mm190: U.S. Health Care – Excuses, not facts

November 11, 2007

MUDGE’S Musings

Access to affordable health care. Five words. Easy to write. Rolls off the keyboard fluidly even. Simple phrase; political cesspool. Can universal access to affordable health care ever happen in the U.S.?

Paul Krugman, the economist whose columns appear in the Opinion section of the NYTimes, this week reminds us that the failings of our health care system are manifest: we spend more, but get less – fewer covered and lower life expectancy than in any other western economy.

Moreover, the usual suspects (our lifestyle) and the usual bugbears (socialized medicine!) are distortions and outright lies.

krugman

By PAUL KRUGMAN | Published: November 9, 2007

The United States spends far more on health care per person than any other nation. Yet we have lower life expectancy than most other rich countries. Furthermore, every other advanced country provides all its citizens with health insurance; only in America is a large fraction of the population uninsured or underinsured.

For those fortunate enough to have health insurance, premiums keep rising, and employers are beginning to push employees to pay more of the freight, or even to start to pay additional for their lifestyle choices.

For example, several cases have hit the news recently where employers have fired, or failed to hire, otherwise qualified people who are smokers.

Aside from the disturbing privacy concerns, the entire concept of group insurance (where the large numbers of average members in good health balances those few with greater needs) is at risk here.

But, as Krugman tells us, what apologists and politicians like Rudy Giuliani have done is blanket us with excuses, not solutions, and inaccurate and downright wrong excuses at that.

[Please click the link below for the complete article — but then please come on back!]

Health Care Excuses – New York Times

As a reluctantly, increasingly active consumer of the U.S. healthcare system, one of the luckiest ones covered through a plan 80% subsidized by my employer, I take for granted that I see medical professionals regularly, for the cost of a nominal co-pay up to that 20%. For what is spent, my experience should be the rule and not exceptional.

Armed with Paul Krugman’s excuse-busters, let’s all work to shed light to undo all of the misinformation out there on this subject.

It’s it for now. Thanks,

–MUDGE

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mm176.5: Sleep: The Threequel

October 24, 2007

MUDGE’S Musings

Turns out that yesterday’s NYTimes didn’t stop at the two sleep stories we picked up yesterday. The obvious topic: pharmaceutical aids to sleep.

nytimes

By STEPHANIE SAUL

Your dreams miss you.

Or so says a television commercial for Rozerem, the sleeping pill. In the commercial, the dreams involve Abraham Lincoln, a beaver and a deep-sea diver.

Not the stuff most dreams are made of. But if the unusual pitch makes you want to try Rozerem, consider that it costs about $3.50 a pill; gets you to sleep 7 to 16 minutes faster than a placebo, or fake pill; and increases total sleep time 11 to 19 minutes, according to an analysis last year.

If those numbers send you out to buy another brand, consider this, as well: Sleeping pills in general do not greatly improve sleep for the average person.

Seen the Rozerem commercials. Kind of silly.

As a person with occasional sleep problems (staying asleep, rather than falling in the first place), I’ve consulted my physician and received over-the-counter advice, but no prescriptions.

Based on this story, that’s probably just as well.

[Please click the link below for the complete article — but then please come on back!]

Sleep Drugs Found Only Mildly Effective, but Wildly Popular – New York Times

At one time I worked with people who swore by a specific, popular sleep drug to beat jet lag. This was an international marketing research group, and its members were always on the go, with multiple-week business in Europe, mainly. Somehow, MUDGE never got invited. Oh, well.

Based on the incidence of reported odd side effects, like sleep-driving, I am happy enough not to need to indulge, for jet lag relief, or any other purpose.

I guess I’ll wait until they perfect them:

Still, researchers and drug companies have yet to find a holy grail. “The problem is, there is no ideal hypnotic,” said Dr. Manisha Witmans, a sleep medicine specialist at the University of Alberta’s Evidence-Based Practice Center. “The magic pill for sleep has not been invented yet.”

It’s it for now. Thanks,

–MUDGE


mm176: Sleep: But after you read this, please!

October 23, 2007

MUDGE’S Musings

Not one, but two fascinating stories featuring the universal topic of sleep hit NYTimes today.

Some editor must have insomnia.

But this is really interesting stuff. First, a story about the processing that goes on while one sleeps.

nytimes

An Active, Purposeful Machine That Comes Out at Night to Play

By BENEDICT CAREY

The task looks as simple as a “Sesame Street” exercise. Study pairs of Easter eggs on a computer screen and memorize how the computer has arranged them: the aqua egg over the rainbow one, the paisley over the coral one — and there are just six eggs in all.

Most people can study these pairs for about 20 minutes and ace a test on them, even a day later. But they’re much less accurate in choosing between two eggs that have not been directly compared: Aqua trumped rainbow but does that mean it trumps paisley? It’s hazy.

It’s hazy, that is, until you sleep on it.

In a study published in May, researchers at Harvard and McGill Universities reported that participants who slept after playing this game scored significantly higher on a retest than those who did not sleep. While asleep they apparently figured out what they didn’t while awake: the structure of the simple hierarchy that linked the pairs, paisley over aqua over rainbow, and so on.

Scientists have been curious about sleep for 100 years, fitfully. Lately, there has been renewed interest in what goes on while sleeping, and the discoveries reinforce what wise people have known instinctively for a long time: sleep is a curative.

Sleep that knits up the ravelled sleave of care
The death of each day’s life, sore labour’s bath
Balm of hurt minds, great nature’s second course,
Chief nourisher in life’s feast.
~William Shakespeare, Macbeth*

The research covered in this story deals specifically with learning and memory.

Yet the new research underscores a vast transformation in the way scientists have come to understand the sleeping brain. Once seen as a blank screen, a metaphor for death, it has emerged as an active, purposeful machine, a secretive intelligence that comes out at night to play — and to work — during periods of dreaming and during the netherworld chasms known as deep sleep.

Again, the poets were there ahead of the scientists.

“Take rest; a field that has rested gives a bountiful crop.” ~Ovid **

It is a common experience that a problem difficult at night is resolved in the morning after the committee of sleep has worked on it.  ~John Steinbeck *

The full story makes for interesting reading. Go to.

[Please click the link below for the complete article — but then please come on back!]

An Active, Purposeful Machine That Comes Out at Night to Play – New York Times

I give up my time to sleep only grudgingly. I guess I feel as did James Thurber (sadly unremembered these days):

Early to rise and early to bed
Makes a man healthy and wealthy and dead.
~James Thurber, Fables for Our Times, 1940 *

The second story also concerns sleep — or the perceived lack of it, especially as felt by the elderly.

nytimes

The Elderly Always Sleep Worse, and Other Myths of Aging

By GINA KOLATA

As every sleep researcher knows, the surest way to hear complaints about sleep is to ask the elderly.

“Older people complain more about their sleep; they just do,” said Dr. Michael Vitiello, a sleep researcher who is a professor of psychiatry and behavioral sciences at the University of Washington.

And for years, sleep scientists thought they knew what was going on: sleep starts to deteriorate in late middle age and steadily erodes from then on. It seemed so obvious that few thought to question the prevailing wisdom.

Now, though, new research is leading many to change their minds. To researchers’ great surprise, it turns out that sleep does not change much from age 60 on. And poor sleep, it turns out, is not because of aging itself, but mostly because of illnesses or the medications used to treat them.

“The more disorders older adults have, the worse they sleep,” said Sonia Ancoli-Israel, a professor of psychiatry and a sleep researcher at the University of California, San Diego. “If you look at older adults who are very healthy, they rarely have sleep problems.”

Insomnia is fertile ground for the quotable.

Insomnia is a gross feeder.  It will nourish itself on any kind of thinking, including thinking about not thinking.  ~Clifton Fadiman *

In my experience, the elderly people who complain about sleep do have a lot of other health issues to complain about.

Question is: are they having health issues because they’re having trouble sleeping?

Or are their health issues causing them to have trouble sleeping? This story believes the latter.

[Please click the link below for the complete article — but then please come on back!]

Aging – Sleep Problems – Health – New York Times

This quote, from another of our favorite science fiction writers, Brian Aldiss, wraps both of these stories together. Insomnia happens, and it might not be a totally bad thing.

It’s at night, when perhaps we should be dreaming, that the mind is most clear, that we are most able to hold all our life in the palm of our skull.  I don’t know if anyone has ever pointed out that great attraction of insomnia before, but it is so; the night seems to release a little more of our vast backward inheritance of instincts and feelings; as with the dawn, a little honey is allowed to ooze between the lips of the sandwich, a little of the stuff of dreams to drip into the waking mind.  I wish I believed, as J. B. Priestley did, that consciousness continues after disembodiment or death, not forever, but for a long while.  Three score years and ten is such a stingy ration of time, when there is so much time around.  Perhaps that’s why some of us are insomniacs; night is so precious that it would be pusillanimous to sleep all through it!  A “bad night” is not always a bad thing.  ~Brian W. Aldiss *

We’ll let that keen observer of the human condition, Bill Fields of Hollywood, have the final words on the subject.

The best cure for insomnia is to get a lot of sleep.
~W. C. Fields ***

It’s it for now. Thanks,

–MUDGE

Quotation sources:

* The Quote Garden

** ThinkExist.com

*** BrainyQuote.com

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mm174: Took the weekend off

October 21, 2007

MUDGE’S Musings

fallcolors

Spent a very relaxing day and a half in one of the garden spots of the U.S. Midwest, southwest Michigan.

Drove for a couple of hours, stopping for lunch at a Denny’s (Denny’s: there’s a story for another day!); shopped for stuff we sort of need at an outlet mall; checked into an affordable, adequate hotel; ate dinner at an affordable, adequate restaurant; spent a more than adequate night; breakfasted at an extremely affordable, almost adequate restaurant connected to the affordable, adequate hotel; checked out a charming shopping street in a town that has successfully come to grips with its status as a post-industrial tourist destination; enjoyed the afternoon with exceptional long-time friends from town in one family’s summer home, including a group adventure riding a narrow gauge Shay-powered steam train at Indiana’s Hesston Steam Museum; and made it home through country and urban traffic in time for Sunday Night Football.

Definitely a mental health weekend.

If you haven’t had one lately — don’t wait longer than necessary. Plan carefully, spend wisely, relax immensely.

It’s it for now. Thanks,

–MUDGE

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mm172: Diabetes: Not so Simple, Simon! (And stay away from that pie!)

October 17, 2007

MUDGE’S Musings

Continuing our medical mini-series, this story was among the NYTimes’ most emailed yesterday.

Type II, adult onset diabetes is the focus of the piece, delving in great detail into recent research that is raising more questions than answers.

It’s a lengthy article, but well written, and well worth your time.

nytimes

By AMANDA SCHAFFER

An explosion of new research is vastly changing scientists’ understanding of diabetes and giving new clues about how to attack it.

The fifth leading killer of Americans, with 73,000 deaths a year, diabetes is a disease in which the body’s failure to regulate glucose, or blood sugar, can lead to serious and even fatal complications. Until very recently, the regulation of glucose — how much sugar is present in a person’s blood, how much is taken up by cells for fuel, and how much is released from energy stores — was regarded as a conversation between a few key players: the pancreas, the liver, muscle and fat.

Now, however, the party is proving to be much louder and more complex than anyone had shown before.

So, the usual suspects, pancreas, liver, muscle and fat have been joined by new candidates: a hormone produced by bone, osteocalcin; inflammation in the immune system; the brain; and the gut.

[Please click the link below for the complete article — but then please come on back!]

In Diabetes, a Complex of Causes – New York Times

We rail in this country against the high cost of health care. We are outraged by the prices we pay for pharmaceuticals.

But people, there’s wonderful work being done to discover how the human system works, and how to repair it when it is impaired. This diabetes research is a perfect example.

Of course it’s partially financed by the big drug manufacturers. Be glad it is — where else would the big money come from? The government? A useful source of research funding, but always constrained.

You’ve heard this before. These days, the cost of bringing a drug to market is measured in $100s of millions (probably a cool $billion by now), and bunches of years (as many as 15!).

When that 1:10,000 long shot hits, drug companies have a very short patent life to receive top dollar for their intellectual property, which by the way is alleviating pain, curing disease, improving life for patients around the world, while providing the wherewithal for research and testing of the next great breakthrough.

When viewed that way, the high cost of medicine in this country doesn’t seem so extreme.

Yes, the insurance driven system at the patient level is broken, a subject for another day.

But, as a person who has been living with Type II diabetes for over a decade, and whose sister’s partner’s juvenile diabetes is rapidly killing her, MUDGE has a personal stake in successful diabetes research, and by extension, all the useful medical research in this country, however it’s funded.

It’s it for now. Thanks,

–MUDGE


mm171: Maintain your brain!

October 16, 2007

MUDGE’S Musings

An interesting week for medical news here at L-HC.

And by the way, it’s not an accident that health-related news dominates our attention.

“Our attention” being that of the ubiquitous Boomers, the oldest of whom are fast approaching age 62!

And we weren’t to trust anyone over 30!

The pharmaceutical companies are aware of demographics big time, as they prepare for the largest individual age-group ever, in the wealthiest nation ever, to treat their assorted and accumulating ailments with the finest chemicals a PPO can buy.

And, as a group we Boomers are as self-absorbed, especially regarding our health issues, as our parents, the so-called Greatest Generation, was self-sacrificing.

So, health related news dominates.

This story by Associated Press by way of Wired magazine concentrates on aging’s effects on the brain.

wired

By LAURAN NEERGAARD
AP Medical Writer

WASHINGTON (AP) — When aging hampers memory, some people’s brains compensate to stay sharp. Now scientists want to know how those brains make do – in hopes of developing treatments to help everyone else keep up.

This is not Alzheimer’s disease, but the wear-and-tear of so-called normal aging. New research is making clear that memory and other brain functions decline to varying degrees even in otherwise healthy people as they age, as anyone who habitually loses car keys probably suspected.

The medical establishment is turning its attention to aging’s effects on the brain, and the brain’s effect on aging.

“We need to understand how to defer normal cognitive aging … the way we’ve invested in fighting heart disease and cancer.”

Amen. The prospect of a decayed brain in a reasonably healthy body is just as foreboding as its opposite. Take a look at the rest of the article:

[Please click the link below for the complete article — but then please come on back!]

Wired News – AP News

So, while the medical wizards research, what’s a guy or gal on the cusp of old age to do?

Staying at intellectually demanding jobs, even crossword puzzles might be an answer. Use it or lose it, indeed.

Drugs. For our generation, definitely the easiest of all.

Finally, exercise. In fact, I can think of an exercise that might be especially appropriate in so many ways, as picked up in this nanocorner of the ‘Sphere© earlier: sex.

And, to turn an old saying on its tail: I guess now I aspire to remaining bright eyed and bushy brained.

It’s it for now. Thanks,

–MUDGE


mm165: Junkfood Science: Obesity Paradox #13 — Take heart

October 9, 2007

MUDGE’S Musings

Welcome to one of the newest members of the Left-Handed Complement blogroll, Junkfood Science.

Sandy Szwarc seems to have the credentials, and she has a point of view.

Points of view are not lacking in the blogosphere (although credentials may be!), but I was attracted to hers immediately.

Anyone glancing at the rendition of Yr (Justifiably) Humble Svt that graces the top of the sidebar of this nanocorner of the ‘Sphere© can probably tell that one might charitably describe MUDGE as horizontally challenged.

Fat.

Obese even.

A war fought over all but six decades. Oh, a battle won here or there, but the trend is lousy. And, the implicit message has always been: get skinny or die early.

Well, heredity and Snickers bars have long impaired my ability to do the former.

And over the past decade, the promised life-shortening chronic diseases have appeared as threatened: diabetes, hypertension, dyslipidemia, all controlled as well as can be expected through (to some extent diet, but mainly) the wonders of the pharmaceutical arts, which is pretty well indeed.

This past summer, a promising exercise program that played to the only exercise MUDGE can comfortably handle (other than blogging!), walking, turned into Achilles tendinosis, and the pounds lost so arduously over the past four years are packing on again, as the recreational and therapeutic walking halted while various medical professionals in MUDGE‘s life attempt to figure out how to end the annoying ankle pain.

Then, the other day, thanks I believe to reddit.com, I encountered Sandy Szwarc.

For the first time in MUDGE‘s time in the ‘Sphere was I tempted to write: “WTF!” But I won’t.

Take a look:

junkfoodscience

What is most amazing is how long it has been known that body fat doesn’t cause heart disease or premature death, yet how vehemently people hold onto this belief. “The notion that body fat is a toxic substance is now firmly a part of folk wisdom: many people perversely consider eating to be a suicidal act,” wrote Dr. William Bennett, M.D., former editor of The Harvard Medical School Health Letter and author of The Dieter’s Dilemma. “Indeed, the modern belief that body fat is a mortal threat to its owner is mainly due to the fact that, for many decades, the insurance companies had the sole evidence, and if it was wrong they would presumably have had to close their doors.” That can still be said today, although the obesity interests have since grown considerably larger.

But the evidence that fatness is not especially harmful has been shown from research that dates back to the 1950s — more than a half a century ago. While many remain incredulous, the soundest body of evidence has shown, and continues to show, that being fat is not a risk factor for heart disease or a cause of premature death, even controlling for the effects of smoking or cancer.

The people of the U.S. are simultaneously getting fatter, and living longer.

Well, knock me over with a feather (not too likely in practical terms; you probably would be more successful doing so with a 3,000-pound bale of feathers).

Quoted is Dr. William Bennett, former editor of the Harvard Medical School Health Letter:

“Detailed epidemiological studies, too, show no impressive connection between obesity and cardiovascular disease.

The occasion for Szwarc‘s article is another new, very underreported study, published in the current issue of the American Journal of Medicine, led by cardiologist Dr. Seth Uretsky, M.D., at St. Luke’s-Roosevelt Hospital in New York, showing the same counterintuitive findings: fat people survive cardiac episodes better than thin ones!.

Take a look at the full story:

[Please click the link below for the complete article — but then please come on back!]

Junkfood Science: Obesity Paradox #13 — Take heart

Is it really possible that I’m supposed to be losing this lifetime battle against obesity?

And if so, why have I been lied to– er, misled all of these years?

Bears researching further I’m thinking, and Sandy Szwarc‘s Junkfood Science blogroll2 blog will now become a regular read.

Because, funny thing: Except for this pesky ankle, I feel pretty good.

It’s it for now. Thanks,

–MUDGE

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