Archive for the 'Health' Category

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.

Fatties (and Forbis) fear success?

This strikes me as an interesting bit of serendipity: just yesterday I was raging against the morbidly obese, and then today, while continuing my reading of “The Great Pain Deception,” I come across the following paragraph.

A small percentage of people prevent healing through repeatedly and unconsciously resisting treatment. A common example is overeating. The conscious-self attempts dieting but suddenly one day she gorges herself on desserts. She has unconsciously rejected the notion of weight loss.

But why has she rejected it?

Her current self image is comforting because it’s known to her. She may fear becoming her true self for fear of succeeding. If she succeeds she is now in the spotlight. … internal conflict rages… because her motivations are instinctively at war.

Ah, the old fear of success which I ruminated on just recently. but why would fear of success cause someone to overeat? I would theorize that the logic goes something like this: the id (the inner brat) wants glory and to be loved by all. The superego condemns this desire because good children sacrifice their wants and needs for the greater whole. How can one ensure they are not at the center of attention (as the superego demands)? By gorging on so much food that they become an obese hippopotamus that nobody wants to look at. (On a related tangent: I think we’ve all heard of molestation and rape victims overeating to — in their minds — make themselves unattractive and not desirable to sexual predators.)

So, I again ask myself, do I set myself up to fail to appease the demands of the superego (e.g. “don’t stand out”)? And do I so callously and deliciously condemn fatties because I recognize that we share a similar avoidance mechanism.

Oh, look, there’s a kitty outside my window!

Rape and pregnancy

It’s rare you see interesting science involved in political kerfuffles. Thus, I was intrigued at the controversial statements by Republican Todd Akin that rape victims are unlikely to have successful pregnancies. His statement was…

“From what I understand from doctors, that’s really rare,” said the U.S. Senate candidate in response to a question about whether abortion should be legal in cases of rape. “If it’s a legitimate rape, the female body has ways to try and shut that whole thing down.”

Is this actually true? After a few days of not seeing anything in the media addressing what would seem to be a key question, I came across this article. Experts: Rape does not lower odds of pregnancy The crux of the article:

[The experts] conclusion contradicts a statement made last weekend by Rep. Todd Akin, R-Missouri, who suggested in an interview with CNN affiliate KTVI that rape rarely results in pregnancy.

However, there’s an interesting side note here. This article, discussing a kind of spontaneous abortion called preeclampsia notes that post conception, the female body can “shut the whole thing down,” and does so with increased occurrence after rape. Some select quotes from the article…

More often than not, preeclampsia is the result of a hostile immunological maternal response to the paternal genome in the developing conceptus. In other words, the mother’s body is unwittingly terminating a pregnancy that has arisen with a man for whom she has an incompatible biochemistry.

By the early 1980s, scientists had started to notice that preeclampsia was more likely to occur in pregnancies resulting from “one-night stands,” artificial insemination and rape than in pregnancies that were the product of long-term sexual cohabitation.

Now why would this be? Scientists have a theory.

“It may be useful to think about preeclampsia not simply as a medical anomaly,” reason the authors, “but as an adaptation that may have evolved to terminate pregnancies where future paternal investment was questionable or unlikely.” [WF: such as rape] Their argument, which is admittedly speculative, is predicated on the basic parental investment theory in evolutionary biology. While males could impregnate a potentially limitless number of females and spread their genes far and wide without any cost but a euphoric 90-second time investment, ancestral women’s genetic interests were compromised by having sex with a man who had no intention of helping her to raise any resulting offspring. Yet, if she did, and conceived as a consequence of that intercourse, preeclampsia was a second line of adaptive defence that would terminate this “costly” pregnancy—a sort of Darwinian morning after pill, as Gallup explained it to me.

The whole article is fascinating and really worth reading.

Now, essentially both articles are correct. Rape does not seem to be a factor in whether a woman becomes pregnant. But rape does seem to be a factor as to whether she “keeps” that pregnancy. (I’d be interested in knowing how much of a factor, but haven’t seen any data yet.)

Bioengineering babies

Over at Reason, they highlight the work of a bioethicist who is arguing that modern potential parents should “screen out” potentially negative genes found in the DNA of their embryo. (It’s unclear as to whether “screen out” is a polite way of saying abortion, or whether what’s being suggested is some kind of embryonic gene replacement.)

The argument, as I understand it, goes something like this: as time passes, we will be more and more capable of identifying genes (e.g. chunks of DNA found in our chromosomes) associated with certain behaviors. If a pregnant couple look at the DNA of their embryo and see something like a gene for psychopathy, shouldn’t they address the situation in some way?

Here’s the bioethicist himself (from an article linked at the Reason page):

“Indeed, when it comes to screening out personality flaws, such as potential alcoholism, psychopathy and disposition to violence, you could argue that people have a moral obligation to select ethically better children.

“They are, after all, less likely to harm themselves and others.”

“If we have the power to intervene in the nature of our offspring — rather than consigning them to the natural lottery — then we should.”

The whole thing, of course, smacks of eugenics. Having said that, I don’t find myself particularly opposed to the notion. And I suspect that modification of genes and how these genes get expressed is going to become more and more feasible as time goes on, through processes that can be applied both pre-and post birth. For example, the whole idea behind gene therapy is that we can swap out genes in actual people (e.g. not embryos.) Right now the focus is on fixing genes that cause diseases, but why not use therapy to fix genes which might make someone more prone to alcoholism or anxiety? (Having said that, gene therapy is still in the early stages and to my knowledge hasn’t really proved itself.)

There are several caveats. For one, pretty much everyone agrees that a person’s personality and biological state are affected by more than just genes; environment is a big factor. Secondly, as the author of the Reason piece makes clear, genes can be a bit two-faced, and have both good and bad sides.

Savulescu’s vision strongly depends on the notion that genetic traits come in nice little packages that can be added or excised at will. However, behavioral “traits” are likely to have two (or more) sides to them, e.g., bravery could well be associated with aggressive tendencies, or prudence with selfishness, righteousness with implacability, etc. Can’t bioengineer away the bad without also affecting the good.

The fat apocalypse

Anyone who knows me knows that I’m about as far removed from these twee, Europhile, America basher types as you can get. Nonetheless, after returning from my recent European trip, I’m reminded once again that Americans are just insanely fat. Just the other day I was at Denny’s and behind me were two women who probably collectively came in at around a ton. It’s quite possible that my entire body could fit in the space that just one of their butt cheeks took up.

I was talking to a friend of mine about this last night. He mentioned an interesting point: Samoans and Hawaiians — a population of people also known for their vast girth — are thought to have created a culture that encouraged getting fat because they lived on isolated islands. If you ran out of food in ancient Hawaii you couldn’t just pack up and go explore the plains; you might have to live off your lard for a while. As a result, it made some sense to eat as much food as was available.

This got me thinking. Obviously obese Americans cannot realistically think that starvation is just around the corner. But, maybe on some subconscious level they do. Maybe after being exposed to decades of our paranoid media, cancer warnings pasted on innumerable products, and endless advertisements for medications for questionable diseases, the average American — stuck in a mode of simmering anxiety — does subconsciously feel like we’re on the verge of an apocalypse. Of course, ironically, we probably are on the verge of an apocalypse — an apocalypse caused by a generation of gigantic Americans becoming handicapped, immobile diabetics. When the culture does collapse and the only viable solution is cannibalism on a massive scale, who’s going to be the most tempting target? Svelte, good-looking ectomorphs such as myself or 400 pound hippos sitting on the couch, scarfing down Cheetos and watching Jerry Springer?

EAT, EAT, EAT!!!

Bleed the pain away!

There seems to be a meme built into Western culture (and possibly other cultures) that success or meaningful accomplishment requires sacrifice. In order to truly gain something, one must work hard. I’ve always been resistant to this philosophy — I often tout the phrase “work efficient not hard” though in truth I seldom do either — but I can’t claim to have escaped this notion’s grasp. If I accomplish something without effort, I’m suspicious of it… it’s “too easy.” To some degree, if I’m working on something like a piece of music or an article, I consider it done when I’m basically tired of it. The process has fatigued me, therefore it must be complete.

As I’ve mentioned, I’ve been reading a book called “The Great Pain Deception” about the emotional causes of pain. The author’s allegation is that most physical pain without an obvious cause (like a bullet hole or something) is fundamentally psychosomatic. He does acknowledge that back pain is sometimes cured by surgery (though the cure rate is not high, a fact I’ve seen confirmed in other sources). He argues that surgery works as a placebo effect — mind over body. (I should point out here that the placebo effect is a well recognized phenomenon even in mainstream medicine.) The author insinuates but doesn’t quite spell out an interesting point: that the placebo effect works in surgery because people are suffering for their cure — they are literally being cut open. It’s almost akin to those Catholic sects that show their subservience to God by whipping and torturing themselves. The logic is, “if I bleed, it must be good.”

Do we fundamentally believe that getting rid of pain cannot be achieved without great effort, great sacrifice? It’s impossible to prove the veracity of such an idea, but it’s certainly interesting to think about.

Sacks on self

I’ve mentioned the concept that maladies of the body – pain and perhaps gastrointestinal and heart issues – have an emotional component e.g. people who suffer these problems are not emotionally “balanced.” To put it another way, “who you are” can have an affect on your physical state. This is a point of view that seems to be gaining traction but only in very recent times. And yet, I just stumbled across this in Oliver Sack’s 1985 book “The Man Who Mistook His Wife for a Hat.”

The patient’s essential being is very relevant in the higher reaches of neurology, and in psychology; for here the patient’s personhood is essentially involved, and the study of disease and identity cannot be disjoined. Such disorders, and their depiction and study, indeed entail a new discipline, which we may call the ‘neurology of identity’, for it deals with the neural foundations of the self, the age old problem of mind and brain. It is possible that there must, of necessity, be a gulf, a gulf of category, between the psychical and the physical; but studies and stories pertaining simultaneously and inseparably to both – and it is these which especially fascinate me, and which (on the whole) I present here – may nonetheless serve to bring them nearer, to bring us to the very intersection of mechanism and life, to the relation of physiological processes to biography.

To be clear, I presume Sacks is not talking about emotional sources of physical pain or dysfunction but rather neurological issues that attack the very fabric of a person’s “self.” (Say, having complete memory loss.) But he does argue for a connection between “mind” and body, between physiological processes and biography (e.g. “who you are.”) This seems to be a view very ahead of its time.

The right balance

Lately I’ve been paying attention to how different foods and substances that I ingest (caffeine, booze etc.) affect my concentration. I find, for instance, that when my blood sugar’s low (say, right before lunch) it’s hard to concentrate and absorb information. The first couple cups of coffee are great for focussing but too many has the opposite affect. I think a lot of the learning process is related to finding the right chemical balance for your metabolism.

It would be interesting to find out whether successful, learned people have a balance of chemicals in the brain and body that allows them to stay focused for long periods. If that turned out to be true, normal people could develop similar abilities by sticking a straw into the heads of successful people and drinking their brains.

Who knew getting smart could taste so good!?

Good cholesterol?

The New York Times says: Doubt Cast on the ‘Good’ in ‘Good Cholesterol’

The name alone sounds so encouraging: HDL, the “good cholesterol.” The more of it in your blood, the lower your risk of heart disease. So bringing up HDL levels has got to be good for health.

Or so the theory went.
Now, a new study that makes use of powerful databases of genetic information has found that raising HDL levels may not make any difference to heart disease risk. People who inherit genes that give them naturally higher HDL levels throughout life have no less heart disease than those who inherit genes that give them slightly lower levels. If HDL were protective, those with genes causing higher levels should have had less heart disease.

I’ve long had my suspicions about how good HDL is. I recall once going into a bar and seeing some HDL there talking to a known prostitute. I was like, “What are you doing?” and the HDL was like, “Beat it! You’re not my dad!” Then it gave the prostitute a big sloppy french kiss. On another occasion I went into my friend’s garage to get some cold beers and there were a couple HDLs hanging out. I smelled pot and said, “Have you guys been smoking something?” and they were like, “What… cough… cough… no man. I think that’s just the barbeque… or something. We’re just hanging… cough!”

So I think you can see why I remain suspicious about “good” cholesterol.

Sacrifice them to the coffee gods!

Here’s an interesting study making the case, yet again, that coffee is actually good for you.

Men who drank 2 to 3 cups a day had a 10 per cent chance of outliving those who drank no coffee, while women had a 13 per cent advantage, according to research published Wednesday in the New England Journal of Medicine.

Specifically…

The study found that men who drank 2 to 3 cups a day had a 14 per cent lower risk of dying from heart disease, 17 per cent lower risk of dying from respiratory disease, 16 per cent decreased chance of dying from stroke and a 25 per cent lower risk of dying from diabetes than those who drank no coffee.

But will this be enough to silence the cofee-haters out there? I doubt it. Nothing will silence them… unless we go into their homes, drag them into the streets and force hot coffee down their gullet.

LONG LIVE COFFEE!!