations (GPOs)—that receive the rebates from drug companies and pass on the rebates to the PBMs, which in turn send the savings to employers. To increase their earnings, the GPOs began imposing new fees on drug manufacturers. Because those were fees, not rebates, and because the fees were technically collected by a different company (the subsidiary), the PBMs weren’t contractually obligated to share them with their clients. Employers are none the wiser. They receive rebates, but they can’t see the billions of dollars in fees that the GPOs take for themselves. In 2022, PBMs and their GPOs pocketed $7.6 billion in fees, double what they were bringing in four years earlier.

Because this subject is complicated, this blog post was no fun to write. It’s probably no fun to read either. Sorry.

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

Do you smell that?

Your sense of smell is related to mental health. A diminished sense of smell is associated with worsening memory, cognition, dementia, and depression. In fact, troubles with smell are among the first signs of Alzheimer’s.

The areas of the brain involved with smell are uniquely connected to the parts involved in cognition. As one neurobiologist noted, “Our brains need a lot of olfactory stimulation in order to maintain their health. The olfactory system is the only sensory system that has a direct superhighway projection into the memory center and the emotional centers of your brain.”

Sadly, our sense of smell diminishes with age. It also diminishes because of infections, such as Covid, and from smoking and pollution. But it may be reversible! Example: master sommeliers sniff wine as part of their profession. Studies have shown that the longer they’ve been in the profession, the larger certain parts of their brains become. Those parts—the insula and entorhinal cortex—normally get thinner and smaller as we age. They are also the areas whose dysfunction is involved in Alzheimer’s disease. With sommeliers-in-training, those areas get bigger!

You can test your sense of smell with self-testing kits (search for them using “smell test kit”). You can also improve your sense of smell—and maybe brain functions—by training your nose like this: find four strong-smelling household items, such as a spice or some toothpaste. Sniff each of them in the morning and evening for at least 30 seconds. The point is to become more aware of smells. (I can’t imagine doing this every day—maybe not at all.) If you want to get serious, for about $375 you can buy a sommelier wine tasting kit. In addition to improving your olfactory acumen, you can become a wine-tasting smarty-pants!

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

Urgent care ripoffs

Danielle Ofri, a primary care doctor, writes that she took her daughter to an urgent care center for a quick x-ray (two were taken). Two weeks later she received a bill for $1,168. Normally, she says, the cost should be around $100 for each x-ray. When examining the bill more closely she discovered that the radiology portion came from a hospital, not the urgent care center. She was told that, because the center was hospital-affiliated, it’s allowed to charge hospital prices.

She says she “…stumbled into a lucrative corner of the health care market called hospital outpatient departments, or HOPDs.” Because they’re considered part of a hospital, the urgent care centers can charge hospital-level prices for outpatient procedures, even though the patients aren’t as sick as inpatients. “I’m a doctor who works in a hospital every day, and I was fooled,” she says.

One study of pricing showed that HOPDs charged an average of $1,383 for a colonoscopy, compared with $625 average at non-HOPD settings. A knee M.R.I averaged $900, compared to $600. Echocardiograms command up to three times as much; prostate biopsies cost over six times as much. You get the idea.

In response to this article, which appeared in The New York Times (digital edition), more than 2000 people wrote comments. One woman said she’d taken her daughter, who was having abdominal pain, to an urgent care center. Before the clinic sent them to the hospital, she was given a urinalysis, a blood test, a dose of  acetaminophen, and an anti-nausea drug--treatments that lasted about 30 minutes. The bill was more than $13,000. Because of her insurance, she had to pay “only” a tenth of that.  

Another commenter said she’d driven out of her way to an urgent care place to avoid the emergency room. This was for a tick bite. She writes, “A nurse looked at the red ring, said ‘yep that’s a tick bite,’ prescribed me antibiotics, and I ended up $600 poorer because this center was ‘affiliated’ with a hospital.” 

As it turns out, before reading the article I had also gone to a hospital-affiliated urgent care clinic. I had bits of a tick embedded in the underside of my upper arm that my husband was unable to extract. My arm was sore and swollen and I wanted the thing out. I haven’t gotten the bill yet, but now I’m worried.

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

Smelling Parkinson’s disease

Joy Milney, a 72-year-old woman living in Scotland is “hypersomic,” meaning she has an unusually sensitive nose. When she met her future husband, she loved the way he smelled: salt and musk with a touch of leather. When he was still in his thirties, she found that his odor had changed, along with his personality. After about ten years, Joy began to think the changes might be symptoms of some disease. He was eventually diagnosed as having Parkinson’s disease—a rather early onset.

Joy talked her husband into attending a meeting of local Parkinson’s patients and their caregivers. There, she discovered that all the other Parkinson’s patients in the room smelled like her husband. A lightbulb went off and she managed, after many months, to locate a scientist who would arrange some tests. For the test they arranged for six Parkinson’s patients and six healthy controls to wear fresh T-shirts for 24 hours. Afterward, Joy smelled the T-shirts at random and correctly identified the Parkinson’s people. (She made one false positive identification from a non-Parkinson’s patient who later turned out to have an undiagnosed case.)

Long story short: it turns out that it was not sweat but sebum that was causing the smell. Sebum is a substance secreted by the skin—a sort of waste disposal for our bodies. Scientists fed samples of sebum into a gas chromatograph-mass spectrometer that separated the substance into its component molecular parts. A few of these chemicals were found to be in higher concentrations in the sebum of Parkinson’s patients. Apparently, these chemicals were causing disruptions in two important metabolic pathways that are particularly active in our brains. The byproducts of these chemicals were being transported to the sebum.

Because of this research, people are now imagining the possibility of using sebum tests to screen for Parkinson’s on a broad scale, with the idea of identifying the disease before symptoms become obvious. Amazon has been in touch with the researchers about the possibility of adding a smell functionality to its Alexa devices. It’s sort of laughable imagining what Alexa might say to you as you walk by.

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

 

Private equity-owned hospitals

Over the last decade, more and more hospitals have been purchased by private equity firms. As of January this year, private equity firms owned 30 percent of all hospitals. Texas has the most; New Mexico has the highest proportion. Nearly a quarter of private equity-owned facilities are psychiatric hospitals.

A private equity firm raises some capital from investors and borrows the rest. Thus, the acquired hospital must generate revenue to pay down that debt. To do this, managers decrease staffing (both overall and specifically for nurses), shift their focus from outpatient care to more lucrative inpatient care services, and adopt profitable, technology-intensive services such as cardiac catheterization, advanced imaging, and robotic surgery. In addition, private equity firms often sell the real estate portion, and, after several years, attempt to re-sell the hospital for a profit.

 So—what’s the impact on the patient? A group of scientists conducted a study to “examine changes in hospital-acquired adverse events and hospitalization outcomes associated with private equity acquisitions of US hospitals.” In other words, they looked at bad things that happened to people after their hospitals were acquired by private equity firms, comparing the private equity hospital to non-private equity hospitals. The results were reported in the Journal of the American Medical Association. The researchers found that rates of hospital-acquired complications for patients increased by 25 percent at hospitals after they were purchased by private equity firms. The increase was driven by a 27 percent increase in falls, which tend to happen on the general floors of the hospital; a 38 percent increase in central line infections, which are associated with ICU care; and a doubling of the rates of surgical site infections.

I tried to include a link that shows a list of private-equity-acquired hospitals, but it got complicated. You can find a listing by searching on PESP Private Equity Hospital Tracker. Ours is not on the list--yet.

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

Sunscreen: yes and no

A consortium of public health groups in Australia, whose predominantly white population has by far the world’s highest rate of skin cancer, issued a new position statement: “Completely avoiding sun exposure is not optimal for health.” Too much shade can be just as harmful as too much sun. That’s because sun exposure triggers vitamin D production in the skin, and low levels of vitamin D are associated with increased rates of stroke, heart attack, diabetes, cancer, Alzheimer’s, depression, osteoporosis, and many other diseases.

Vitamin D in a pill is no solution. In fact, it has turned out to be a spectacular failure. In a five-year trial of 26,000 older adults, The New England Journal of Medicine reported no benefits whatsoever in any of the health conditions that the study tracked, including cardiovascular disease, prevention of falls, age-related macular degeneration, and a host of other diseases. The final word: “People should stop taking vitamin D supplements to prevent major diseases or extend life.” You must get your vitamin D from the sun.

People at higher latitudes (less sun) suffer from higher rates of many diseases than people living at low or middle latitudes. This difference is most pronounced in autoimmune disorders, especially multiple sclerosis. That’s because UV light retards the immune system’s attack on cells, tamping down inflammation. Diseases now believed to be connected to chronic inflammation, including cardiovascular disease and Alzheimer’s, are often less prevalent in regions with more sun exposure. Also, bright morning light, filtered through our eyes, helps regulate our circadian rhythms, improving energy, mood and sleep.

Bottom line: UV light is both harmful and beneficial, so the trick is to find a balance between too much sun and not enough. In Australia, experts have come up with an approach that divides its sunscreen recommendations into groups according to skin color and susceptibility to skin cancer. Depending on your skin type, length of exposure, and the UV index for the day, you may need a lot of sunscreen or you may need none. It’s a customized solution.

Health authorities in some countries are beginning to follow Australia’s lead. In the U.S., dermatologists are sticking with their always sunscreen approach. As for myself, I never use sunscreen, mostly because of laziness. Of course, I’ve had plenty of skin cancer, but I don’t have the other diseases associated with a lack of vitamin D—yet.

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

Caffeine and you

Coffee is good for you! It contains thousands of chemical compounds, many of which may influence health. Studies suggest that coffee drinkers live longer and have lower risks of Type 2 diabetes, Parkinson’s disease, cardiovascular conditions, and some cancers! As one scientist states, “Overall, coffee does more good than bad.” (For what it’s worth, the FDA cites 400 milligrams—about four or five cups of coffee — as a safe amount for adults.)

Coffee (caffeine) is a stimulant that enhances mental sharpness and physical performance. Here’s how it works: throughout the day your body produces a chemical called adenosine, which binds to receptors in your brain and makes you feel drowsy. Caffeine perks you up by blocking those receptors. It takes about 20 to 30 minutes for caffeine to be absorbed into your bloodstream and reach your brain. Because adenosine levels in your brain decrease while you sleep, they’re at their lowest immediately after you wake up.

Everyone responds to caffeine differently. It makes some people jittery and anxious. Others require more caffeine to feel its stimulating effects. That’s because its effect depends on your genetics. Your genes influence the rate at which you metabolize caffeine. According to the experts, it could take anywhere from two to ten hours to clear half a dose of caffeine (200 milligrams) from your blood. You’re probably aware of caffeine’s effect on you and adjust your consumption accordingly. If you begin to experience symptoms of having too much, you cut back. If you need a pick-me-up, you have another cup.

I probably don’t drink enough coffee to get its health benefits—or any benefits, for that matter. I make a six-ounce cup in the morning and drink about half of it. Must be my genes. Holding that thought, I went to my 23 and Me account and looked it up.  Here’s what I got: “Constance, based on your genetics, you are likely to drink less caffeine than average, if you drink caffeine at all. This report is based on genetic variants near two genes that play a role in how your body handles caffeine.” Freaky!

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

Perusing my medical records

On March 20 and again on May 1, I had “transforaminal epidurals,” a procedure whereby the doc injected corticosteroid medication into spaces between my spinal column and spinal cord in the lower lumbar/sacral area. The idea was to relieve pain by reducing inflammation and swelling caused by my “radiculopathy” (pinched nerve in my spinal column). The treatment, which is temporary, helps lots of people, but not me. According to the doc, the area was too “tight” and the meds couldn’t get through.

The first time I was aware of a problem was about ten years ago when I was having pain in my right calf just below the knee. An orthopedic guy said it was because my knee wobbled. Not. I certainly never associated it with my spine. After the pain became more widespread, an MRI showed that I had “severe spinal stenosis”: a narrowing of the spinal canal that puts pressure on the nerves. (The nerves run from spine to feet.) Anyhow, the point of this discussion has to do with the records of my treatment. Medical records are now available through the “portals” of the big medical conglomerates to which most of us belong (mine is Dignity).

I can’t remember why I decided to look at a couple of my records. One was of my follow-up appointment with the doctor's nurse practitioner. Her notes said that I had “lower back pain” that was expressed as “spasms and cramps.” No! I never said that because I’ve never had lower back pain, cramps, or spasms! (My pain is from hip to foot and is burning, as I told her.) I also looked at the record of one of my procedures. Among other things it said I was given oxygen through a canula (those things they stick up your nose). No! That never happened! There may be more errors. I only looked at a couple of records.

These errors make me mad because they make me feel unseen. Just another old lady with complaints. What's more, I think they exemplify the slap-dash, time-restricted approach used by medical practitioners to meet the institutional requirements of "Medicine Inc." Not only did I get lost in the process, but Medicare was probably charged for the oxygen I never got. 

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

 

Whole grains: what’s the big deal?

Nutrition advice almost always starts with “whole grains,” followed by fresh fruits and vegetables. I find this advice to be tiresome. What’s so great about whole grains? Whole grains are the seeds of cereal grasses, such as brown rice, bulgur, whole wheat, and oats. In their natural “whole” state, grains have a hard inedible husk that covers three edible parts: bran (fiber); germ (contains some B vitamins, minerals, fat, and protein); and endosperm (the major portion of the grain, which is mainly starch with a small amount of protein, vitamins and minerals).

Refined grains, such as white flour and white rice, have their bran and germ removed during milling, leaving only the endosperm. Most whole grains are also processed to some degree. For example, whole wheat is ground or crushed to create whole wheat flour; old-fashioned oats are steamed and rolled to make them more palatable and easier to digest.

Often, eye-catching messages on food products include terms such as “Contains 14 grams of whole grains.” Such products often contain high levels of added sugar. In fact, a review of more than 500 grain-based products found that those displaying a “whole grains” stamp contained more sugar than similar products without the stamp. What’s more, whole grains by themselves rank high on the glycemic index, the scale that measures how much a specific food raises blood sugar.

Studies that purport to show an association between whole-grain consumption and good health are examples of “healthy user bias”: those who eat whole grains are people who tend to engage in healthy behaviors such as not smoking, eating lots of fruits and vegetables, and exercising.

Nathan Myhrvold, former Chief Technology Officer for Microsoft, who holds a doctorate in theoretical and mathematical physics from Princeton University and did postdoctoral work with Stephen Hawking, turned his attention to food science. One of his studies compared whole grain bread with white bread. He found no evidence that whole grain bread is better for you than white bread. On a nutrient-by-nutrient basis, whole wheat bread might be slightly better because the bran contains manganese, phosphorus, and selenium, but, he says, “these components are not things that most people run a deficit of.” Plus, our bodies don’t absorb many of the vitamins and minerals in raw grain. Good to know. The only bread in our house is white.

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

Mind over matter

 For 45 years, a Harvard-related lab has been researching the ways in which the mind “has enormous control over health and wellbeing.”  Using elaborate experiments, researchers have found, for example, that—

• People’s perception of the passage of time influenced how quickly their wounds healed (wounds healed faster when participants believed more time had passed and slower when they believed less time had passed—even though their actual elapsed time was the same in every case).
• Expecting fatigue causes people to feel more tired.
• Thinking you will catch a cold is associated with an increased likelihood of doing so.
• People who expected certain benefits, such as weight loss, from daily exercise, did see those benefits, while those without the same expectations did not see the benefits, even though their activities were the same.
• Given a diagnostic label, such as “prediabetic,” affects people’s health outcome. This is the “borderline effect”: people above the prediabetic borderline score (5.7 percent) experienced significantly greater increases in their blood sugar levels than those with a 5.6 percent score, even though there’s no relevant difference between the two.

Then, of course, there’s the placebo effect. Under the right circumstances, a placebo can be just as effective as traditional treatments. For example, in one study on migraines, one group took a migraine drug labeled with the drug's name, another took a placebo labeled "placebo," and a third group took nothing. The researchers discovered that the placebo was 50 percent as effective as the real drug to reduce pain after a migraine attack. As one researcher noted, “The placebo effect is more than positive thinking — believing a treatment or procedure will work. It's about creating a stronger connection between the brain and body and how they work together."

 There’s now a product called Zeebo, in which “you are the active ingredient.” For $25, you can get 45 cellulose pills. You focus on what you want to treat, set your expectations for the treatment, design your own regimen, and follow it. Another chance to do science.

I have my own mind-over-matter trick. I’ve found that most people, if they’ve had a sleepless night, complain about being tired the next day. I never am, even if I’ve only had a couple hours sleep. I just assume I’ll be fine.

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

Get dirty!

Various studies have shown the value of being exposed to dirt. People who grow up on farms have lower rates of Crohn’s disease, asthma and allergies than those who live elsewhere. In a Finnish experiment, children attending a day care center where the surrounding yard was a “forest floor” had stronger immune systems and a healthier microbiome than those whose daycare yard consisted of gravel. What’s more, the forest floor children continued to harbor beneficial gut and skin bacteria two years later.

Scientists are increasingly discovering how broad a role dirt microbes play in our mental and physical health. One soil-dwelling bacterium, called Mycobacterium vaccae, has an anti-inflammatory effect on our brains, possibly both lowering stress and improving our immune response to it. When we’re touching soil or even just out in nature, “we’re breathing in a tremendous amount of microbial diversity,” according to one scientist. A clay deposit in Canada has been found to contain powerful antibiotics, solutions of which can kill 16 different strains of multi-drug-resistant bacteria.

In a 2016 blogpost I mention other health benefits of dirt. Some pregnant women crave it and eat it. For one thing, it strengthens both the mother's and child's immune systems. It is also supplies the minerals needed to fulfill a pregnant woman's increased demands. (This is particularly true for a white clay called kaolin.) Clay absorbs toxins and contains the same antacid compounds found in Maalox and Rolaids. 

A company called AOBiome sells a spray-on tonic that contains billions of cultivated Nitrosomonas eutropha, an ammonia-oxidizing bacteria that is commonly found in dirt. They act as a built-in cleanser, deodorant, anti-inflammatory and immune booster. It once lived happily on us too before we started washing it away with soap and shampoo.

It’s easy enough to be exposed to dirt. If you want to eat it, you can order kaolin clay from the internet. Enjoy!

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

Dangers of polypharmacy (taking many medications)

About one in five adults is taking five or more prescription drugs. The older the patients, the more likely they’re taking even more than that. Studies have shown that polypharmacy is associated with a faster decline in memory, greater risk of falls, excessive bleeding, dangerously low blood sugar, and other complications. More than 6 percent of all hospital admissions are because of adverse reactions to medications. For people over 65, it’s more like 12 percent. 

Prescriptions pile up for several reasons: people see a variety of providers who may not be communicating with one another; they’re prescribed drugs to counteract the side effects of other drugs; they’re not taken off drugs they no longer need. (In Salman Rushdie’s book, Knife, which describes his horrific stabbings, he says he was given meds to raise his blood pressure. Months later he was alarmed at his high blood pressure, which, he later discovered, was caused by his still being on the BP-raising meds. Duh.)

Speaking of side effects, Scientific American published an article about the increased risk of dementia for those taking Benadryl for a long time. Benadryl is an over-the-counter medication for allergy relief. Its active ingredient, diphenhydramine, is used in many allergy, cold, and anti-itch drugs. This ingredient is an anticholinergic: it blocks the action of acetylcholine—a chemical that carries messages from your brain to your body through nerve cells. As stated in a National Health Service publication, “More than 600 medications possess some level of anticholinergic activity, and except in the case of a few drugs, experts generally consider the anticholinergic properties to be the cause of adverse rather than therapeutic effects.” Ack!

As to medications in general, you can see a list of “potentially inappropriate medications” for older adults on the Cleveland Clinic’s website. The list is called the Beers Criteria. It’s long.

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

Blood pressure meds

Various blood pressure medications work in different ways:

• Removes fluid by making you pee more, which lowers the amount of fluid flowing through veins and arteries. These are diuretics, such as hydrochlorothiazide.
• Slows down the heart by blocking the action of hormones, such as adrenaline. These are beta blockers, such as metoprolol.
• Relaxes and widens the blood vessels, so your heart doesn’t have to pump as hard. These include both ACE (angiotensin-converting enzyme) inhibitors, such as lisinopril, and calcium channel blockers, such as amlodipine.

“Normal” blood pressure is supposedly 120/80. (The top number is the pressure when your heart is beating; the bottom number is the pressure when your heart is at rest.) But blood pressure is higher in older people because our vessels are less elastic, so the “rules” for old people—over age 65—are a bit more relaxed (130/80). Nevertheless, 80 percent of us elderly are considered to have high blood pressure (hypertension).

Blood pressure numbers can be all over the place, depending on what you’re up to. Mine is always very high in medical environments— “white coat syndrome.” (Stress releases adrenaline and cortisol that tighten blood vessels and cause retention of salt.) I don’t normally take blood pressure meds, but I’ve taken them prior to medical procedures, such as knee replacements, to keep people from freaking out.

Because white coat syndrome is common and because older people naturally have higher than "normal" blood pressure, it’s estimated that around 25 percent of people are taking blood pressure meds that they don’t need. To get a better picture of your blood pressure, it’s best to take it at home at different times of the day. (You'll have to buy a monitor if you don't already have one.) Also try slow, deep breathing and see how it changes your blood pressure. You can do science experiments! 

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

Ignore nutrition studies

I ignore nutrition studies, especially when they demonize red meat and saturated fat. The information is not trustworthy. The problem is that there are multiple ways to analyze data. Researchers are often looking for results that are publishable. For this reason, they can easily make decisions—consciously or subconsciously—to get the results they want.

The problem is “analytical flexibility.” An analytical survey can involve hundreds, if not thousands, of decisions about how best to conduct an analysis. Different decisions about analyzing data can produce different answers: one set of criteria will be associated with an increased risk of a particular disease; a different set of criteria can yield the opposite conclusion.

A group of researchers, called “methodologists,” at McMaster University in Canada and Stanford University are looking at how the strategies and analytical decisions chosen by researchers might influence the results of studies. In one case, the methodologists reviewed 15 studies that were trying to determine whether the consumption of red meat is associated with premature death. In those 15 studies, the methodologists identified 70 different analytical strategies, and 1,208 possible combinations of analytic choices. Using sophisticated mathematical techniques, they then determined how the analytical techniques chosen might influence the results. Depending on the choices made, the results showed wildly different outcomes: 435 concluded that red meat consumption is associated with an increased risk of premature death; 773 led to the opposite conclusion: the more red meat consumed, the longer people lived.

As far as I’m concerned, it makes sense to avoid red meat for ecological reasons, but not for fear of an early death.

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