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.

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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.

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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!

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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!

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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.

Yet another health insurance ripoff

This one is a bit complicated. It has to do with out-of-network providers--those who are not contracted with the health insurance plan.* Big insurers such as UnitedHealthcare, Cigna and Aetna use a data analytics firm called MultiPlan to determine how much out-of-network medical providers should be paid. Both MultiPlan and the insurance companies cut reimbursements to providers as much as possible, which means saddling patients with large bills. The smaller the reimbursement, the larger their fee.

Example: A woman with a complicated and serious condition saw an out-of-network specialist, whose bill was open to negotiation by her insurance company, UnitedHealthcare. UnitedHealthcare paid the doctor $5,449.27—a fraction of what he’d billed the insurance company. The patient received a bill of more than $100,000. The difference between the bill and the amount paid equals a savings for the employer who provides the insurance. But it also means big money for both MultiPlan and the insurer, since both companies often charge the employer a percentage of the savings as a processing fee.

The burden can fall hardest on people with chronic or complex conditions who see specialists, including treatment centers for mental health or substance abuse treatment. Here’s another example, this one related to a substance abuse treatment facility: For providing treatment, the facility received $134.13; for processing the claim Cigna received $658.75; for recommending a payment amount, MultiPlan received $167.48.

MultiPlan affects more than 100,000 health plans covering more than 60 million people. It has annual revenues of about a billion dollars. Former employees talk about a numbers-driven culture in which their bonuses were tied to their success in reducing payouts. It’s a private equity company, as are many physician groups and hospitals nowadays. Last year it identified nearly $23 billion in bills from various insurers that it recommended not be paid.

To be honest, I don’t fully understand the intricacies of these shenanigans. Nevertheless, I thought it was worth mentioning.

                   

                   * "Out of the way--I'm a doctor!" "Out of the way--he's not in-network."

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I learned too late about Advil

I used to take Advil (ibuprofen) for aches and pains—always on golf days. After about ten years of this (I’m guessing) I started getting acid reflux and heartburn—a condition in which stomach acid flows back into your esophagus (the tube that connects your mouth to your stomach). Normally, when you swallow, a band of muscle (a sphincter) around the bottom of your esophagus relaxes to allow food to flow into your stomach, after which the muscle tightens again. If that sphincter isn’t working as it should, stomach acid can flow back up into the esophagus. It’s usually worse if you’re lying down.

I’d had no idea that Advil and other anti-inflammatory drugs could cause acid reflux and heartburn. It can also increase the risk of stomach ulcers. That’s because it increases acid production in the stomach, inhibits the production of mucus that lines and protects the stomach lining, and irritates the esophagus. I quit taking Advil and the acid reflux stopped, although I still get heartburn occasionally. I wish I’d known.

Advil is in a class of drugs called non-steroidal anti-inflammatories (NSAIDs), which also include aspirin, Motrin, Naproxen, Aleve, and others. To get a tad technical, the fundamental mechanism of NSAIDs is to inhibit the COX enzyme. The problem is that the enzyme comes in two forms: COX-1 and COX-2. COX-1 protects the stomach and gastrointestinal tract (good). COX-2 induces inflammation (pain). Unfortunately, with NSAIDs you can’t reduce inflammation caused by COX-2 without also reducing the protective effects of COX-1.

Pharmaceutical companies have been trying to develop pain-relieving drugs that target just COX-2. No luck so far. Maybe that’s the way Mother Nature wants it.

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

Resistance exercises: a good thing to do

I used to go to Jazzercise classes. They shut down during Covid and I never went back. But I signed up for Jazzercise on Demand, so I continue my exercise regimen that way. Several times a week I do 20 minutes of aerobic/cardio exercises and 10 minutes of weight training, using five-pound weights. (Ten minutes doesn’t sound like a lot, but it’s about all I can stand, as are five-pound weights.) The primary benefit of muscle-strengthening activity comes from the way it taxes the muscles: it generates microscopic tears in muscle tissue that prompt the muscle to repair itself and build more fibers to become stronger.

In addition to increasing muscle strength, various studies and analysis of muscle-strengthening exercises have shown—

• A 10 to 17 percent lower risk of all-cause mortality. Data on 100,000 older Americans showed that those who did both aerobic and resistance training had the lowest mortality of the entire group.
• Less loss of muscle mass as we age.
• Stronger bones. Muscles pull on bones and in response bones add new cells and get stronger.
• For cancer survivors, less fatigue and improved quality of life; for diabetics, improved glucose storage and circulation.

Experts recommend two or more sessions a week of muscle-strengthening. They say any kind of resistance training will do, such as pulling on elastic bands, push-ups (not me!), free weights or weight machines. The important thing is to put strain on your muscles. But you also need to allow sufficient rest between workouts to allow the muscles to repair themselves.

Experts also say to increase weight and intensity over time. I’m not doing that. Somehow, my five-pound weights get heavier each time I use them.

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

Consuming the chemicals in plastics

 By now, we’ve all been warned not to heat up food in plastic containers: the chemicals leach into the food. There are more than 16,000 chemicals used in plastics manufacturing and over 1,000 of those are suspected of disrupting our endocrine systems. In fact, they’re called endocrine-disrupting chemicals (EDCs). A common example is BPA, which stands for bisphenol A, an industrial chemical that has been used to make certain plastics and resins since the 1950s. It’s often found in food and beverage containers and in resins that coat the inside of food cans.

Our endocrine systems act like well-oiled machines, releasing certain hormones in precise quantities and at precise times to reach receptors spread throughout the body. The endocrine system helps to moderate everything from fertility and reproduction to growth, metabolism, immunity and brain development. The problem with EDCs is that they mimic, block, and otherwise disrupt normal hormone functioning and lead to a cascade of signaling that is not supposed to happen in that moment. Synthetic EDCs have a similar structure and size to dozens of hormones, including estrogen, testosterone, and thyroid hormones. BPA, for example, mimics estrogen. Pregnancy and fetal and infant development are considered periods of heightened vulnerability to the effects of EDCs. (I’m glad I reached adulthood before EDCs were so ubiquitous.) 

Many researchers think there is no “safe” consumption level for EDCs because these chemicals don’t act in a predictable way. The European Food and Safety Authority has established a safe limit of 0.2 nanograms of BPA per kilogram of body weight per day. With that limit, you can exceed your daily tolerable exposure level by eating one five-ounce can of tuna.

It all feels rather hopeless. Our recycling box always has plastic containers in it. The warnings seem too late for me, so I don’t worry about it. But maybe you should.

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

Prior authorization

 As I’m sure you know, before you can get treatment or medication your doc may have to convince your insurance provider that you need it. Prior authorization gives your insurance company more power than your doctor. If your prior authorization is denied, you have three options: pay out of pocket (not realistic); give up (this happens 80% of the time); or the doctor can go to bat for you.

One doctor says that she must get approval 95 percent of the time. Another doctor notes that she has four full-time employees whose sole focus is on obtaining prior authorization for medications to treat Crohn’s disease and ulcerative colitis. A frustrated pediatrician says, “I end up talking to someone who’s not even a physician—people who couldn’t pronounce the names of the drugs I was trying to prescribe.” Another says that the insurance company was giving her a hard time getting approval for chemotherapy for a patient diagnosed with lymphoma. “I was so emotionally exhausted. And that was just one patient.” By one estimate, the U.S. spends about $35 billion a year on the administrative costs of prior authorization.

Decades ago, prior approval was used sparingly to make sure that treatments and long hospital stays were necessary. The idea was to save us money. Now, it’s devolved into a system where treatments are denied for no reason. Even everyday medications, such as test strips for blood sugar and ADHD meds, require insurance approval.

The way insurance companies profit is to deny care. If they deny or delay care, that’s money they get to keep. Prior approval only serves to enrich the insurance companies: Cigna made $5.2 billion in profit last year; Elevance made $6 billion; United Health care made $22 billion.

I have never been turned down by my insurance providers (Medicare plus a supplement). But I have no idea if my physician has had to suffer on my account.

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

GoFundMe: the go-to site for paying medical bills

 GoFundMe—a privately held, for-profit company—started as a crowdfunding site for underwriting “ideas and dreams.” Now, “medical expenses” is the most common category of fundraiser. People use it in desperation to pay medical bills.

In 2020, there were 200,000 medical-related GoFundMe campaigns in the U.S., which was 25 times higher than the number of such campaigns in 2011. Right now, there are more than 500 campaigns asking for help in paying for gene therapy for young children with spinal muscular dystrophy. (A single-dose treatment costs $2.1 million.)

The thing is, unless you’re famous or have lots of rich friends, the campaigns rarely help much. Almost all fall short of their goal, and some raise little or no money. The average campaign makes it to about 40 percent of the target amount, percentages that are getting worse over time. One woman, who was presented with $65,000 air ambulance bill (out of network), was able to raise only $1,400.

Apparently, this way of paying medical bills is becoming normalized. In some cases, patient advocates and hospital financial-aid officers recommend crowdfunding to people who can’t afford their medical bills. That’s sick.

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

Hierarchies and health

 A friend recommended a book titled The Nation of Plants, by Sefano Mancuso, a leading authority on plant neurobiology. The book discusses the eight principles that govern the lives of plants. One is the fact that plants are governed by decentralized “vegetable democracies,” rather than by hierarchical command centers. Instead of specialized organs, all their functions are distributed throughout their entire bodies.

Not only are our bodies organized in a hierarchical way—with brains at the top—but so are our societies. Our hierarchical organizations evolve bureaucracies in which commands coming from the top get transmitted throughout the levels of the hierarchy. Problems with hierarchical organizations include the Peter Principle (in a hierarchy every employee tends to rise to his or her level of incompetence), as well as Parkinson’s Law (bureaucracy expands as long as it is possible to do so, which, in fact, is usually between 5.17 and 6.56 per cent per year).

Hierarchical organizations can also be unhealthy. The Whitehall study in Great Britain examined more than 28,000 employees for ten years. They found that employees at the lowest level of the hierarchy had a mortality rate three times higher than that of employees at the highest level. Even when risk factors, such as low income, smoking, or on-the-job safety risks, were controlled for, employees in the lowest levels of the hierarchy suffered from cardiovascular disease at a rate that was 2.1 times higher than that of employees at the highest level. The cause of these discrepancies is the substantially higher stress levels at the lower levels of the hierarchy. Subsequent studies have confirmed such findings.

As you might expect, Mancuso recommends that we organize ourselves like plants do: in a diffuse model, in which consensus and authority derive from one’s own capacity to influence, rather than being conferred from above. Rather than having a single command center, decisions can come from the periphery where the needs are clearest, and information is more readily available.

One wonders: how’s the health of those folks we deal with at the DMV?

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

Think twice about taking antibiotics

By now, I think most of us know to be cautious about taking antibiotics. Experts now estimate that 28 percent of antibiotics prescribed to children and adults are unnecessary. Not only that, but they can also do more harm than good. Here are some reasons for caution:

• Antibiotics are useful for only bacterial infections. They have no effect on viruses.
• They kill the beneficial bacteria in your gut (collateral damage).
• Disruption of good gut bacteria may lead to metabolic disorders such as Type 2 diabetes and autoimmune diseases.
• Antibiotics encourage bacteria to evolve drug resistant strains (“superbugs”) which can lead to antibiotic-resistant infections.

If you need an antibiotic, take the shortest course. Experts now agree that you don’t need to take all the pills prescribed. As Dr. Martin Blaser, the director of the Center for Advanced Biotechnology and Medicine at Rutgers University says, “After minimizing the biological costs of antibiotics for decades, medical scientists are finding that longer courses are more damaging than shorter ones.” In fact, shorter courses can be just as effective as longer ones. (For a urinary tract infection, two days of taking an antibiotic did the trick for me.)  Most cases of bacterial infections don’t require antibiotics for longer than five days. But for something like Lyme disease, take the whole course.

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

Red wine and sloppy science

More than 20 years ago, some scientists declared that drinking red wine was good for your heart, the idea being that it had “a flushing effect” that prevented clot-forming cells from clinging to artery walls. Drinking red wine was touted as the answer to why French people—lovers of pâté, butter, and triple crème Brie—had lower rates of heart disease than people in the U.S. The studies supporting the health effects of red wine have since been debunked. Many new studies are now saying that no amount of alcohol is good for your heart.

Who can you trust? Shoto David, a scientist with a PhD in molecular biology, quit his job to pursue his hobby of finding flaws in scientific papers and trying to get the errors rectified. So far, he has flagged about 2,000 error-riddled scientific papers, including those produced by the Harvard-affiliated Dana-Farber Cancer Institute in Boston. That Institute is retracting six research papers and correcting 31 more. In 2021, a surgeon at Columbia University quietly withdrew his cancer study because of flawed research. The fact that these papers appear in top scientific, peer-reviewed journals makes you wonder about the peer review process—and about research studies in general.

Nutritional research is plagued with credibility problems, partly because the world of scientific research is competitive. Grant money depends on getting research published. Journals select articles that make splashy news. In 2019, the often-quoted founder of the Food and Brand Lab at Cornell University was booted from his position because of academic misconduct, including “misreporting of research data.” His studies have been cited more than 20,000 times. Fifteen of those studies have been retracted.

So how about those cheese-loving French people and their healthy hearts? I’m just waiting for the nonsense about the dangers of saturated fat to be debunked.  

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

How our sense of smell affects social interactions

I feel sorry for those who lost their sense of smell after contracting Covid. I think most people regained that sense, but it would be awful to lose it permanently! It not only affects our enjoyment of food and perception of our surroundings, but it also plays an important role in our social interactions. It turns out that our body odors convey information to others—all subconsciously, of course.

Researchers can now use behavioral measures, brain imaging and molecular biology to test how odors affect people. Here are some interesting factoids revealed through their studies:

• Most new mothers were able to identify their babies by their smell after spending as little as 10 minutes together, and newborns can recognize their mothers.
• People can match pairs of identical twins by their body odor, even if the siblings live apart.
• People who smell similar to each other were more likely to enjoy chatting with one another.
• Women’s brains reacted more strongly when they smelled the sweat of men who played an aggressively competitive game, than they did after smelling the odors of men who had just enjoyed a calm construction game.
• People with a better sense of smell had a larger social network and more friends. fMRI studies revealed that the same brain circuits may be involved in both our sense of smell and the size of our social circle.
• Sniffing women’s tears makes men less aggressive.

This last one is interesting. Conducting the study was a challenge because of the difficulty of collecting tears from donors. Researchers needed at least one milliliter (a quarter of a teaspoon) of tears for the experiment. Onions didn’t work because irritants create a different type of tears, so researchers had to find volunteers who cry easily, then had them watch sad movies. Testing men’s reactions to tears required game playing and MRI brain scans. Researchers found that when men sniffed the women’s tears, they were 44 percent less aggressive in the game than when they sniffed a saline solution. Also, the region of the brain associated with aggression showed less activity.

Someone should manufacture those tear ingredients and rain it down on some groups. I can think of lots of candidates.

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