{mp} mental.pestilence

What Are You Talking About!?

savemike@gmail.com (savemike) — Mon, 27 Jul 2009 13:00:00 +0000

It is frustrating to sit nearby and listen to men and women try and talk politics or some other current event topic when they are ill-informed. It is especially annoying for me to hear the super-spin on health care reform that is now dominating many conversations. "You know I'll tell you something George, if this socialzed health care bill goes through congress that will be the end of us!" says an overly dramatic, overly zealous roundtable coffee-shop patron.

It is the usual rhetoric heard within mostly conservative think tanks, talk shows and pundits. What did he mean the "end of us?" Rediculous! The end of what? Society? Freedom? Hold on a second, I'm getting a tweet from Glenn Beck. Oh my god armageddon is coming in the form of health care reform! Run for the hills! (Or a church, I believe that is actually an understood "safety" in the game of religion.)

The reason why it is so completely frustrating to hear this rhetoric is because we aren't even anywhere near implementing socialized medicine. Not Obama, no one in congress, and zero in the senate are advocating socialized health care. For the record socialized health care is care which is administered and run by the governement through government ran hospitals, doctors offices and government staffed doctors.

But I guess that doesn't really matter for people who are preaching to the choir, or those who only wish to feel better about their opinions by enlisting others to feel the same way through malignant duplicity. They are just silly sound-bites they've memorized and have been perpetuated by certain media outlets to obfuscate the topic.

Moreover, I don't even support Obama's health care reform package. However, I've come to that conclusion based on reasons other than those stated above. I am opposed to the new health care reform because it is a complacent proposal to the current for-profit insurance industry system we have in place now with high overhead costs, unecesarry profits and excessive paperwork for physicians. It does nothing to address the way health care is practiced: the number of primary care physicians v specialists, the prices private practice doctors charge (which are more than other countries), the types and number of expensive services that are used with celerity yet don't always convincingly provide extra benefit, etc.

To me the health care reform debate is an unfortunate example of the political racket conservative and liberals engage in which limits real constructive analysis. This type of propaganda has lead people to believe half-truths about single-payer health insurance, or should I say freedomless, socialized, beaurocratic, wait-line, rationing, in-efficient health care.

- m.tsang

Market Failure v1.2

savemike@gmail.com (savemike) — Fri, 26 Jun 2009 14:00:00 +0000

In my last post I started to tell you why I believe the free-market is the wrong arena for health care. Specifically I stated how health insurance is unlike other "commodities" that are bought and sold in a commercial setting. These claims are largely based on the tenants proposed by the Nobel-Prize winning economist Kenneth Arrow in the 1960's. So in that respect it has failed to lower overall health care costs.

Also it has not been shown, convincingly, to improve overall quality of care. Let me clarify what I mean by convincingly. Obviously there have been some ways in which the health of our country has improved over the last 40 or so years. But how much can we attribute to the free market?

Lets take, infant mortality rates as an example. Those rates have improved significantly by coming down to 7 deaths for every 1000 births compared to 20:1000 in the 1970's. Alright, here comes the convincingly non-convincing part. However great that achievement of lower mortality rate is, we still place 29th in the list of first-world nations based on infant mortality. That is to say we rank lower than countries that have single-payer health care systems. So in that respect we can't say that the free market creates the best possible health care system possible.

Then to be completely fair I assume we should analyze the quality of our care internally within the U.S's own system. For that, there are a good amount of studies which have demonstrated that non-profit institutions have higher quality of care versus their for-profit counterparts. For example, in a 1999 study concerning quality of care between profit and non-profit HMOs, David U. Himmelstein, MD et. al. concluded that "Investor-owned HMOs deliver lower qualityof care than not-for-profit plans".

Similarly, Bruce E. Landon, MD et. al. concluded in their 2006 study that "patients are more likely to receive high-qualitycare in not-for-profit hospitals and in hospitals with high registered nurse staffing ratios and more investment in technology."

Unfortunately, similar studies show that this goes well beyond the hospital setting. For-profit nursing homes, kidney dialysis centers and other care facilities have all been found to have higher rates of code violations and less quality of care.

Here the evidence only corroborates the claim that the commercialization of health care does nothing to improve the quality of care received, and arguably in some cases lowers the quality of care. I guess this is what happens when your priorities happen to simultaneously be the patient and the shareholders! Nurses start to be staffed less abundantly, fewer services might be offered and motives may become dubious (William McGuire's 1 Billion Dollar Salary in 2006 as CEO of United Health Group) all in the name to save money and inevitably pocket that money.

- m.tsang

Market Failure v1.0

savemike@gmail.com (savemike) — Wed, 24 Jun 2009 14:00:00 +0000

Take a moment; sit down. Can you hear that? That's the sound of the free-market workings its talismanic properties to create an efficient, cost-effective and high quality health care system. Wait, you don't hear it? Its ok, neither do I. And we are not alone. But you wouldn't know it based on the current soiree of congressmen, senators and AMA members who don't dare consider a health system not based on the free market structure (ie. single-payer).

Ever since our current style of health care started to take shape in the middle of the 20th century, it has always been based on the free-market concepts. The exceptions are of course Medicare, Medicaid, SCHIP, the VA and the Native American Health Groups. But for the majority of the population we only have the option of picking a private insurer to cover our health care.

Anyway, as the free-market story goes, the price of obtaining insurance, seeing a physician and being checked into a hospital should go down based on the concept of competition. Additionally, in order to attain and sustain lower competitive costs, those institutions will be forced to become more efficient and deliver more effective services. Thus, this should keep costs under control and help improve over all quality.

However, since the 1960's, when major private and for-profit institutions started to enter the health care system, we have seen nothing of the sort. Why is this? In his book "A Second Opinion", Dr Arnold S Relman describes the evolution of the commercialization of health care and why it hasn't worked to keep costs down. Specifically, he mentions Kenneth Arrow's article "Uncertainty and the Welfare Economics of Medical Care" from the American Economic Review of 1963 which gives a pellucid view as to why health insurance is unlike any other "commodity" of the free-market.

For one, the relationship of supply and demand break down since the demand for health services is not regular or predictable. Two, the supply of services does not simply respond to the desires of the buyer. What that means is physicians are the ultimate informed consumers of health care. Although a patient can voice their opinion or insist on a specific treatment, the physician is the person who will be ordering the types and number of tests, procedures and prescriptions.

Three, there are limitation on who can enter the provider side of the market due to high start up costs and education, licensing and so forth. And finally, there is significant insensitivity of prices in the health care system. No hospitals or doctors are actively advertising lower prices or clearance procedures! Simultaneously, a majority of patients don't actively seek out those price reductions. There aren't many individuals who are willing to risk monetary savings for assumed quality of service.

Thus, we shouldn't expect to see many changes by trying to alter the current system a little here or there, or going as far as implementing cumpolsory health insurance. Let me include this caveat: by no means am I saying that single-payer health insurance is the answer to all of our problems. There are many other reasons why health care costs are continuing to rise and are hard to control (ie. how health care is administered). However, as Dr Michael Ybarr a states, "administrative costs make up 7% [of health care costs]. [Accounting] for $168 billion dollars annually". The significance of this number is shown when compared to Medicare's 2% administrative costs.

So, lets say, even if health care costs weren't escalating higher and higher ever year and the financial stability of our country didn't depend on recasting the entire health care industry, wouldn't it still make sense to change a system of payment if the saving would give our country back 168 billion dollars? The question is even easier to answer when you consider that amount could cover the 47 Million Americans who are currently without health insurance.

- m.tsang

Monopsony Myths

savemike@gmail.com (savemike) — Fri, 19 Jun 2009 14:00:00 +0000

Alright, here we are. On the verge of "change" in health care. Some - mainly conservatives - are upset because they think Obama's plan will inevitably lead the way to some sort of arduous socialized health system under the guise of single-payer. And then some such as I are upset because I know single-payer health care is not in the works.

There are many other aspects that completely upset me about the health care reform issue. However, today I am only going to address the payment side of things, mainly the single-payer obfuscations that persist in the public debate.

Issue numero uno: the name. The term single-payer in itself has become somewhat enigmatic, and is meant to be that way. Single-payer health care has been replaced with such titles as "Socialized Health Care" and "Public Options". The stigmas that are attached to these terms are not fitting in the least bit. Socialized health care is a system whereby the government runs and controls the financing as well as the delivery of health care. And yes that is complete government control.

On the other hand, single-payer health care is a system whereby all medical treatments are paid for entirely by one entity (ie. the government). In other words, an individual has complete freedom of choice to which doctor they would like to visit, which hospital to be admitted to and so on. The difference being that the payment would come from just one payer instead of the hundreds of private (mostly for-profit) insurance companies we have in place today.

So that's that. Same system of health care delivery we have today. Same hospitals, same doctors, same procedures. Single-payer would just take advantage of being a non-profit, consolidated and more efficient means of paying those doctors and hospitals. I find that the Physician's for a National Health Program sum the situation up quite eloquently:

"Private insurers necessarily waste health dollars on things that have nothing to do with care: overhead, underwriting, billing, sales and marketing departments as well as huge profits and exorbitant executive pay. Doctors and hospitals must maintain costly administrative staffs to deal with the bureaucracy. Combined, this needless administration consumes one-third (31 percent) of Americans’ health dollars.

Single-payer financing is the only way to recapture this wasted money. The potential savings on paperwork, more than $350 billion per year, are enough to provide comprehensive coverage to everyone without paying any more than we already do."

Over the next three or four posts, I will continue analyzing the single-payer debate from different angles. I will touch on topics of physicians autonomy, health care as a right v. a privilege, wait times and lessons from Canada, and other topics.

- m.tsang

The Great Escape!

savemike@gmail.com (savemike) — Tue, 09 Jun 2009 14:00:00 +0000

Well, I don't know how they've done it, but those beguiling little devils south of the border pulled off an amazing and lucrative stunt. Don't know what I'm talking about? Just think about it. We just happen to have contracted swine flu at a time that our nation's health care system seems to be in its most tenuous position, and Latin American countries are increasingly benfitting from US Citizens traveling across the border to go get medical treatment.

I know what your thinking. "But what do you mean 'they' pulled this off?". Eh hemmm. I think its quite obvious from CNN and FOX news reports that Mexico created this little virus in their backyard. (For those of you who are extremely credulous or oblivious, I am being facetious.)

But as for the amount of "medical tourism" ocrruing, that is as real as it gets. According to the most recent Gallup Poll on the matter, overall 29% of U.S. Citizens would consider traveling abroad to receive treament for various medical problems. How many of you (faithful and wonderful patrons of my blog) see the obsurdity in this? Although our country has some of the most skilled doctors and advanced treatments in the world, some of our fellow citizens are forced to travel elsewhere to see the doc.

So who are these people traveling abroad to get care? Upon first guess it seems quite logical to answer with the uninsured. I mean there are only 46 million of them in the country; I'm sure someone must be jumping at the opportunity to get their hip replaced for 75% off the $80,000 suggested price for someone who has to pay out of pocket.

Alright, that part of the survey is mostly unprepossessing. On the other hand, another facet to the survey tells of something a little more interesting: 26% of those who currently have health insurance would still consider traveling abroad to receive treament for a medical condition! Ok, now I'm a bit nonplussed. Why? Why would you risk traveling, sometimes extremely far distances, to receive health care in another country, if you already have health coverage down the street from your house?

Its no secret, the decision comes down to cost. I mean, no one goes to Guadelajara because they heard the cancer treatment is better than John's Hopkins. This poll is merely a reflection of the degree of underinsured in this country: the group of citizens living in parallel with the uninsured who make up those who can't receive adequate health care to effectively keep healthy.

The underinsured are a product of all parts of our health care system. They are products of private health insurers as well as Medicare and Medicaid. The Commonwealth Fund estimates that 25 million people in the U.S. are currently underinsured. An individual who is underinsured is someone who has insurance yet still has to pay more than 10% of their income on out of pocket medical expenses. These out of pocket expenses can be the cause of high deductables, co-pays, and limits on what the insurance company is willing to pay to medical providers.

Deductables can reach well over a few thousand dollars for the most non-comprehensive plans. And compulsory co-pays can slowly drain the income of a patient with chronic conditions. Medicare recipients often have to supplement their coverage with Medi-Gap plans whereby they pay extra for extended private coverage. On the other end of the spectrum payment-caps limit the types of procedures the insurance company will cover.

As a consequence a significant number of the underinsured forgo necessary medical screenings, check-ups and treatments in order to avoid forking over a large percentage of their income. What good is health insurance if you are afraid to use it because of colateral cost or if the health insurance company isn't willing to foot the bill? It just shows that the issue of increasing health expenditures is more than just a burden on the economy or a burden for those who can't "buy" into the health care system: those who've bought already bought into the system are having trouble getting the health care they need. Its sadly just another reason why complete reform of the financing and delivery of health care is needed.

Biased: Who Isn't?

savemike@gmail.com (savemike) — Thu, 04 Jun 2009 14:00:00 +0000

Just recently I heard former US Ambassador to the United Nations, John Bolton, comment on the controversy surrounding Sonia Sotomayor. Bolton, reading from two post-it notes, reflected on the Oath of a Supreme Court Justice which states,

"I, [NAME], do solemnly swear (or affirm) that I will administer justice without respect to persons, and do equal right to the poor and to the rich, and that I will faithfully and impartially discharge and perform all the duties incumbent upon me as [TITLE] under the Constitution and laws of the United States. So help me God."

Bolton stated that because of this oath judges are required to exhibit "blindness" in their decision making. That they shouldn't be interpreting how they would have written the law but how they believe the law applies based on its original intent.

However ideal, noble and effective this mode of decision making may be, how likely is it that anyone is truly "blind" in their decision making? Is it possible to be indifferent at all times when coming to a conclusion about some issue at hand? How can one be sure that others are being genuinely impartial?

Yet a majority of the public puts great faith in the belief that most professionals do carry out their work with equitable judiciousness. This is especially true in the medical sciences, epidemiology and the like.

Now, unlike the laws of a nation which are written with some degree of general context, data from a survey is less lucid. A law has structure and arguably a specified intended meaning. For example, let me make up a mock-law that states, "X" shall be required of all companies unless "Y" has occurred concurrently.

This differs greatly from epidemiological research where one might measure an "X" and a "Y" yet there is no "law" initially to state how those two are associated. That is the job of the scientist, the epidemiologist, the researcher: to judiciously interpret what associations, if any, exist between X and Y.

Raj Bhopal, from his 2nd edition of Concepts of Epidemiology, notes that, "interpretation is a matter of judgement which depends on the prior values, beliefs, and interests of the observer". And in epidemiological research interpretation is huge! It is not very common for diseases and conditions to have any one specific cause. Many times it is the case that factors "X", "Y", "Z", "A", "B" and "C" seem to all be related to a specific disease. Then the researcher needs to find out which factors are artifact, which have real associations and which influence the disease the most.

But what if the researcher's initial hypothesis was that only "A", "B", and "C" were contributing factors to disease? Might one be inclined to doubt the data, if for no other reason but, to alleviate the disappointment? How will that effect the researcher's analysis of the data? The influence of a researcher undoubtedly goes well beyond failed fruition. There could be long held beliefs on the subject, past experiences related to the study subject, entrenched interests supporting the researcher and so forth.

I can't imagine many scenarios that involve a scientist conducting research without interest: without some force of motivation to drive them to do what they do. Bhopal also points out, bias goes well beyond how you interpret data. It can start with how you phrase your question of study, your hypothesis and how you choose your methods or populations to study. Take this for example, how many hypothesis do you think sound like: "Diets with the highest fat content increase one's life span".

Now, I'm not saying that all research is unfair or biased. Most definitely many scientists start their research from a certain vantage point and judiciously come out thinking from the other side. The key is to be impartial in data collection, methods and analyzing. One needs to be aware of their own biases, inclinations and motivations. One should also be open to criticism, disappointment and alternative evidence. If not, not only is the scientist blinding himself from the truth, but more importantly they impede on the greater scientific community and the larger public from finding it as well.

- m.tsang

Planes, Trains and Swine Flu.

savemike@gmail.com (savemike) — Fri, 29 May 2009 13:00:00 +0000

Ok. Alright. Back at it! Returning from a momentary hiatus: gratefully not from swine flu or anything! Although, over my last month of traveling I have seen my fair-share of face masks, travel warnings, and hand sanitizer sell-out sprees.

A little over a month ago my girlfriend and I left for the East Coast -- New York to be exact. In the days leading up to our departure I had been perusing some of the new reports of "swine flu" that had been occurring in Mexico. And by this time, a young boy and a young girl in San Diego had been confirmed with this new influenza strain.

Then, as you all know, it hit: the pandemonium! Well, I didn't quite know at first. My girlfriend and I were less than vigilant about reading the news in our first days in NY. It was vacation. We were riding bikes around Manhattan and seeing shows in the East Village. News what? Plus, at the friend's house we stayed at we really had no access to TV or Internet.

But then it happened, I turned on CNN in our comfy, newly, checked in-to hotel! Duh, Duhn, Duhhhhhnnn: "Swine Flu and You: Pandemic hits level 3...no 4, now 5!" (exaggerated excerpt from CNN). I immediately started throwing my things back into my suitcase, put a garbage bag over my face and headed for home. Just kidding. Although, I think Vice President Biden offered similar advice to those who were considering traveling.

Swine Flu. That's it. That's all the news was talking about. Oh, and don't travel to Mexico. Don't let Mexicans travel to the US. Don't speak to Mexican's. Don't make eye-contact with Mexican's. Pandemic level is high. Look at us we are covering the news. We have terrifyingly important information and without it you might die?!

This is just a classic example of how news agencies intentionally perverse a subject and for what? Ratings? For example, lets take the World Health Organization's pandemic rating system. The system has six rankings. One being low human risk of acquiring the disease while six means there is sustained human to human spread of the disease. That's fine. It is good to know when a flu-strain has the ability to transfer itself from person to person. But that isn't exactly what the news agencies were telling us. They just liked to throw that five out of six ranking our there and say pandemic whenever possible. Pandemic is one of those words that just sound threatening. It's almost as if it's an onomatopoeia for "shit hitting the fan".

But back to the ranking system. Level five: significant human to human transmission in at least two countries. That is the level where we are currently at. I don't think the news agencies cared to acknowledge that based on that classification many diseases are a five out of six: the seasonal flu, herpes, aids. And that's not to say it isn't significant. But the news agencies made it seem like this was some uber-all powerful disease where they had to break out the pandemic scale for the first time just to get a grasp of how significant this was.

Also, at the time of the initial reports, there was a free-flow of the word "death" in the news. Now, I don't want to dismiss those deaths that have occurred. It is both sad and unfortunate that people have died during the spread of swine flu. However, the extent to which death has occurred is small in context to even the seasonal flu. According to the CDC approximately 36,000 people die from "seasonal" flu-related causes. To contrast, to date 95 people have died from swine flu.

Although I am sure all the news agencies would love to take credit for what seems to be a downturn in swine flu right now, these types of purposeful distortions perpetuated by them are largely unhelpful and irresponsible. A calm, clear iteration of what swine flu is, what the pandemic level actually means and its comparison to the seasonal flu could have been just as helpful. Plus, it could have avoided needless anxiety and questionable statements regarding Mexico and Mexicans. I am sure they understand that, but that doesn't matter to them.

So I will do it for them: Swine flu is a new strain of influenza which means that most people around the world have not built up a immunity to it yet. This makes the average person a little more susceptible to catching the disease. At this point there is human to human transmission with low mortality (approximately 95 people have died). Those who have died had other medical complications that had already weakened their immune systems.To contrast, the seasonal flu is also transmitted via human to human interaction with about 36,000 flu related deaths per year. Wash your hands frequently and cover your mouth when sneezing or coughing. And if you don't feel comfortable traveling to Mexico then don't. If that's the case you may not want to travel around your neighborhood either considering the US has 2,000 more confirmed cases of swine flu than Mexico does.

- m.tsang

Mike Is Currently: Blogging

savemike@gmail.com (savemike) — Tue, 05 May 2009 15:00:00 +0000

Hold on a minute. Keep waiting. Sorry about that. I was just updating my Facebook status alerting all eager listeners that I was about to blog about facebook updating. Why is it that some people are compelled to tell other people what they are doing no matter how trivial or banal? "I just ate pancakes", says joe facebook. Well, great. I'm just thrilled you were able to enrich my day so much. I can't wait to here what comes next. You just changed the channel on your tv? Shocking.

Its almost as if back in the good ol' days of internet messaging you had to have someone who wanted to talk to you in order to have a conversation. And now people don't actually have to be engaged in conversation to get their thoughts out. Almost reminds me of blogging. I said almost.

The difference is that most of what people twitter or update their facebook status about is stuff only pertaining to themselves. And its usually nothing interesting or special. They seem to do it just to do it. Its simply narcissistic and exhibitionist. And the more attention some people get the more obsessed they become with the online versions of themselves.

This can become a competition for attention. Competition is a natural activity for humans to engage in. Hot-dog eating contests, running, spelling. It doesn't matter. We like to compete, and that can be a good thing. It can make us healthier and smarter, or simply achieving a set goal can make us feel accomplished.

However, falling short of our goals can get us all wound up. Sad, enraged, defeated, confused and even envious. Although it might not be obvious, some of these mental dispositions can be constructive. As Randolph M Nesse MD and George C Williams PhD state in their book Why We Get Sick, "envy was useful to motivate our ancestors to strive for what others could obtain".

Being motivated towards attention-striving competition just seems mentally unhealthy. In the context of Facebook, others may become envious of what they perceive others to have via their online-selves. Not surprisingly, these online-personas are nothing more than meticulously compromised versions of themselves. As Joanna Lipari, a clinical psychologist at the University of California, Los Angeles notes, "People only present the crème de la crème of their lives on Facebook. It's very seductive."

Nesse and Williams note that "extensive studies by psychologist Douglas Kenrick have shown that after being exposed to photos or stories about desirable potential mates, people decrease their ratings of commitment to their current partners." And as individuals become addicted to these types of sites and more obsessed with competing for attention and perfect pictures it could prove to bring on a number of psychological ailments. I think a friend of mine summed it up quite nicely the other night when he said, "all I care about is looking at pictures of girls I like who are with other guys so I can get all bent out of shape about it".

- m.tsang

Necessary Change

savemike@gmail.com (savemike) — Thu, 30 Apr 2009 15:00:00 +0000

During the first one-hundred days of Obama's presidency there have been many debates about health care. Many democrats such as senators Max Baucus (Mont) and Ted Kennedy (Mass) have been eyeing health care reform down for a long time. But they aren't the only ones. Another notable democrat Peter Orszag, the new Director of the Office of Management and Budget, has a few ideas of his own.

Orszag's opinions have garnered a little bit of attention in the past few months. For one, he has asserted that without controlling health care costs we will persist to have an intractable budget and worsening debt. He's right, but that's old news. Most of those in the government know that we need to control health care costs, but few have proposed any ideas like his.

The traditional way those in government, especially republicans, have addressed controlling health care costs is by altering how it is paid for. Either through alterations in medicare or medicaid (to try and reduce the government's burden) or through increasing "market competition" (to lower rates on private plans). And yes, altering the way we pay for health care can help control costs and this should be thoroughly addressed -- you'll notice single payer insurance hasn't been realistically considered as an option.

However, Mr Orszag has brought to attention an important fact: the way health care is delivered also needs to be changed. As the Ney York Times reported, "to address the problem, he wants to do no less than change the way medicine is practiced, eliminating unnecessary tests and unproven treatments in favor of what he calls a higher-value approach that he says will actually improve health."

I touched on this a bit the other week in my post "Why Are Costs So High?". In it I comment on the fact that we tend to utilize expensive procedures and options much more often that other countries. However, we don't have any markers that show we get added health benefits above and beyond other countries. In fact, it is quite the opposite. With our higher infant mortality rates and lower life expectancy, we rank as one of the lowest developed countries in terms of health.

In his book Introduction to Health Policy, Dr Donald Barr M.D. also talks about excessive tests and unproven treatments especially when it comes to new technology. The history of treating high blood pressure is a useful example. Traditionally, physicians prescribed relatively cheap diuretic pills to patients for their high blood pressure. Then calcium-channel blockers became popular in the 1980's. Again, in the 90's a new category of drug called an ACE-Inhibitor became widely used. There was a problem though. To physicians, the efficacy of these treatments was inherent in the fact that these pills were new and not necessarily that they were any more effective.

Don't get me wrong. They obviously worked because patients were getting the results they needed. However, It took nearly two decades for clinical evidence to surface that showed the newer treatments were no more effective than the older diuretics. Plus when you take into account that these pills cost 10-15 times more than the $10 diuretic pills, you start to understand the usefulness of having a system of evidence-based medicine: practicing medicine that is put up against the scientific-method to assess the quality of evidence on a cost-effective basis.

And that is just one area in which we can change how health care is delivered. There are other ways in which we can save money and change the delivery of care. And that will be essential to fixing our health care problems. Focusing only on the financing of health care alone (ie. single-payer) isn't going to solve the problem of increasing health care expenditures. Only a comprehensive approach will.

- m.tsang

Aborting Appointments

savemike@gmail.com (savemike) — Tue, 28 Apr 2009 15:00:00 +0000

One-hundred days. It's been nearly one-hundred days since Obama has taken office. A lot has been going on: countries have been visited, documents have been released, money has been spent and secretaries have been appointed. Well, all but one. As Carrie Brown from Politico Magazine expressed last Friday, "the Department of Health and Human Services holds a dubious distinction in the Obama administration: last on the list to install a secretary."

Who could have guessed HHS would be the last to appoint a secretary? Tom Daschle was practically one of the first cabinet members nominated by Obama immediately following the election. Daschle was anticipated to be a major impetus of change in health care. That was until he got held up on tax issues during congressional hearings. As ABC News explains, "Daschle failed to declare on his income taxes a chauffeur service that he used for years, as tax laws require. Though he corrected the violation during the vetting process, he was unable to overcome the political hurdles that came with the territory."

So on February 4th, Daschle removed his name from nomination. Less than a month later Obama nominated former Governor of Kansas Kathleen Sebelius to be the new Secretary of HHS. Sebelius, too, has been met with opposition in her appointment. Republicans blocked a vote last Thursday that would have most likely ended up in her appointment as secretary of HHS.

Their reasons? According to the Associated Press, RNC Chairman Michael Steele was quoted as saying, "Significant questions remain about Gov. Kathleen Sebelius' evolving relationship with a late-term abortion doctor as well as about her position on the practice of late-term abortions. If Gov. Sebelius and the Obama administration are unwilling to answer these questions, President Obama should withdraw her nomination." These inquiries are born by the fact that Sebelius received over $35K in campaign contribution from a Dr Tiller who owns an abortion clinic in Kansas.

It doesn't matter to Republicans that "Sebelius told the Finance Committee that she personally opposes abortion" according to the AP. However, they apparently think there is something sinister lurking behind the prose of this woman who respects the rights of those who want the choice to have an abortion. As Governor, Sebelius repeatedly vetoed legislation redacted by anti-abortion groups who tried to take away a women's right to choose.

If I'm not mistaken that should be the type of person congress is looking for: one who upholds the right of choice. During the election polls showed that most people were actually in favor of abortion by some 13%. But by and large I think it is safe to say that the majority of people are split down the middle regarding this issue. So why not have a woman as secretary of HHS that inherently sees this division? As one who personally opposes abortion, but also upholds the right for women to choose.

- m.tsang

Smoking = World War III

savemike@gmail.com (savemike) — Fri, 24 Apr 2009 15:00:00 +0000

What costs five dollars and can catalyze World War III? Cigarettes! Alright, you got me. In the U.S. cigarettes on average cost less than five dollars with tax. Ok, and they won't cause World War III. I was just attempting to utilize what advertisers and marketers call "somatic markers". In the book Buy-ology Martin Lindstrom explains that "somatic markers are typically associations between two incompatible elements".

In the brain they work as shortcuts to create a linear, succinct train of thought. That way we can "connect an experience or emotion with a specific, required reaction" states Lindstrom.

Earlier this month, there was an advertisement that incited a lot of contention for depicting a kid at the train station without his mother. The kicker? It was an anti-smoking advertisement that intimates, “this is how your child feels after losing you for a minute...just imagine if they lost you for life.” Unfortunately, the debate isn't centered around whether the message is effective or valid. People seem to be more concerned about the crying child in the video: whether he was truly acting or not. (I really don't wish to debate that aspect of it. But I will say this, I have seen an elephant instructed to paint another elephant. I'm sure someone can get a kid to cry on command.)

What I do wish to comment on is that this video makes use of the somatic marker in a very pointed way. It connects the experience of losing your child, or your child losing you, through smoking. As I recounted above, somatic markers are used to link two elements that aren't traditionally associated, and that association is supposed to elicit specific responses. In a way, the ad links two things that are conceivably associated. People do die from smoking, and they inevitably will be survived by some family or friends. Yet at the same time that association is about the largest tangible stretch one could propose.

I wonder, how effective is this message?

Lets take a look at the typical associations anti-smoking campaigns utilize: disclaimers on cigarette boxes. We've all seen them. The black and white letters advising you that smoking will cause: birth defects, lung cancer, and emphysema among other things. This association is much more straightforward, thus you might not think there is an inherent difference in these two ad techniques I've mentioned. But I do.

In his book, Lindstrom notes one particular study in which brain activity was recorded using fMRI while test subjects were shown anti-smoking ads. The results? The most activity in the brain was recorded in the Nucleus Accumbens. Don't worry, it meant nothing to me when I first read it either. That's a region of the brain strongly associated with pleasure and addiction. Thus, what Lindstrom was arguing is that those ads are actually counterproductive and "encourage smokers to light up".

How is this so? The hypothesis lies in the existence of Mirror Neurons. These neurons have been shown to exist in primates and are thought to exist in humans. In primates, mirror neurons have been shown to fire while both participating in an action, such as picking up a nut, or just watching that action take place.

Therefore, it seems as though when smokers see or read traditional anti-smoking ads their mirror neurons fire and activate their nucleus accumbens. You can imagine this through the envisioning the thought process step-by-step. You see the warning of emphysema, telling you it is caused by smoking; you think of the smoke in your lungs; you imagine having to physically take a drag in order to get the smoke in your lungs; and by this time your mirror neurons have already started freaking out. Done. Over. You want to smoke.

Why is this different than the video ad's technique above? Because the association is remote. There are too many reasons why a child and a parent could become separated. It should be hard for the brain to linearly connect smoking with losing your child. That just isn't a known association, and maybe it won't set off any mirror neurons.

However, the point being is that this remote association has been forged and it is very memorable. Now, possibly, not only are no mirror neurons firing, but you might have some furtive apprehensions about wanting to light that cigarette. Advertisers use this technique relentlessly. Ever watched a commercial and said "what? how is that related?". It doesn't matter. The ad now created an alliance between two disparate trains of thought, and next time you look for toilet paper you might think "yeah, guys with double comb overs are funny...I'll buy that toilet paper".

So if you take away anything from this lot of information remember this: smoking isn't exactly what is considered healthy. Every eight seconds someone dies from smoking; twelve times more British citizens have died from smoking than in WWII; smoking kills one in ten adults globally; and smoking related diseases caused more than $150 billion dollars in health care expenses in the U.S. Oh, and cigarettes will kill your pets.

- m.tsang

Poor Health, Literally

savemike@gmail.com (savemike) — Wed, 22 Apr 2009 16:05:00 +0000

On Monday, I came across the Union Tribune's article that stated San Diego County Health Officials now claim that the number one cause of mortality in the county is cancer. Historically, cardiovascular disease was the number one killer in the county. That is consistent with the national trend where cardiovascular disease is the country's top killer -- cancer and stroke follow as the second and third leading causes of death in the nation respectively.

But for a number of reasons, in many areas cancer has supplanted cardiovascular disease's spot as the nation's largest health threat. San Diego County joins the ranks of other areas in the U.S. that are faced with similar statistics. States such as Minnesota, Washington, North Carolina and Colorado all list cancer as the number one cause of death among its residents.

After reading the article I was able to peruse through some of the other reader's comments, and I came across this opinion: "...disease effects the rich and the poor. It has no preference." Well, honestly it does seem to be that way doesn't it? I can't imagine rogue cancer cells, infectious bacteria or menacing viruses deny applications based on a person's gross income the year before. However, there are many well-designed studies that have demonstrated that the poor and less-opulent bear a disproportionate amount of the world's health woes.

Last December, Medical News Today reported on a study out of Colorado called "Cancer and Poverty in Colorado: 1995 - 2006". The study analyzed the rates and incidence of multiple cancer types across the state of Colorado. Overall, the report noted that poorer residents of the state had a greater disadvantage in battling cancer. The authors of the report note that, "for most cancers, Coloradans who lived in poorer neighborhoods were more likely to die within the first five years following cancer diagnosis".

They went on further to state, "the inequities of the health care system put poor people at a tremendous disadvantage in the fight against cancer. Poor people are less likely to get properly screened for cancer, although early detection is a crucial component in fighting its development. Poor people also are likely to have poorer health insurance coverage or no coverage, and coverage plays a crucial role in an individual's [health]."

For instance, lets look at Medicare coverage. Patients on Medicare coverage often have less aggressive treatment and are not given the same amount of care than those with private insurance are provided. This has been shown to be especially true for patients with kidney disease. Even though under Medicare a patient is covered for kidney treatment. Shockingly, medicare patients are consistently referred less often than those with private insurance to undergo kidney transplantation.

Moreover, as Donald Barr MD says in his book Health Disparities in the U.S., "the relationship between social class and health is a continuous relationship that spans all levels of the social hierarchy from the very lowest to the very highest". Health tends to get better proportionally as one's socioeconomic status increases.

This has been demonstrated in the Whitehall study. This study tracked the health, morbidity and mortality of workers in the British Civil Service for more than twenty years. Within the U.K. all citizens are all guaranteed the same health coverage and access to care. Thus one might assume that health of their workers would be less stratified. Surprisingly enough, the study demonstrated that, starting from the lowest, less-prestigious job positions chances of mortality steadily declined as you traveled to the ranks of CEO's.

However, why relationships between being poor, having lower socioeconomic status and health exist have not fully been made aware yet. Similarly to what Jillian Jacobellis said in Medical News Today, I am not arguing that being poor is the ultimate cause of acquiring a disease. It is clear that there are many factors that guide the health of any one individual or any one society: health behaviors, lifestyle, income, place of residence.

Although it is clear that being poor significantly compounds ones chances of acquiring disease and succumbing to its pernicious effects. It is unfortunate that where one lives might make them more susceptible to, say, cancer, or that how much money one makes might make them more susceptible to high-blood pressure. But it does. Sadly, it seems as though disease has an inherent propensity. A propensity for the poor(er).

- m.tsang

Because Its Socially Accepted

savemike@gmail.com (savemike) — Fri, 17 Apr 2009 16:02:00 +0000

Non-scientific claims. Warped sense of logic. Need for immediate gratification. Mixed with a little stubbornness and perhaps credulity. Out comes the drive to begin the "Master Cleanse" detox diet. Also known to detox connoisseurs as the "Lemonade Diet" or "Cayenne Pepper Diet".

This so-called diet is actually a concoction of maple syrup, lemonade, and cayenne pepper. That’s it. Mix that in a cup and drink it a few times a day. The individual is supposed to be on the diet for about ten days. Although some people take it to the extreme and have reported being on it for upwards of 40 days!

The basic tenants of this diet were born by Stanley Burroughs*. As a self-proclaimed natural healer focusing on the practices of alternative medicine, Stanley claimed he could cure many ailments and diseases through reflexology massage sessions, exposure to colored lights and lemonade concoctions. Don't worry. It its not as specious of a treatment as it sounds. There is a completely cogent explanation for his treatments: Mr Burroughs actually found and translated the lost tablet of Joseph Smith.

The diet has been further perpetuated by Peter Glickman. Glickman basically took Burroughs' lemonade diet, added the syrup and pepper and wrote a book about it in 2004. He again advocated that this diet can magically do many things like rid the body of toxins, cure ulcers and break one free from habits like smoking. I say magically because these claims by the likes of Glickman and Burroughs have no backing by science based medicine. There has never been any evidence submitted to a peer-reviewed journal showing empirically that any of these claims are true.

Actually, there is one outcome that is typical of this diet: weight loss. It’s no surprise. Of course you will lose weight if you are only ingesting syrup and lemonade daily. Given a few hundred calories a day, your body is going to need to get extra energy from somewhere. Mainly from fat and muscle. Your muscle and bone will start to rarefy due to the lack of nutrients in the diet such as protein and calcium. In fact, prolonged fasting such as this can elevate compounds called Ketone Bodies that lower the pH throughout the body and can have damaging effects on cells, tissues and organs.

I have come to think that the people who take on this diet inherently understand that it probably isn't as good for them as it sounds. They see the smoke and mirrors of "detox" but choose to embrace the gimmick anyway for what it really does: helps you lose weight by starving yourself. I was having a hard time understanding this, until a friend proposed an idea to me. She said simply, "it is socially accepted anorexia". I kind of thought "yeah yeah yeah, but what about the ketone bodies do you think they heard me say that"?

However, the more I thought about it the more it became clear that this is a completely viable theory. Its a common way of life: immediate gratification. People want the results but don't want to put in the work. Not only that, but our society puts a high price on being thin, especially for women. An idealized image can be hard for people to obtain with their regular routine. It can be difficult to go join a gym or start running regularly.

So why not? Why not starve yourself for ten days to lose the weight you want like Peter the Gimmick Clickman have proposed? Why not lose weight with the Lemonade Diet like Beyonce did for her role in Dreamgirls? Because you can eat breakfast, lunch and dinner and still lose weight. Because your body doesn't need to be starved to detoxify itself. Because a gimmick is a gimmick, and if you understand that from the get-go than there is a greater problem you need to deal with even if it is socially acceptable.

- m.tsang

[*Mr Burroughs' treatments actually ended up killing one of his quote, un-quote patiends]

Hold The Sugar

savemike@gmail.com (savemike) — Wed, 15 Apr 2009 14:56:00 +0000

Are you one of the lucky television viewers who has witnessed the horrible High Fructose Corn Syrup (HFCS) commercials? I'm sorry. Well, beyond the absurd script and the clear bias of the Corn Refiners Association there is a real debate at hand: how bad is HFCS for us? Does HFCS cause obesity? Will HFCS steal your car stereo in the middle of the night?

First, let's brake it down in context of the contentious debate regarding HFCS versus Table Sugar (Sucrose). In this country, over the last 50 years HFCS has edged its way onto our tables and into our food. Traditionally, Sucrose was used as sweeteners in soft drinks, juices and other foods. Then, HFCS was developed in the 1950's, but it wasn't initially heavily used in foods. However, tariffs on imported table sugar plus subsidies to corn farming (which is the source of HFCS) made it cheaper to use HFCS in products in the U.S. than to use Sucrose -- thats why you can buy Coca-Cola in Mexico made with Sugar and not HFCS. Currently, HFCS receives equal usage in food products as does sucrose.

Now let's look at these two chemically. Sucrose is a compound of two individual sugar molecules: one Glucose and one Fructose. These two are connected to one another through a hydrogen bond. So whenever you ingest Sucrose you get exactly 50% Glucose and 50% Fructose. HFCS is also made of Glucose and Fructose, however there is no bond holding them together. Thus, depending on the product, you could be ingesting either 42% fructose, 55% fructose or even 95% Fructose (rarely used).

Metabolically speaking, these two substances haven't proved to be much different either. While its true that Sucrose absorption is technically limited by the amount of enzyme sucrase available (which breaks the bond between glucose and fructose), studies haven't shown that there is any real difference in blood glucose levels from ingesting one or the other.

So, what HFCS proponents enthusiastically point out is that these two substances are virtually the same, and they are both "natural". Also, Fructose is the sweetest of all the sugars which makes it attractive for food processing. Thus, why not use HFCS?

As Kathleen J Melanson et al state in their December 2008 article, " although Fructose is present in fruit, honey, and some other carbohydrate sources, the quantities consumed from these sources are not as large as is found in foods and beverages sweetened by HFCS".

In contrast, the most common sugar in nature is Glucose. Glucose comes in the form of starch (in plants) and glycogen (in animals). Glucose and Fructose have inherent differences in their chemical properties. Within the stomach, they use different transport channels to enter the body. Glucose can activate insulin release, but fructose can't. Also, Fructose can bypass a critical step in fat synthesis that Glucose cannot.

The current research also suggests Fructose plays a much more noxious role than was previously assumed. For example, many studies have demonstrated that Fructose effectively inhibits the feeling of fullness while eating. "Stimulation of the AMPK/malonyl-CoA signaling pathway from fructose leads to more eating, while glucose intake leads to less eating, as glucose levels rise in the brain" states Kathleen Blanchard RN reflecting on recent research out of Johns Hopkins University.

Increased Fructose consumption has also been shown to decrease Leptin concentrations. Leptin is a hormone that regulates appetite throughout the day and is associated with energy expenditure. Therefore, as Kimber L Stanhope and Peter J Havel suggest prolonged Fructose consumption could be "contributing to weightgain and obesity as a result of reduced insulin and leptin signalingin the brain".

As George A. Bray, MD, stated, "it is interesting to note that nature did not select fructose to circulate in the blood." "Human milk has essentially no fructose, nor do the foods that comprise most traditional diets."

Some companies have tried to shake this bad press and are now advertising that their products contain only natural sugar and no HFCS. Hopefully this whole time your intuitive mind has been screaming "but Sucrose contains Fructose too!". And it does, as I clearly stated above. Yet, until clear, definitive data arises on these subjects we will still be left with increased sugar levels in our food -- in the form of Sucrose, HFCS or some other sweetener.

The average person in the U.S. has steadily increased the amount of calories they eat over the past half century. And there is strong reason to believe added HFCS or even Sucrose in processed foods and beverages abets this trend. "Between 1991 and 2000 there was a 120% increase in calories from HFCS" argues Kiyah J Duffey and Barry M Popkin. Multiple studies have also shown clear evidence that drinking beverages with added sugar amounts to increase weight gain.

So what is one to do?. Try curbing your consumption of foods with added caloric sweeteners altogether. Stay away from sugary beverages. Drink water instead. However, in a processed food haven like the U.S. you might be trying to find yourself a needle in a haystack.

- m.tsang

If the Price Is Right

savemike@gmail.com (savemike) — Thu, 09 Apr 2009 16:15:00 +0000

Over the last few posts I discussed a few reasons as to why our health care costs are so high in this country and also how the control in health care expenditures has become intractable. Even with this large and uncontrollable health care spending there are over 46 million citizens uninsured in this country. An increase in the number of uninsured is partly due to the lack of employer-based health insurance. Since the start of the recession, roughly 500,000 working aged Californians have lost their jobs. This, and the fact that some employers find themselves struggling to insure their current employees, is going to significantly contribute to the amount of uninsured people.

That's when public coverage comes in. Programs such as SCHIP have actually curbed the amount of uninsured in this country by covering children whose families meet certain income requirements. Also, the American Recovery and Reinvestment Act of 2009 (ARRA) will allocate a large sum of money into other public programs such as Medicare. The ARRA designates $150 billion for health care-- with $86.6 billion of that going straight to Medicare.

However, what good is it to give out health insurance if doctors won't accept it? According to Julie Connelly of the New York Times, many more doctors have been turning down Medicare and Medicaid payments. Connelly notes that some doctors have "opted out of the insurance system" altogether, or "they are not accepting new patients with Medicare coverage." Most of these doctors are internists and primary care physicians, but specialists such as gynecologists and psychiatrists have also been rejecting the plans. The reasons why aren't new or unusual: "reimbursement rates are too low and paperwork too much of a hassle" states Connelly.

Reimbursement rates are too low they say. It is true that physicians aren't reimbursed the full amount charged for an office visit or procedure through Medicare and Medicaid. The typical reimbursement to the physician is 80% of the actual fee charged. That doesn't seem that unreasonable. Especially in light of the fact that, as I said last Tuesday, the fees that physicians in the U.S. charge for general lab tests, procedures and office visits are typically 30% higher than what their counterparts in Canada are charging.

I can see their frustration to an extent. A doctor will complete a certain amount of work and charge the system accordingly. Thus, they expect to see that money. They've most likely calculated their budgets according to that pay scale. And above all, they earned it. So, when they aren't getting the remuneration they expect it is probably very discontenting.

However, there seems to be more to it that just that. For starters, not all doctors are opting out of the Medicare system. As Connelly notes, "a 2008 survey by the Texas Medical Association found that while 58% of the state’s doctors took new Medicare patients." This is very similar to the percentage of physicians who support single-payer national health insurance in this country. A 2008 report showed that 59% of physicians support this idea while 32% reprove it.

I believe the two polls express opinions concerning one underlying concept: autonomy. Both the Medicare situation and opinions regarding single-payer national health insurance deal with physicians having to relinquish a certain amount of autonomy in their practice. That autonomy is the freedom to charge what they wish.

I am going to take two excerpts from Dr Donald Barr's (MD, PhD) book Introduction to U.S. Health Policy that shows two disparate positions regarding this autonomy in more detail. The first is from Dr R. M. Sade and was published in the New England Journal of Medicine in 1971:

"Medical care is neither a right nor a privilege: it is a service that is provided by doctors and others to people who wish to purchase it".

On the other hand, we have the position of Dr. John Bowman who released this statement in 1918:

"As a people we are accustomed to hospital service; we look upon that service no longer as a luxury which we may buy, but rather as an inherent right...we regard the right to health today as we regard the right to life".

In the former view, either you have the money to pay what a doctor will charge or you don't. These are the doctors who feel they shouldn't have to comply with a system that won't let them freely charge what they wish. The latter view suggested that we should all be able to receive care when necessary. If that means accepting a discounted rate on services or supporting a single-payer national insurance system than so be it.

I interpret the former view as one that flirts with selfishness. And being a doctor requires a bit of something quite the opposite: selflessness. The motivation to be a doctor seems that it should stem from wanting to help others even when the price isn't right. Although I understand, not everyone can walk around wielding their services for free. No one can live off of that, and certainly no one expects their doctor to work for free.

The main point is: doctors do and will still get paid if they accept Medicare payments. The same goes for a single-payer insurance plan. Also, a doctor still has complete autonomy over how, when and in what manner they wish to wield their services. They are no-less a physician because of these systems. So which price are physicians willing to pay in this country? The price of fiscal autonomy? Or the price of health for their fellow citizens?

- m.tsang

"Why Are Costs So High?" for 2.2 Trillion

savemike@gmail.com (savemike) — Tue, 07 Apr 2009 15:40:00 +0000

I ended last week with a post that pointed out something most of us already know: we can't afford our current health care system! Literally. I'm not just saying we can't afford it now, or we couldn't afford it in the 90's. For the last fourty years the cost of health care has been out-pacing inflation and the growth of GDP almost two to one. That means tax revenues are increasing only half as fast as health care costs. Think about it in terms of government spending: 46% of all health care costs are paid by local, state and federal government funds, and if tax revenues are outpaced by spending than you increase your debt. If you notice that something is absurdly inept with this situation then you win the daily double. New category, "Why are costs so high?" for 2.2 trillion dollars.

Taking a look to our neighbors in the the North can help us figure out part of this problem. Overall, Canada's health care expenditures as a percentage of GDP were 9.9% in 2003 as opposed to 15% in the U.S. Whats more is they only have to shell out half the amount of money per person to cover everyone in their country with health coverage while we have over 46 million uninsured. So how is it that we spend on average twice as much or more on health care compared to most other industrialized countries yet we can't afford to insure all our citizens?

As the Organization for Economic Co-operation and Development stated in their recent report Health Care Reform in the United States, "it is difficult to judge whether the high level of health expenditures in the United States mainly reflects a high volume of health care services or high relative prices for health care." Alright, lets hypothesize for a moment: maybe all the smog and fast food is giving us health problems and we see the doctor much more often than other countries? The answer is frankly we do not! Donald Barr, M.D. points out in his book An Introduction to U.S. Health Policy that "people in the U.S. go to the doctor 28% less often than people in Canada and are admitted to the hospital 9% less often than Canadians."

Are you as nonplussed as I am? Lets recap as I am in disbelief: Canadians spend less money per person for their health coverage, the go to see the doctor more often and they are admitted to hospitals more frequently, yet we spend more and have 46 million uninsured. Unbelievable, truly unbelievable.

If we aren't using health care services as often than we may quite possibly be paying more per service rendered. Dr. Barr notes that "resources such as laboratory tests, medications, and supplies used in providing care in physicians' offices cost 30% more in the United States than comparable resources in Canada." He also points out that U.S. physicians charge more than two and a half times more for services rendered to their patients.

Moreover, when we do go to the doctor we receive some of the best and most advanced treatment in the world while utilizing some of the newest and most expensive procedures available. And we as patients put an extremely high value on these services. Often we equate new and expensive with better and effective. We want to see x-rays; we want MRI's. We want CT scans and new drugs. According to the OECD, the U.S. has the second highest number of MRI machines and CT scanners per million individuals. (Trailing only to that of Japan whom spend the second lowest share of GDP that is put towards health care, 7.9%).

In the U.S. most of us expect nothing but alacrity in a physicians' use of new or advanced services, and much of the times physicians themselves eagerly await the chance to wield them too. This can be seen as a reflection in the amount of specialists there are in this country. Over the last 30 years, the number of specialists has nearly doubled while the number of primary care doctors has only increased by about half. Close to 70% of physicians are specialists in the U.S. states Dr Barr. That is in stark contrast to Canada where they have a 50/50 ratio of primary care to specialist ratio.

The United Kingdom, under a universal health care system might I add, has a similar ratio of doctors like the United States, yet their national health expednitures are the lowest in terms of GDP! Again, this can be at least partially explained by the lack of celerity in which they utilize specialist services and expensive technology. Before a patient can be seen by a specialist they must first be checked out and referred by a general practitioner. This "gate-keeper" method is virtually unknown in our country whereby we are able to go visit our cardiologist today if we impulsively wanted to do so.

Alright, we now realize medical services tend to cost more in this country; we utilize a higher volume of expensive services; and doctors are payed more in the U.S. So we must be doing it for some good reason, right? We should be pretty damn healthy at this point. Surprisingly we aren't saliently any healthier than other industrialized nations, in fact in some ways we have poorer health. For example, the OECD reports that out of the top 27 industrialized nations the United States ranks 23rd in terms of life expectancy. This poor ranking has much to do with the fact that we also have the second highest rate of infant mortality of those 27 nations - trailing only to that of Slovak Republic.

But don't get me wrong. Lowering physicians pay in this country, lowering the prices of medical services or trying to limit the use of expensive technology isn't going to solve all problems associated with health care expendituers. The technology is beneficial to many people, and the specialists are needed. But maybe not everyone needs an MRI when they go see their doctor for a hurt knee or the newest drug for their hypertension, which will cost more. Those are actions that can help the problem at least a bit. Although, that will take effort and a shift in our proclivities. A shift away from "a system that provides the most expensive care in the world while also excluding the largest number of people from care" (Dr. Barr).

- m.tsang

Playing Catch-Up

savemike@gmail.com (savemike) — Fri, 03 Apr 2009 15:00:00 +0000

By now we are all well-aware of the infelicitous turn our economy has taken since the later half of 2007. The housing bubble, job losses, bank bailouts, investment firm collapses and accumulation of debt have all turned us upside down. And here, in California, we are clearly no exception. In just one year California has jumped up 4.3% in unemployment to a total of 10.5%. More than 481,000 homes were relegated to foreclosure in 2007. And we have a projected 14 billion dollar deficit to boot.

What this actually means is that we have no money to spare. So how can we afford to pay for all the things we need? Like health care? Technically we can't. As Donald Barr, MD notes in his book Introduction to Health Policy, "state and local governments typically are forbidden by law from engaging in deficit spending." Therefore, there are realistically only two ways to get funds for services like health care:

a) Through increasing taxes, or b) Taking funds from other programs

Programs and services will have to be dropped in order to stay afloat fiscally. "Likely targets for deeper budget cuts include higher education, public schools, transportation, the prisons and health care" notes Eric Bailey of the LA Times. (If you are scratching your head also because you are unsure what else the government is spending our money on, you are not the only one)

That is exactly what is on the upcoming special election ballot on May 19th. Propositions 1D and 1E deal with such issues. According to the California Healthline,

"Proposition 1D would temporarily shift $608 million from First 5 programs to fund services for children, including programs for foster children and kids with developmental disabilities. First 5 was created in 1998 when voters approved Proposition 10 to increase the state tobacco tax to fund early childhood health care and education programs.

Proposition 1E would shift $226.7 million from mental health care programs funded by Proposition 63 to the existing Early Periodic Screening, Diagnosis and Treatment Program for low-income children for two years."

Along with 4 other ballot initiatives, Governor Schwarzenegger needs these all to pass in order for our state's budget to stop drowning in debt. But these piecemeal measures aren't going to pull us out of the water. Nationally, health care costs occupy close to 16% of the total GDP in the United States. Barr also notes that "governments at all levels - federal, state and local - are responsible for a combined 46% of all health care expenditures".

The 140 Billion that will go towards health care from the stimulus package is a nice gesture, but its not going to cut it. As Arnold Relman, MD exclaims in his book A Second Opinion, "the average rate of increase in health expenditures since the late 1960's has been between nine and ten percent per year, which is more than twice the rate of general price inflation".

Do you see the problem yet? Government obtains the money it needs for health care through acquisition of taxes, and taxes generally rise at the same rate as GDP growth. But Barr sagaciously points out "health care expenditures rise faster than GDP". Thus, the government and all purchasers of health care have historically been playing an unachievable game of catch-up. Unless major reform is considered in the financing, organization and delivery of health care we are only going to be running into short sighted dead ends. That is the challenge we face - as patients, doctors, health care practitioners, politions and citizens.

- m.tsang

Warning: Reading This May Upset Fast Food Industries

savemike@gmail.com (savemike) — Tue, 31 Mar 2009 16:15:00 +0000

Can the Food Industry Play a Constructive Role in the Obesity Epidemic? That is both the title of an article and the question posed in the October '08 issue of the Journal of the American Medical Association (JAMA). David Ludwig, MD and Marion Nestle, PhD survey the so-called "responsible policies" food companies are taking on to promote healthy eating and living. They note how companies such as Pepsi Co, McDonalds, Kraft and Coca-Cola state they are trying to educate the public about energy expenditure (calories consumed v calories burned in physical activity), nutrition and encouraging physical activity.

What, you mean you haven't seen a McDonald's marathon (there are actually McDonald's Marathons)? And of course they are trying to educate us on nutrition why wouldn't they? I mean, they are in the business of selling nutritious foods. They understand the human body and its physiology so well that they've pioneered techniques to pack as much fuel as possible in their foods - a.k.a refined starch, concentrated sugars and low quality fats - in order to make our bodies work and feel better.

My diatribe brings up an interesting question: do major food companies in fact have a duty to try and curb their malignant effects on society? And can we rightfully place blame on these institutions for adverse health outcomes the world faces? That is to say who should be acting more responsibly consumers or the food industry?

The authors of the JAMA article point out what Michele Simon, professor of health policy at University of California Hasting's, argued in her 2006 paper Can Food Companies Be Trusted to Self-Regulate?

"The food industries lobby vociferously against policies to improve children's health, make misleading statements and misrepresent their policies at government meetings and in other public venues; and make public promises of corporate responsibility that sound good, but in reality amount to no more than public relations"

Thus we have major food industries not only promoting unhealthy foods, but also obfuscating any policies or regulation aimed at safeguarding the public from their products. So these industries are allowed to flood the market advocating the purchase of unhealthy foods and advertise them in virtually (literally virtually) all avenues of life, and consumers are to bear, what, the total responsibility for sound choice and good decision making? Let's put it this way, as Zoë Robert stated in her article Junk Food Advertising: Are Children the Biggest Losers?, "for every $1 USD [the World Health Organization] spends on trying to improve nutrition around the world, $500 USD is spent by the food industry promoting processed foods".

Therefore back to one of my questions I brought up, does the food industry bear a significant part of the blame and responsibility of the ill-health effects associated with their foods. I think that their lack of discretion says it all: from carefully calculated advertising placements in schools to their enlistment of "lifetime customers" - as Eric Schlosser warned inFast Food Nation - with products such as McDonald's happy meals.

Do these food industries have a duty to try and curb their malignant effects on society? Maybe not - sarcastic tone can be interpreted here. Maybe they aren't obligated to do anything but sell their products. Maybe they don't have to promote healthy alternatives if they don't want to. But maybe they should have to oblige to regulation limiting their scope of marketing. Or regulation that rightfully warns people how misleading their products are.

It wasn't long ago that cigarette makers were fighting the research that linked cigarette smoking to lung cancer and birth defects. It wasn't long ago that they fought tooth and nail to oppose warning labels on cigarette packets. Should that be the fate of the fast food industry? Maybe; Maybe not. But it does have a nice ring to it: Quarter Pounder with Cheese comes with fries, a drink and an increased risk of diabetes, heart attack, stroke and cancer if consumed regularly.

- m.tsang

TB Island

savemike@gmail.com (savemike) — Thu, 26 Mar 2009 15:36:00 +0000

Pop quiz: Which disease do you have a 30% chance of having, and is the second leading cause of death by infectious disease in the world? Well, that was sort of a trick question - but I probably have your attention. Tuberculosis is the second leading cause of infectious disease in the world, according to the CDC, with about one third of the world's population (2 billion) having non-active or latent Mycobacterium Tuberculosis (LTB).

However there is no true 30% percent chance of having the disease - some more than others and vice versa. As Clifton E. Barry III and Maija S. Cheung mention in this month's Scientific American article New Tactics in the Fight against Tuberculosis 90% of those who have LTB live in third world countries. This reminds me of my father's response to a Doctor's inquiry of his history of LTB, "Of course I have [LTB], I grew up in Hong Kong; back then they call it TB Island". The Doctor just kind smirked and said "ok, ok, never the active form though correct?" To which my Dad smugly replied "no".

Barry and Cheung note that "ninety percent of people infected with [LTB] never develop active TB disease". However, that still leaves us with a large number of people around the world with active TB. The disease itself is caused by the bacteria Mycobacterium Tuberculosis which primarily takes home in the lungs. This is a good place for the bacteria to camp out since they work most efficiently in an oxygen rich environment (aerobic). The bacteria invade and exploit the lung tissue which kills it - this is why TB patients often cough up blood. Moisture droplets containing the bacteria can spread to non-infected persons through spit, coughing or sneezing.

TB can be cured if the patient sticks to a tedious six to nine month antibiotic regimene. In the first half of the twentieth century developed nations employed antibiotics with alacrity, and along with other improved public health measures diseases like TB were all but extirpated in places like the US. In fact, as Randolph Nesse M.D. and George Williams PhD write in their book Why We Get Sick, "In 1969 the US Surgeon General felt justified in announcing that it was 'time to close the book on infectious diseases'."

Well the book has not only been re-opened since then, but it has been re-written. Now, some of the bacteria causing TB has evolved to withstand the first-line antibiotics, so-called multidrug resistant TB (MDR TB). Barry and Cheung say to effectively fight off the defiant MDR TB "requires therapy for up to two years with second-line anti-TB drugs that produce severe side effects". Even worse, there are cases of Extreme Drug Resistant TB (XDR TB) that can go virtually unscathed by all lines of defense put against it. "People with tuberculosis resistant to multiple drugs have about a 50% chance of survival, note Nesse and Williams. "That is about the same as before antibiotics were invented!" they warn.

Antibiotic-resistant strains of TB can occur when patients don't complete their entire six to nine month regimen of pills. Prematurely stopping the medication will leave some bacteria in the body. Then ultimately certain bacteria are selected which are better suited for that antibiotic environment.

As Laurie Barclay points out, "nearly all regions of the world, including the United States, now have reported cases of XDR TB". The resurgence hasn't been matched with an equally mounted response. Incidence rates of TB in developed countries is low. In the US, since the last major TB outbreak between 1985-1992, TB rates have been declining. However, rates of decline have been slowing ever since 2000. Much more research into XDR and MDR TB strains is needed to effectively address the problem.

Moreover, "with the overwhelming majority of TB patients concentrated in some of the world’s poorest countries, large pharmaceutical companies have had little incentive since then to invest heavily in research and development for new drugs" note Barry and Cheung. And in places like the US, mainly minorities are inflicted with the burden of TB. Facts like these make it easier for TB to stay under the health radar. Yet if we don't get on it soon we could be faced with strains that are completely resistant to drugs and our only defense will be opening the doors and letting the sun shine in as the WHO has advocated.

- m.tsang

Cutting Through the Fat

savemike@gmail.com (savemike) — Tue, 24 Mar 2009 15:00:00 +0000

Usually I am not so cynical, but my initial reaction to this new piece of research was less than exciting. I began to imagine sedentary life deepening its roots into an abyss of malnutrition - although the people end up skinnier! Droves of people lined up outside of an Olive Garden tormented my brain as they forgot about all the other nutrients, vitamins and minerals bottom-less baskets of pasta and bread lack.

The research led by Hei Sook Sul PhD. of UC Berkeley showed that mice without the gene DNA-PK acquired less body fat than regular mice do. The gene works by inhibiting the liver's capacity to convert glucose into fatty acids which themselves are stored as adipose tissue (fat).

Now, I admit, I am less optimistic about the potential this research possesses. Not that because I think the research won't be ready and usable in the future, but that it will be: that by stymieing the action of an enzyme people can eat all the junk they want and not see any outward consequence a.k.a. fat. My pessimism stems from the immediate gratifying diets and weight loss programs that so plague our culture. I mean we already have diets that exclaim they can help you lose you ten pounds in ten days, but at what cost and how healthy of a diet is it? We even already have pills on the market claiming to burn off your fat for you without any actual effort.

However, maybe I am being a little too negative. Let me take a step back and conclude that this would be beneficial to certain people as a short term treatment. As I said in a past article of mine "Casual or Causal" conditions such as elevated body fat increase your risk of cardiovascular disease, stroke, diabetes and even some types of cancer. Thus, eliminating that risk factor could have an enormously positive effect on mortality rates, quality of life and controlling health care costs across our country. People at greatest risk of a heart attack might be able to forgo that experience. Obese patients who can't walk unassisted might be able to shed enough weight to engage in extensive physical activity.

One individual who was interviewed in the video-report exclaimed "I would still have to watch what I eat". So yes, people know that they have to watch what they eat, but will they? Do they? Even without a "miraculous" fat-saving pill we are plagued by escalating obesity and diabetes rates which is roughly 32% and 13% respectively of adults aged twenty or older. Would we expect people to watch what they eat when a super-pill is available if they don't already?

The overall message that is being overshadowed is eating healthy: balanced, diverse and nutritious. The world doesn't necessarily need a super-pill; we don't need miracle-diets. Eating nutritious and balanced will inevitably lead to reductions in obesity and diabetes. Eating fruits, vegetables, whole grains, and meat. Eating the least amount of processed foods. Eating foods low in excess sugar and fats. That is the diet plan we should follow - the one that evolved over millions of years of human lineage. It is the one our bodies respond to best. Unfortunately, it is the one many of us utilize the least.

- m.tsang

Beneficial Bugs

savemike@gmail.com (savemike) — Fri, 20 Mar 2009 17:00:00 +0000

Last week some friends and I took a trip to the local Chinese grocery store. We were on a mission: to grill out. Our intent was to get some food we usually wouldn't otherwise obtain at the local Ralph's or Vons supermarkets. Long story short, what we ended up purchasing was one whole salmon (head to tail) and a packet of larvae. Yes, larvae! As in the intermediate stage of the insect lifecycle that takes on a elongated mushy capsule shape.

After they were cooked it didn't seem like it was going to be so bad. They were just crispy little morsels at this point. Similar to the look of a little oval pretzel. Similarities stop there however. Its not so much that they tasted absolutely horrible - I mean, there was a musty dirt like after taste. It was more of the fact that they were bugs. Once, mushy slimy wiggly little masses. Now dried, fried and caught in-between my teeth.

Why were we all - five of us brave souls - so turned off by this? It was our preconceptions. All negative and making it impossible to enjoy each crunchy bite. Yet some of us eat this kind of stuff everyday - but we don't know it! Take for example Carmine, this compound, according to wikipedia, "may be prepared from [cochineal, a bug], by boiling the dried insects in water to extract the carminic acid. Carmine is most commonly used in food coloring. Manufacturers who use this product in their foods have come under fire for not letting their vegetarian consumers know they were eating animal products. Now the FDA requires these products to be labeled as carrying Carmine. (How someone is supposed to know carmine is a bug derivative is beyond me).

Something you might also not be aware of is this: some manufacturers are chalking their products full of bacteria (probiotics). This is more or less a good thing though. A recent CNN report noted that "Scientists have known for decades that probiotics can boost your health. That's why yogurt's "active cultures," or good bugs, are touted so often. And now these bugs can be found in cereal, cheese, energy bars, soup, and a wealth of other products filling up grocery and pharmacy shelves.

This isn't as crazy as an idea as it sounds. There are well over ten trillion micro-organisms that take shelter along your intestinal tract. 500 - 1000 different species. Outnumbering human cells by ten to one. They perform a myriad of functions such as digesting undigested parts of plant matter, signaling the endothelium to absorb certain chemicals, and creating essential vitamins and nutrients such as Vitamin K and B12. Others will even do your laundry*.

In fact the majority of the cells in the human body are actually foreign "invaders". As Richard Dawkins notes in his book the Ancestor's Tale, "most animal cells house communities of bacteria so comprehensively integrated into the smooth working of the cell that their bacterial origins have only recently become understood". Case in point are mitochondria. Dawkins points out that "they were once free-living bacteria." Without mitochondria we wouldn't have the energy to sustain such a large body style or the active lives we seek out.

However, not all bacteria are beneficial. E. Coli is a well-known example. Whereas the gut is normally inhabited by certain strains of E.Coli, Escherica coli 0157:H7 is the one that can wreak havoc causing severe diarrhea and even kidney failure leading to death. Cholera, a condition that also leads to severe cases of diarrhea and sometimes death, is propagated by Vibrio Cholerae, a bacteria that signals the gut to secrete chloride. Water naturally follows by osmosis which causes the diarrhea. Ironically, probiotics were first experimented with in the early 20th century to cure bowel irritations and conditions such as cholera.

Major steps in eradicating such diseases didn't come from using probiotics, instead they were effects of increased sanitation, clean water and refuse removal in the developing world. Antibiotics have also helped to the body to get rid of these pernicious bacteria. Interestingly, as the CNN article points out, use of antibiotics can kill off the beneficial bacteria in your body too leaving ill-effects. According to that article, supplementation with probiotics can help re-colonize the gut biota population. However, overall beneficial effects have not been shown to be conclusive. There are interesting trends that show slight benefits, but more research needs to be done as this Reuters article points out.

Also, a research team out of Northwestern University is shedding new light on vaccine efficacy via probiotics. They argue that by ingesting probiotics you can get the bacteria to produce a vaccine naturally in the gut. "Nature isn't used to seeing antigens injected into a muscle," said Terrence Barrrett, M.D, of Northwestern University. "The place where your immune system is designed to encounter and mount a defense against antigens is your gut." This is one clear example where probiotics can be seen to have a realistically beneficial effect. I just want to know which yogurt I have to eat to get my laundry cleaned.

- m.tsang

[*If you are reading this because you were unsure if I was joking, then I feel bad for you]

Pestilencia Mental

savemike@gmail.com (savemike) — Wed, 18 Mar 2009 15:00:00 +0000

Last week an extensive Gallup Poll disclosed the state of emotional health in the U.S. The poll surveyed people's responses to questions about depression, anxiety, stress, hopefulness, optimism and other similar states of mind. The responses were translated into a so-called Emotional Health Index (EHI). And I'll let you in on a little secret: the EHI...not so good.

Taken over almost every day of 2008, the survey was able to track changes in the overall mood of the nation in what was an incredible year indeed. There were a multitude of salient events that occurred creating many ups and downs. Most notably the election of our first black President ever created a sense of pride and optimism amongst a majority of people in the US. And we saw the last days of former President Bush to boot - although some sadly misinformed citizens didn't see that as a laudable affair.

Unfortunately that Yang didn't occur without its Yin*. 2008 was also a year of recession which we are still experiencing. The burst of the housing bubble and failing of all the dubious mortgage-backed securities brought a sense of insecurity across not only the nation, but also the world. Bear Sterns collapsed. Lehman Brothers went bankrupt. And tax payers found themselves giving bonuses to CEO's who needed a bailout in order to offset their profligate ways. Even Botox procedures took a hit of -8.5% last year.

According to USA Today, these latter developments had more of an impression on our moods than anything else. (Latter as in the failing economy, although a lack of Botox might definitely make some "appear" to have taken a turn for the worse!)

Stress shot up over 2008, peaking in the fall and winter as the economic crisis deepened, then continuing high through February. The 10 least happy days of 2008 all were in the last quarter.

The report also noted that mental wellbeing was worse for Latinos than any other group.

There were few racial differences, but Hispanics, the nation's largest and fastest growing minority, had the worst emotional health all year long.

This fact isn't particularly surprising to me. Latinos are often hit worse by some of the major infectious diseases and ailments our nation is faced with. For example, if you are Latino you are twice as likely to have diabetes and Latina women have five times the rate of HIV/AIDS compared to non-Latina whites. Moreover, the emotional downturn impacted the poorest individuals the most which constitute a large body of Latinos.

Tough and ardent times like these take their toll on individual stamina and hopefulness. Most of us are aware that unemployment often means health might take a stab or two due to being uninsured, but mental health seems to be overlooked in many ways. In the USA Today article, Lanny Berman, executive director of the American Association of Suicidology, notes that unemployed adults have two to four times the suicide rates of employed people.

And in terms of California's large Latino population the situation could perplexingly become worse. According to a recent study by Guilherme Borges, ScD, et al, the rate of those who seriously consider and actually attempt suicide is higher for Latinos that were born in the U.S. and those who moved to the U.S. before age thirteen.

As the largest home for Latinos in the US, this has serious public health implications for California. In fact, California ranked 30th among all the other states in terms of their EHI. With California's unemployment rate inching above the national average towards 10% we ought to take notice not only to the lack of health coverage our citizens will be seeing but also the mental health we will be experiencing.

- m.tsang

[*As an artifact of my article presintation I was forced to write Yang without Yin which sounds considerably less casual as Yin without Yang. Yang is associated with sunny; Yin with dark.]

Stem-Cells: Another Religious Soapbox

savemike@gmail.com (savemike) — Wed, 11 Mar 2009 15:15:00 +0000

Seven years. Seven years and seven months, to be precise, is the amount of time former-President Bush squandered. I am referring to stem-cell research (however, I could have been talking about any number of issues!). Thankfully President Obama has the prudence not to commit the same mistake. On Monday President Obama rescinded the ban that stymied federal funding towards stem-cell research.

Although, this now allows federal funding to be allocated towards research involving stem-cells, under the Dickey-Wicker Amendment it is still illegal to use federal funds that involves creation or destruction of an embryo. So there are only two ways to extract new stem-cells from an embryo: through private funding or state funding (if your state has a law in accordance with that type of research).

Scientists have long touted the potential stem-cells as a cure-all. They are able to take on the characteristics a myriad of cell types within the body. These cells could then create tissue types to cure diseases and injury such as: Parkinson's and Alzheimer's diseases, spinal cord injury, stroke, burns, heart disease, diabetes, osteoarthritis, and rheumatoid arthritis.

It's no secret that support for such bans arises from religious and pro-life ideology. The same support base which wants to also ban the cloning of embryos whose stem-cells could be used for therapeutic purposes. Without cloning researchers have to rely on in-vitro fertilization patients to donate their left over embryos for research. Whatever the source, proponents of such bans argue they are savings lives because the embryo has the potential to develop into a fully formed fetus.

The subject becomes extremely torpid with so many stipulations as to what constitutes life. What pro-lifers consider life is really a blastocyst - the two to five day old embryo in the shape of a hollow ball (from which stem-cells are taken). It has no nervous system. It can't think. It's a ball of cells. Men's sperm looks more alive then a blastocyst does! At least those can swim. When a man masturbates he releases a plethora of potential cells that could turn into a fetus. Are these pro-life groups worried about us masturbating? (It wouldn't put it past me if they were). What about each egg that sheds during menstruation? What about having sex with a condom on? I mean, conception is so close you can almost hear the little semen yelling "let me out!" But let's be honest, you’re really not giving life a chance with jr's raincoat on. How non pro-life of you to do that.

I can't even begin to point out all the other hypocrisies when stem-cell opponents exclaim embryos are real humans with the same entitled rights as you and me - well, unless your a gay embryo.Yet for all pragmatic purposes, there is one very ironic part to this whole issue. According to a USA Today report approximately one half-million embryos lie frozen in US fertility clinics. Frozen! So instead of using these cells to promote and expand great research to save actual lives, proponents of the ban would rather the embryos stay frozen. How non pro-life of them to do that.

These issues disclose an important fact: science has been stymied by a major impetus. That force is religion: an unscientific force that has been allowed to impede the progression of science. Why? Why in Texas was there recently a 7-7 tie as to whether creationism should be taught in schools? Why should we allow religious groups to falsely discredit and disparage factual, tangible scientific work? Just because the fossil record isn't completely intact? Because a book says the earth is at the center of the universe?

Science is in the business of understanding the beautiful complexities of life. There is no room for perversions. There is no room for putting a man on house arrest for the remainder of his life because he advocates the sun is at the center of the galaxy - which the Vatican did to Galileo. There is no room for putting a teacher on trial for teaching the principles of descent with modification - which is what happened to high school teacher John Scopes in 1926. And there is no room for holding scientists hostage because they want to use blastocysts to cure disease and save lives. Especially when opponents to stem-cell research exclaim their reason it is to save a life.

- m.tsang

No Walk in The Park

savemike@gmail.com (savemike) — Mon, 09 Mar 2009 15:00:00 +0000

Let me ask you this, how many reasons can you come up with for not exercising? How about for exercising? Now which are more important? Well, to answer that you would have to know the effects of exercise, and unless you are: a) in denial or b) in denial, you should know it is best to exercise! The most well known effects of regular exercise are obvious: more muscle, less fat, toner body, and weight loss.

Mere physical appearance isn't the only effect exercise has on the body. A superfluous of studies over the past several decades have shown regular exercise creates a stronger heart, clearer lungs and reduces your chance pathologies such as atherosclerosis, diabetes, hypertension, stroke and heart attacks. Moreover, a number of new studies have found that those who exercise regularly have less chances of developing cancer, cataracts and age-related macular degeneration (in the eyes).

So far we've got exercise at: effectively reducing your chance of succumbing to the top three killers in the U.S. - Heart Attack, Cancer, Stroke (In that order). And some of you still be at: denial. Ok, exercise takes time and planning to fit into the daily grind. Completely understandable. But can you find 15 minutes out of every other day to reduce diabetes? Researchers at Heriot-Watt University of Edinburgh, Scotland hope you can. Their research found that 15 minutes of high intensity workout (i.e. running) every other day for two weeks significantly reduced individual’s blood-glucose levels.

Great! You now have your 15 minutes set aside. Maybe you can find just 15 more? The American College of Sports Medicine argues that 30 minutes a day five times a week is the best way to go. That’s to keep the weight off and body healthy. "More recent evidence has supported this recommendation and has indicated that more physical activity may be necessary to prevent weight regain after weight loss", states the ACSM. Keeping the weight off keeps the blood-glucose low, your blood-pressure down and dampens your the risk of stroke and heart attack.

Hopefully I didn't create complete aversion by telling you about the 30 minute recommendation! Yet that seems to be a normal reaction to exercise. Instead you often get people who either skip exercise all together or try some kind of diet, especially "hollywood" diets. Take for instance the "Master Cleanse" diet: the detox diet to clean out your GI while losing weight. I know what you’re thinking, but hold on a second. It is completely normal to supplant millions of years of evolution that created organs such as your liver and kidneys with: squeezed lemons, maple syrup, and cayenne pepper several times a day for 10 days! Wow! I can skip over the physiological implications this has on your body by simply bringing attention that this diet lacks: calcium and protein - among a plethora of other nutrients.

The lesson that science has taught us is this: exercise is good for you - for your bones, heart, body and mind. Let me put all salubrious reasons aside for the moment and just reiterate one of the seven reasons the Mayo Clinic encourages people to exercise: because it can be fun! So join a team, a pick-up game, go hiking, take up kung-fu, hoola-hoop your way to number one on Wii Fit, chase squirrels out of your yard, or go to yoga to pick up girls (or guys). Just do it?

- m.tsang

[The title comes from the quote "People say that losing weight is no walk in the park. When I hear that I think, yeah, that's the problem." I found it online and it is attributed to Chris Adams who was a former world class wrestler. He once died on an overdose of GHB, but was brought back to life in the emergency room. A few years later he was shot and killed during a drunken brawl.]

Where's the Pain?

savemike@gmail.com (savemike) — Wed, 04 Mar 2009 16:45:00 +0000

Perusing through some back-logged evolution news stories I came across one titled "Painful Labor: A Modern Thing". The author went on to say how in 2001 the remains of a pelvis were found from the fossils of a Homo Erectus female. The 1.2 million-year-old pelvis demonstrates how the birth canal of Homo Erectus is considerably larger - about 30% - than the average women's you would find today. Anthropolgists previously estimated the last batch of large canals occurred around 2.4 million-years-ago.

It was interesting because the author exclaimed that this demonstrates that birthing pains are more of a recent adaptation - only within 1.4 million years have female pelvises narrowed as opposed to 2.4 mya. The author even went as far to state that a few million years ago babies might have just slid right out - rolling of eyes appropriate here.

Although, as one observant commenter pointed out, this article had it all wrong. Labor pains aren't normally derived from the pelvis, they are born from muscle contractions of the cervix. So besides being a tepid article at best, the author was also misguided in her importance of the find. The importance of the find is that it helps connect the dots to our distant past. That's about it.

However, there is a terribly painful thing about labor that came to mind and is very apparent in the US: infant mortality rates. Among industrialized first-world nations the Centers for Disease Control ranked "the United States 29th globally in infant mortality in 2004, the latest year such data were available for all countries", according to a MedScape article commenting on the subject.

The average US infant mortality rate is close to 7 out of every 1000 births. Thats down from nearly 20:1000 in 1970. African-American women have the highest rate at almost 14:1000 births. Next sits Native Americans and Puerto Ricans at just over 8:1000. Whites at over 5:1000 and Cubans at the lowest with just over 4:1000.

So where's the pain? Although overall rates have gone down these facts still reveal some of the major troubles facing our health care system. Why as the country who spends the most money per person on health care are we still ranked 29th in terms of infant mortality? Why does there exist such prominent gaps in health-access and disease between people of different race, ethnicity, socioeconomic status, etc? Why are there over 46 million U.S. citizens without health care? However complicated they may be, these are problems we can fix. Aren't they?

- m.tsang