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.