Friday, July 21, 2017

Chiropractic - Handle With Care

Several months ago I noticed a couple of friends going to the chiropractor on a regular basis and tried to talk them into trying a yoga class instead.  They said they were too old and stiff for yoga, a typical response, and besides, Medicare paid for the chiropractor.  I wasn’t sure this was correct, but let it go.

Recently though, I ran across a fact sheet from the government and learned the following: “Spinal manipulation is a covered service under Medicare. However, maintenance care is not considered by Medicare to be medically reasonable and necessary, and is not reimbursable by Medicare. Only acute and chronic spinal manipulation services are considered active care and may, therefore, be reimbursable.”  It went on to define maintenance therapy, which sounded exactly like what my friends were getting.  Of course, I don’t have all the information and may be wrong, or the chiropractor may be violating the law.

From what I have read most chiropractors are honest and sincere.  They and their patients believe that treatment of subluxations in the spine provides relief from pain and other back problems.  Likewise Medicare recognizes subluxation as a problem that calls for medical attention.  But this in itself may be a problem.

One of many skeptical sources shares a different view.  “According to classical chiropractic, a ‘subluxation’ is a misalignment of the spine that allegedly interferes with nerve signals from the brain. However, there is no scientific evidence for spinal subluxations and none have ever been observed by medical practitioners such as orthopedic surgeons, neurosurgeons, or radiologists. On May 25, 2010, The General Chiropractic Council (GCC), a UK-wide statutory body with regulatory powers, issued the following statement:  The chiropractic vertebral subluxation complex is an historical concept but it remains a theoretical model. It is not supported by any clinical research evidence that would allow claims to be made that it is the cause of disease or health concerns.”  It’s like a metaphor that American professionals and  their patients take seriously.

Besides proper coding and billing, chiropractors must also be careful about the results they promise.  Some have advertised that spinal manipulation can improve general health, cure many different diseases, cure children of earaches, autism, and asthma, and prevent spinal degeneration.  None of these claims have any scientific backing.

Then there are the cases of unethical behavior like this one in Utah where the doctor was disciplined for financially abusing two patients and failing to cooperate with board investigations among other offenses.  But ethical failings happen in every profession.

In short, it is smart to be skeptical about the benefits of a visit to the chiropractor.  Maybe yoga, physical therapy or some other stretching routine will yield the same benefits.  Maybe most of the effect is placebo, based on a belief it will work.  All I know is that when I do a weekly review of medical articles, information about an investigation of problems with one chiropractor or another – ethics, false claims, and other problems – appears quite often.

(For a comprehensive scientific critique of the practice, see this YouTube video.  But I know many will read this or even view the video and still ignore facts that don't agree with a worldview they don't want to change.)

Monday, July 17, 2017

Dietary Fad Alert!

It’s almost like I can see into the future.  At least these kinds of fads don’t surprise me anymore.  If you pay attention to behavior, they won’t surprise you either and better still, you won’t be caught in the trap of the latest health craze.

And what is the latest health craze?  There are so many it’s hard to keep track, but this one is right up there:  Lectins.  The Washington Post tells us, “Going ‘lectin-free’ is primed to become the next big thing in dieting.”  They characterize lectin-free as “the latest pseudo-science diet fad.”

The article explains that research over the years has found both positive and negative effects from lectins, a type of protein found throughout nature.  Unlike gluten, lectins are not a single compound, but many different ones with many different functions.  They have been researched for years in isolation, but there are not yet any definitive findings about health effects.  Some are toxic and some make it difficult for certain people to absorb certain vitamins, whereas others have beneficial qualities, such as assisting the body to resist cancer.

“The problem is that online health gurus are painting all lectins with the same brush, and playing up the negative effects without the evidence to back it up.”  These warnings are easy to find on line, but it’s like saying some members of the nightshade family are highly toxic so it’s dangerous to eat tomatoes, potatoes or bell peppers.

Much more information is included in this article, but it appears to be just one more publicity-seeking scare tactic used by people who fancy themselves “online health gurus” and crave attention over truth.

MSN agrees.  Asking if lectin is the new gluten, they put it bluntly: “Why you shouldn't fall for the latest dumb diet fad.”  In fact the Mediterranean diet, that some consider the gold-standard to reduce the chance of heart disease, “contains plenty of foods containing lectins.”

This is just one more case of foodie fanaticism.  As I wrote just last week, there is a “tendency for people to blindly adopt views on health and good eating regardless of a lack of scientific support.”

If you too have been a keen observer of behavior, you will expect to see in the near future people who are sure that going lectin-free is the best (safest and healthiest) answer for themselves and their families.  They will have fallen for the “latest dumb diet fad” and no discussion of science or logic will talk them out of it; they read it on Facebook or their favorite “online health guru” said it’s so.  If it goes far enough, the food industry will chime in with labels boasting “lectin-free” just to increase sales among science-challenged consumers.  We've seen this happen so many times with gluten, organic, GMOs, pink slime, sea salt and rBGH, why would anything change now?

And so it goes in America today.  Money is thrown away on so many unsupported beliefs, magical supplements and worthless gadgets.  And then we worry about consumer debt and retirement insecurity.  When will we ever learn?

Friday, July 14, 2017

Unpredictable Consequences

The premise that behavior has consequences and that the nature of those consequences usually follows from the wisdom of the behavior is accepted by almost everyone (and is common to most religions).  Most consequences are predictable in this way, but some people need to learn the lesson the hard way and many do.

A recent example was the man who had to be rescued two days in a row from Wildcat Creek in Indiana.  On a Thursday he and three others were rescued when their boat capsized on the flooded creek.  The next night he returned to the same spot to try to retrieve belongings that had been left behind, and he drowned.  The consequences of his Thursday misjudgment were not enough to deter him from repeating the risky behavior.  Consequences can be cruel.

More troublesome are those consequences that are harder to predict because the decisions are based on faulty information or grounded in fear.

I read a book a few weeks ago by Gene Stone called The Trump Survival Guide.  In it he criticized the idea of private Social Security saying the stock market might yield a higher return (most of the time) but the Trust Fund was invested in government-backed securities, so although the return was lower, the investment was safer.  Fine, but individual Social Security returns are not based on the investment vehicle of the Trust Fund.  They are based on a set formula that rewards at a higher rate those who contributed less. (See the graph here.)  This assumption also perpetuates the myth that the money you paid as F.I.C.A. taxes are invested in a “lock box” or trust fund and are waiting for you to collect them.  This is absolutely incorrect.

One week earlier I read a book by David M. Smick called The Great Equalizer.  At one point he tells of the difficulty of raising the Social Security cap to get the rich to pay more, thus extending the time before the Trust Fund is depleted (an estimated 15 years from now).  He gives the example of a husband and wife who together earn more than the current cap of about $120,000.  (I couldn't believe an author with his credentials could be so mistaken.)  The Social Security cap applies to individuals.  You can’t file jointly to try to reach the cap sooner.  That’s not how it works.  That couple would not have been affected by such a change unless they were each expecting a huge raise!  Yet such misinformation could easily get them writing anxious letters to Congress.

These may be fine details, but how can voters make intelligent decisions when well-educated people from both sides of the political spectrum (not to mention AARP) don’t seem to understand a system that affects so many?  Faulty information leads to poor decisions, which in turn may lead to poor outcomes we all must live with.

Decisions grounded in fear are also problematic.  I also read in the Trump Survival Guide how the prospect of a Trump presidency was characterized as horrific.  This is simply a kind of fortunetelling, anticipating and worrying about a destructive future that may or may not play out.

As a demonstration of how unpredictable that kind of future can be, consider this scenario.  In 2012 Mitt Romney wins the election.  In 2016 instead of having a 16-way debate among Republican candidates, Romney is running for re-election against Hillary Clinton.  Donald Trump would have no way to throw his hat into the ring.  There is no working class backlash against the establishment and Mrs. Clinton has Romney's 4-year record to run against.  Whatever the result of the election, there is no Trump presidency and no potentially horrific outcomes.

Now if Romney had run on a platform:  If you don’t vote for me, Donald Trump will become President of the United States, people would have called him crazy.  No one would have believed it, no one!  So today we are in a situation no one could have predicted a couple of years ago, yet so many people are stressing about and making decisions often based on wild predictions of future disasters.

Decisions based on inaccurate information or motivated by fear also have consequences.  Inaccurate information may lead you in the wrong direction.  Decisions based on fear of possibilities leads to highly unpredictable consequences and can have a detrimental effect on your health.  Is it really worth panicking about the pessimistic speculation of people with their own agendas who bank on such an emotional reaction from their followers and contributors?  (We know had the election come out the other way,  the same dynamic would be happening on the other side).

For the record:  I supported neither of the major party candidates as was clear from an entry on this page last November.  I still contend that America deserves better.

Monday, July 10, 2017

Greatest Hits

After 6 years and over 630 posts, it’s time to pick out some favorites. 

The objective of Real American Solutions is to demonstrate, using examples from the news or common experience, how most of the problems we stress about daily and most of those crises highlighted in the headlines are under our control.  Washington did not cause them, so attempts to solve them through government action often make them worse.  We are not overweight or unready for retirement because of some governmental failure.  No, most of the problems we have can be traced to behavioral errors on the part of individuals as they accumulate to societal trends, sometimes referred to by the media as epidemics.

Viewing the problems through the lens of behavior (in the five key dimensions shown above) gives a new perspective, a new set of solutions, a chance to fix what is wrong through individual actions.  One by one, as people come to understand the theory, seeing their own actions and decisions and those of others in this light, these crises and epidemics will fall away putting America back on the right track.  The idea that better outcomes don’t depend on the party in power should be refreshing to everyone.

So over the years I have given many examples of behavior in each of these dimensions not just to fix those particular problems, but to show how any unwise decision leads to undesired consequences and how they can be categorized into a dimension to simplify understanding and lead to improvements.  This can all be done without accusing others (or ourselves) of some character flaw or dastardly motive.  People make mistakes not because they are stupid or evil, but because they choose the wrong behavior (and face undesirable consequences).  To fix it, choose the opposite behavior next time – and watch out for other opportunities or traps that come up in the same dimension in the future.  (We do tend to make the same kinds of mistakes over and over.)

So here are some of my favorites.  Please check them out at your leisure.

How Much Consumer Protection tells about one of so many questionable products that could not possibly deliver what they claim.  

Another favorite example along the same lines is Performance Bracelets.  

Even back in 2014, before EVERYTHING became political, I was not impressed with the news we were getting.  As I explained in First and Fluffy, we deserve and should demand better.  

Just three years ago I wrote about the Retirement Crisis and followed up later with several explanations of how people misunderstand Social Security.

A favorite subject has been the tendency for people to blindly adopt views on health and good eating regardless of a lack of scientific support.  This includes the trend toward all natural, non-GMO and gluten-free.  Americans also spend billions on vitamins and supplements without understanding the dangers and lack of evidence to justify promises.

There are more than 600 other choices to help polish everyone’s appreciation of how to think about behavior to choose better options, avoid the name-calling and accusations and find Real Solutions.

Remember, the first step is to see the world as a set of behaviors.  Then figure out which ones lead to better results.  Repeat these, and for the rest do the opposite.  We can’t do anything about North Korea, but we can make sure our kids get a good education, that we pay our bills on time, that we disdain frivolous lawsuits, that we research health issues instead of following fads and rumors, that we don’t fall for every get rich or get thin quick scheme, that we quit trying to “keep up with the Jones,” that we live with gratitude and that we anticipate and avoid behaviors we will later regret.  If everyone takes these simple steps and encourages friends and family to do the same, there will be many fewer crises and epidemics on the news and America will begin moving in the right direction based on the behaviors of its people.