Archive for the 'Health' Category

Who you calling a turkey?

Interesting… you might recall my recent synopsis of a New Yorker article that alleged that our nation’s predilection for antibiotic shots might be partly to blame for our obesity epidemic (read the link for further details.) Today, I come across this:

As Lynne Peeples reported last year, tens of millions of turkeys in dense factory farms are fed a diet that includes low doses of antibiotics, which help animals grow faster for still-mysterious reasons.

And you thought turkeys got fat sitting around watching TV and drinking Budweiser.

Bacteria, our friend

Keen eyed readers are doubtless aware of my fixation on the question of why there are so many fat people in America. Why so many VW sized hippos waddling through our supermarket aisles and fast food establishments? I was just at a barbecue ribs joint and was stunned at the obese monstrosities shoveling food into their gullets.

The October 22 New Yorker has an interesting article on bacteria. It turns out our war on bacteria may be a factor in our growing obesity problem. Bacteria, as you probably know, are tiny lifeforms living in areas like our stomach, mouth, ears and other fun places. They cause various diseases. About 70 years ago, antibiotics, which kill bacteria, were developed. You probably got many shots of antibiotics as a child and throughout your life. One bacteria that might have been attacked by your antibiotic shots lives in the stomach and is called H. pylori. The article says…

There is… convincing evidence that destroying H. pylori could alter metabolism in ways that increase the risk of obesity.

Why would this happen? It’s complex and you have read this article for full details, but basically H. pylori has a strong relationship with two stomach hormones which effectively tell us when we feel full or hungry. If you eradicate this bacteria, you throw these hormones are out of whack, and consequently, you keep eating long past when you should stop. To quote the article…

“A generation of kids are growing up without H. Pylori regulating their levels of ghrelin [one of the hormones],” Blaser told me. These results suggest that the message to stop eating never makes it to the brain. If those hormones aren’t controlled, it becomes far more difficult to control one’s weight.

A team from Blaser’s lab then fed antibiotics to mice in dosages that were comparable to those used to treat children with ear infections. The diet of the mice remained unchanged, but, compared with a control group, they gained considerable weight.

This might explain all those hideous, fat kids you see running around. At least fat mice are kind of cute.

The cats of Jemaa el-Fnaa

Frequent readers doubtless recall that I was in Morocco just over a year ago. One of the cities we visited was Marakesh, which has an ancient but still bustling city center called Jemaa el-Fnaa. Jemaa el-Fnaa is a crazy place; a montage of tourists, shopkeepers, men handling snakes and monkeys, loud music and ever present buzzing mopeds that angrily honk it you if you’re in their way.

What I remember most of Jemaa el-Fnaa is the cats. The place is covered with essentially feral but tame felines who stroll about with a regal arch to their backs*. And here’s the kicker: in every other part of world, cats are quite anxious and flighty creatures. You drop your coffee cup, and the cat on your lap leaps up and runs through three rooms of your house to go hide under the bed. The cats in Jemaa el-Fnaa are quite mellow. A moped might loudly race past a snoozing feline and he’ll barely raise a whisker.

* My most treasured Jemaa el-Fnaa cat memory: I was walking down a back alley and saw a cat eagerly nibbling on a morsel of something. I looked closer and realized he was gnawing on a chicken head.

Say, wouldn’t it be nice if I could tie this observation about cute kitties into the neuroscience/physiology topics I’m always talking about? Well, indeed I can.

As I’ve mentioned, I’ve been reading Robert Sapolsky’s “Why Zebras Don’t Get Ulcers.” Fundamentally, what the book imparts is a description of the process by which the stress response of animals (including humans) operates. The stress response is basically what fires off when we sense danger or alarm; flight or fight, that sort of thing. So how does this work? You notice a potential danger — say, an approaching cannibal savage — and your body immediately releases adrenaline, making you sharper, stronger, more focused. But your body also releases chemical glucocorticoids which set you up to maintain the sharper, stronger more focused you down the line. Adrenaline is a immediate fix, glucocorticoids are more long-term (the effects can last hours, even days.) In essence, evolution gleaned that when one becomes aware of danger, one should stay prepared for quite a while.

Now, I think over recent times I’ve become fairly aware of what all this feels like. I mentioned how I recently heard some noise in the night and even though I intellectually understood it to be nonthreatening, I still got a minor jolt of adrenaline. And as I go throughout the day, I have a definite sense of how even a subtle but slightly anxious thought can give me a very mild sense of “the tinglies” which I intuit to be either adrenaline or glucocorticoid related. On the flipside, I’m aware how just visualizing a pleasant scene (say, playing with a puppy, or smothering an annoying baby) calms the system down. (Deep breathing is also quite effective.)

So how does this relate to the cats of Jemaa el-Fnaa? One has to wonder about their nervous system. As I’ve mentioned, regular cats scamper away at the slightest sound. Why don’t the cats of Jemaa el-Fnaa? I think what is frightening to regular cats — loud noises, buzzing mopeds etc. — has become unremarkable to these cats. And their nervous system has learned to respond accordingly.

The unanticipated benefits of stretching?

I’m continuing my reading of the Sapolsky book and just went through a section which makes clear how energy intensive thinking is for the brain. When you’re at your sharpest — mildly stressed but focused — blood is trucking oxygen into your noodle. It’s because you need this oxygen, you’re burning the stuff up. This explains why after a day of intensive learning or studying you feel physically tired. Your brain has been using all your energy.

Now, to jump topics: a few minutes ago, I was doing some stretching. Stretching is, of course, well prescribed for any physical activity, as well as also recommended in dealing with repetitive strain issues. Of course, I stretched heavily for maybe the first three or four years of my repetitive strain, and, frankly, best as I can tell, it did absolutely nothing. This isn’t quite a surprise. There are some who argue that at least warm up stretching (which is essentially what repetitive strain stretching is) really has little value. Evolution did not design creatures who needed to bend down and do a hamstring stretch before they ran away from an approaching tiger. Our muscles should be able to leap into action on command (within reason.) (Cool down stretching is, I believe, still recommended.)

Having said that, there’s no denying there’s a certain pleasure in stretching. You get to really feel your body. I’m considering this possibility: by stretching, you place your focus on your muscles and away from your “thoughts.” As a result, your brain is burning less fuel (because you’re not really thinking in that focused manner.) Additionally, thoughts are often really worries or anxieties but you can’t really worry when stretching (because you’re focused on the stretch.) Stretching is kind of a “break” for the mind. So my thinking here is that the benefits of stretching are not those that are conventionally understood — making the muscles more malleable or whatever — but are benefits appreciated by your brain. A chance to shut down and chill for a while.

How erections work

I’m continuing my reading of the book “Why Zebras Don’t Get Ulcers” and today came across some interesting tidbits about a special focus of this blog: penises.

Specifically, in a chapter on how stress affects reproduction, the book goes into great detail on how erections work.

First, we should understand that your nervous system — the complex pathway of chemical signaling that controls things like your heart rate, digestive system etc. — has two components. There’s the sympathetic nervous system which is basically what fires up when you get anxious or panicked. And there’s the parasympathetic nervous system which is what’s firing up when you’re chilling out.

By a strange twist, it’s actually your parasympathetic nervous system which needs to be activated to get an erection. However, it’s your sympathetic nervous system that signals for the act of ejaculation. So, during the complex process when you are pounding away at a sleazy Thai hooker, err, I mean, your darling wife, the two components of the nervous system have a delicate interaction. One must first be turned on, then turned off, whereas the other starts off off, and then turns on.

It’s a wonder it works at all.

The monkey gland craze

I’ve just started reading a book I’ve been very curious about: “Why Zebras Don’t Get Ulcers” by Robert Sapolsky. It’s a breakdown of the various physiological processes that occur when we undergo stress, and what their evolutionary advantage was (and, often, what their disadvantage is in modern times.)

The book has a number of interesting anecdotes. For instance, in the early 1900s, it was presumed that men lost their sex drive as they aged because of declining “male factors” in the testes. As a result…

Soon, aged, money gentlemen were checking into impeccable Swiss sanitariums and getting injected daily in their rears with testicular extracts from dogs, from roosters, from monkeys. You could even go to the stockyards of the sanitarium and pick out the goat of your choice — just like picking lobsters in a restaurant… this soon led to an offshoot of such “rejuvenation therapy,” namely, “organotherapy” — the grafting of little bits of testes themselves. Thus was born the “monkey gland” craze, the term gland being used because journalists were forbid to print the racy word testes. Captains of industry, heads of state, at least one pope — all signed up.

It’s a good thing I wasn’t around back then. People would doubtless observe my awesome manliness and demand — perhaps by force of law — that I contribute my impressive “male factors” to inferior specimens of man.

Re-thinking fatties

Recently, I’ve been contemplating America’s growing obesity problem and its likely effect on the cost of health care (among other things.) As such, I was interested in this interview with author and academic Paul Campos who argues that obesity is overstated as a problem. He would probably go as far as to say it’s not a problem. The crux of his argument:

Obesity is defined completely arbitrarily as a body mass index of 30 or higher (175 pounds for an average height woman). Now body mass follows more or less a normal distribution, whiich means if the the mean body weight is in the mid to high 20s, which it has been for many decades now, then tens of millions of people will have BMIs just below and just above the magic 30 line.

This might be meaningful if there was any evidence that people who have BMIs in the low 30s have different average health than people with BMIs in the high 20s, but they don’t. At all. So the “obesity epidemic” is 100% a product of tens of millions of people having their BMIs creep over an arbitrary line. It’s exactly as sensible as declaring that people who are 5’11 are healthy but people who are 6’1″ are sick.

Despite my loathing of fatties, I’m fairly receptive to what he’s saying. I think we have heard for years that the BMIs are out of whack and that fairly stout individuals who can nonetheless run a marathon qualify as obese.

I tend to break “overweight” people up into three groups. There’s fat people, who basically fit into the Alfred Hitchcock mold — clearly big, but not really overflowing. Then there’s obese people — Kenan Thompson from Saturday Night Live might be good example. Then there’s morbidly obese people; these are the gigantic men and women I often see at Denny’s whose butt cheeks look like they weigh about 100 pounds. I’m not surprised to hear that being fat has little effect on health, and I can buy that the same might be true with some levels of obesity. But gigantic, morbidly obese people clearly seem headed for early graves. Of course, an early grave does not necessarily mean they’ll be placing a heavy burden on the healthcare system. If you die at 60, you save the system all the healthcare expenses you would’ve run up over the next 25 years had you lived to be 85.

Having said all that, I think further expiration of this topic is needed. Fat people don’t get fat in a vacuum, they get fat by eating crappy food and not exercising. If we’re saying being fat is not a problem, are we by proxy saying that crappy food and lack of exercise are not problems? (We can get into a nightmare of correlation versus causation here: one could argue that fat people who don’t exercise are not unhealthy because they’re fat, but because they don’t exercise, but that kind of argumentation is a dog chasing its tail. The moral is obvious: exercise to be healthy and you also won’t be (too) fat.)

Nonetheless, I like the contrarian nature of Campos’s logic and might even get around to reading his book.

Surgery and the placebo effect

Earlier, I was lamenting the state of modern healthcare, and arguing that a lot of tests and procedures ordered by doctors are done more in the interest of the doctor padding their wallet than out of necessity. (In many situations doctors are reimbursed by the cost/complexity of the procedure.) Specifically, I noted two surgical procedures that had been performed on people I know with no apparent benefit.

Now, you can say, “Fine, Wil. Some surgeries fail. But many surgeries succeed, showing that they are indeed useful.” In reply, I will first stew in the corner, red-faced at your insurrection. I will then state that, yes, many surgeries do seem to have value. But perhaps not for the reasons we assume.

The placebo effect is a commonly understood notion. It’s the idea that something with no medicinal or therapeutic value (a water pill, for example) can have some kind of positive effect. Though it’s certainly a controversial idea, many medical authorities do recognize the placebo effect, partly because it makes their job more difficult. If you have a new pill to test, even if you do double-blind studies, you still have to wonder, “Did the pill actually work? Or was it that damned placebo effect?”

So what does this have to do with surgeries? The book I’m reading, “The Cure Within,” revisits an article from the New York Times Magazine called “The Placebo Prescription,” which had a fascinating anecdote. The story goes…

In the early 1990s, a surgeon by the name of Bruce Moseley persuaded his hospital to allow him to conduct a placebo-controlled trial of a common form of arthroscopic knee surgery. Surgical techniques are rarely subjected to controlled trials since the inherent risks of surgery are considered too great to justify asking patients to submit to them without clear benefit. Nevertheless, in this instance Moseley prevailed. Patients were recruited for a trial and then divided into two groups. One group underwent the usual surgical procedure. The other group was subjected to all the paraphernalia and theater of a real operation, but Moseley actually did not cut, scrape, or do anything therapeutic to their knees at all — he just open them up and then closed them again. He himself did not know whether or not he would be “really” operating until he opened an envelope in the operating theater. What was astonishing about all this was that the patients who received fake treatment improved: not just briefly or subjectively, but on multiple measures of objective function. Even after they were told they had received placebo version of the surgery, they continued to walk better, declared they slept more soundly, reported they were able to mow the lawn again, and more.

Fascinating stuff. But perhaps not enough to convince everyone. And, in fact, the website skepdic.com criticizes Moseley’s experiment.

Typical of the kind of flawed research methodology Hróbjartsson is referring to would be that of surgeon J. Bruce Moseley who performed fake knee surgery on eight of ten patients. (Fake surgery involves making an incision on the knee and stitching it up.) Six months after the surgery all the patients were satisfied customers. Rather than conclude that the patients didn’t need surgery or that the surgery was useless because in time the patients would have healed on their own, he and others concluded that the healing of the eight who did not have surgery was due to the placebo effect, while the two who had real surgery were better because of having had the operation.

Where lies the truth? I don’t know. But one point would be true in both the placebo effect scenario, and the “healed on their own” scenario: surgery was not really necessary, or least it did not work the way it was presumed to.

Now, if your doctor recommends that you have surgery for some ailment, am I saying you shouldn’t have it? No, of course not. It’s your decision. But I would recommend thinking critically before making a commitment.

I’ve written previously about the placebo effect, here.

How do the Japanese handle stress?

As I’ve been thinking about the theory that stress has a great effect on health, obesity and longevity, one point has nagged at me. The Japanese are fairly healthy, suffer low rates of obesity (around 3% compared to our 35%) and have the longest lifespan on the planet. Nonetheless, my general sense of the Japanese is of a group of people who are pretty stressed. We always hear of the long hours the Japanese worker must endure. And any time you watch an old samurai film there’s always a scene where a character walks up and says (subtitled), “The fact that I was late to dinner three times last week has brought dishonor to my family. Therefore I will now commit suicide via our traditional method of hari kiri. As I dig this blade into my intestines, I will suffer greatly and hopefully my agony will appease the spirits of my ancestors.”

If that’s not enough, check out this article: Japanese office stress at record levels.

So, if the Japanese are so stressed, how do they maintain their health? I’ve been reading an interesting book on the history of mind-body medicine — it’s called “The Cure Within” — and it touches on this. It reports on a study conducted in the 1960s that tracked the health of Japanese people who integrated into Western culture, specifically migrants who moved to Hawaii and California. The presumption was that Japanese migrants who adapted the high-fat Western diet would suffer ill health. And, at first, that seem to be the case. But an interesting thing was noted (from page 182):

It turned out… that the “most traditional” Japanese-Americans living in California had coronary heart disease prevalence no higher than what had been observed in Japan. In contrast, “the group that was most acculturated to Western culture had a three- to five-fold excess in CHD prevalence.”

What did traditional Japanese culture offer that might account for these health benefits? Marmot’s answer was “a close knit community, that is, a community to provide its members with a great deal of stress reducing emotional and social support…. It began to look as if the Japanese lived longer than any other group on the planet not just because they ate a healthy diet but because they, perhaps more systematically than other countries, had developed a culture that had learned to exploit the power of healing ties.”

So the idea is, yes, the Japanese have stress, but they also have effective means of handling stress. In a sense, this notion of “loyalty to family” (which I openly mocked in my samurai example above) is actually part of the explanation of their health and longevity.

However, as the book continues, the picture gets a bit muddled. As research went on, it began to look like it wasn’t so much a lack of community ties that caused stress, but rather being on the low end of a hierarchical structure (such as any corporation or the military or family etc.) A famous study in England noted that British civil servants on the low end of the organizational hierarchy where “more than 2.5 times” likelier to die of a heart attack. (Interestingly, I’ve seen reports on studies of monkeys that make the same point. The lower you are on the monkey hierarchy, the more stressed your heart is.)

Well, everyone knows that the Japanese culture (especially the professional culture) is very hierarchical. (As a former student of Japanese language, I can note that the grammar of the language itself changes depending on whether you’re speaking to someone whose status is higher or lower than yours.) So wouldn’t this oppressive hierarchy again damage their health?

Maybe… but let’s consider the possibility that there are different kinds of hierarchy. The book notes that the Japanese people…

… lived in communities where everyone was provided with a clear and secure social role, where overt displays of status were discouraged, and where conformity was encouraged…. Adults might spend their entire lives working for the same corporation and follow a very predictable career trajectory. In the United States, in contrast, much of life is organized around a goal of continuing upward mobility, with resulting competitiveness, discontent, and stress.

So the idea here — and this is my analysis, not directly taken from the book — is that while the Japanese might live in a hierarchy, it’s a relatively fair hierarchy. If you work for the same company for 50 years, you will be treated well and climb up the ladder*. That’s a completely different experience than living in an unfair hierarchy where the monkey with the biggest pecs gets to beat everyone up and have sex with all the chicks.

This also gets an idea which is anathema to both the individualistic and egalitarian sides of Western culture. It’s the idea that being a lowly, put down upon scrub isn’t so bad if you accept your lot in life. And, if you don’t torment yourself by comparing what you have to those around you, you can be content. (It’s the whole Buddhist, “get rid of the wanting,” concept.) Frankly, it’s a pretty controversial idea, and I’m not sure I can accept it, but it does make some intuitive sense.

* As opposed to more Western models where companies aren’t particularly loyal to their employees, and employees often jump ship for a higher salary.

The sorry (and expensive) state of healthcare

One of my recent themes around here has been that modern healthcare is in a state of crisis. This recent LA Times article entitled “Medical spending likely to remain high despite healthcare law” states (as is obvious from the headline) that healthcare costs are not going down anytime soon. One interesting reason…

Technology has helped other industries lower costs by eliminating waste and increasing efficiencies, but it’s done the opposite in healthcare, said Michael Thompson, a principal in Price Waterhouse Coopers’ health and welfare practice in New York.

Although engineers keep building more powerful CT and MRI scanners, for example, there’s no evidence that more scans are helping to prevent disease.

Still, we’re using an awful lot of them. A study published in June in the Journal of the American Medical Association found that from 1996 to 2010, the number of ultrasounds conducted in the U.S. doubled, CT scans tripled and MRI scans nearly quadrupled.

This caught my attention. As I’ve mentioned in the past, at the onset of my unbalance issues several years ago, I had an MRI (which did uncover a brain lesion that doctors fundamentally decided wasn’t worth worrying about.) About a year later, I felt that I had uncovered the source of the problems: damage to my vestibular system. I went to an ear nose and throat doctor and… well, what I don’t let myself tell it (quoting from this blog post.)

[The doctor] was interested in the [first] brain MRI, but, during the course of the appointment, was willing to accept the findings of the previous doctors [that it could be ignored]. But at the very end of our meeting, he said something like, “Why don’t we go ahead and do another MRI just to be safe?”

So, I went ahead and did the MRI (at about $1500 cost to me, and much more to my insurance.) Several days later I called up the MRI lab. To help them find my record, I gave them the name of the doctor. They said something like, “Oh yes, we know him. He’s a frequent flyer.” (Meaning he orders a lot of MRIs.)

That comment stayed with me. Was this doctor ordering an excessive amount of MRIs? Why would a doctor order MRIs that weren’t necessary? Again, the LA Times…

The way we pay providers is another major contributor to the high cost of American healthcare, both now and in the future. The more procedures doctors and hospitals provide, the more they get paid. It’s a recipe for runaway costs, Thompson said.

When you think about it, that’s just insane. In the same way that car salesmen are paid more if they sell you not just the car but the installed security system, antilock brakes, GPS system and solar powered self warming coffee holder (I’m not sure those actually exist, but it’s a great idea) Doctors are incentivized to pile on more services and procedures to the initial bill. Of course, car salesmen don’t enjoy the level of trust that doctors do in our society (I respect most piles of dog feces more than I respect car salesmen.) Additionally most people pay for cars out of their own pocket — we’re not sharing the costs for our car purchases through an insurance pool. So what we have is a system in which trusted authority figures are given a financial incentive to prescribe excess procedures and services. Is that going to result in unnecessary prescriptions (and thus higher shared costs)? Duh!

I’m reminded of a few other anecdotal* cases that might be relevant here. An acquaintance of mine recently had some kind of shoulder surgery. Once the doctors got in there, they determined that it would not be possible to complete the goal of the surgery (which, I think, was shaving down some bone or something.) Someone else I know recently had cataracts removed, but, post-operation, it was determined that his vision had not improved.

Were these surgeries failures? Maybe… if the goal was to actually increase health. But if the goal was to increase wealth (of the doctors), then these surgeries were pretty successful.

By the way, here’s another fact from the LA Times article worth considering while ruminating on the high cost of health care: 35.9% of Americans are obese. Suddenly my “death camps for fat people” idea doesn’t seem quite so controversial, does it?

* Yes, I agree that anecdotes are not evidence. But I do think, especially if they are easily summoned, they contain a certain wisdom.