Health Insurance Is Not The Same As Healthcare

“Half the harm that is done in this world is due to people who want to feel important. They don't mean to do harm; but the harm does not interest them. Or they do not see it, or they justify it because they are absorbed in the endless struggle to think well of themselves.”  ― T.S. Eliot

For more years than I have been writing this, politicians have been ranting about the cost of healthcare and how to fix it. Unfortunately, the conversation does not center on healthcare, instead they keep talking about insurance. The reason is simple: Insurance is much easier to fix; just throw money at it. Healthcare itself is a complex mechanism with many moving parts. But fixing insurance does not change the underlying issues. In some cases it makes them worse.

 

People often talk about how healthcare was good, but not great, back in the 1960s; and it was affordable. Some doctors still made house calls. They yearn for the good old days. Along these lines, an interesting comparison occurred to me.

 

Back in 1960 a typical television looked like this.

Just over half the population owned a black & white tube television, and you were lucky if you could get five channels.  The TV had no remote, and there was no cable, so you needed an outside antenna or an inside antenna known as "Rabbit Ears".  In 1960 an RCA black & white 21 inch console TV cost $268, most people financed this for about $10 a month.

Today the equivalent of $268, adjusted for inflation is about $2400, and here is what you can buy for a little more than half that!

But the costs of medicine and the education moved in the opposite direction. Today we live longer and healthier due to medical advances, but the price has increased faster than inflation. The cost of becoming a medical professional has likewise soared.

One reason for both, ironically, is government interference: low cost insurance on one hand and student loans on the other. This greatly reduced competition. Make it easier for citizens to pay for something, and the people who sell it have no incentive to control costs.

 

The only way to control cost, any cost, is to focus on the reasons behind the high cost. Politicians are silent about these underlying reasons for soaring healthcare costs, and have made no plans to deal with them. The primary reasons for the high cost of healthcare are summarized below. (A thorough explanation was given back in the spring of 2012.) 

• Insurance Design:  Insurance companies separate the provider from the patient. 
• Innovation: New medical technology and treatments save lives but add cost. 
• Lack of open competition.
• Over-testing.
• Billing and coordination issues.
• Regulations and Restrictions: Rules vary from state to state. 
• Liability: The high cost of malpractice insurance affects all patients' bills.
• Lax eligibility rules and outright fraud.

Unless someone comes up with a plan and makes a serious effort to address these issues, all the insurance or Medicare-for-all schemes will not succeed. The alternative would be for the government to fix a price on everything and see how many drug companies continue to innovate, how many doctors stay in business and how many students chose to get a medical degree.

But politicians will continue to promise the easy non-solution to give the appearance that they care about fixing the problem.

Why Do They Bother?

I often wonder about news agencies. They publish flashy headlines, but the details later in the stories turn out to be much less interesting or conclusive. Here is a recent example from CNN health: “People with blood type O may have lower risk of Covid-19 infection and severe illness, two new studies suggest.” (At least citing two studies is better than their frequent practice of citing one unnamed source in their political news, but let's get into it.) 

 

The studies concluded, “People with blood type O may be less vulnerable to Covid-19 and have a reduced likelihood of getting severely ill.” To compound the weakness of this conclusion that they “may be less vulnerable” they add a disclaimer that “Experts say more research is needed.”

 

What we know so far, provided we read the headline carefully, is that something “may be” going on, and even if true, the connection is not clear.

 

A study from Denmark found that of a sample of 7,422 people who tested positive, 38.4% were blood type O, whereas 41.7% of a separate non-tested group of the 2.2 million Danish people has that blood type. The article doesn’t explain where that 2.2 million came from. The population of Denmark is about 5.8 million. Were those 2.2 million representative of the entire population?

 

It is likely the results were statistically significant or they would not have been published. Still, statistical significance is overrated, and the difference between 41.7% and 38.4% does not seem to be of any practical significance to a CNN audience. 

 

The difference for Danes with type A blood goes in the opposite direction, 44.4% ill compared to 42.4% of the population. But the Type O and Type A does not account for everyone, only 84.1%. The remaining type B and AB people must comprise 15.9% of the population and account for 17.2% of the cases, which is actually proportionally higher than the type A cases. Why they reported what they did, the way they did, is puzzling.

 

The second, a Canadian study, looked at a much smaller sample, only 95 critically ill patients. Of them, 84% of those with blood type A or AB required ventilators compared to 61% of type O or B. They didn’t make the same comparisons under the same conditions as the Danish study. The only common finding was the better performance of blood type O.

 

The final conclusion of the CNN article is that no one should worry and no one should become complacent. Blood type does not supersede other risk factors. The information is useful only to researchers in this narrow field of trying to discover a link between blood type and COVID susceptibility or seriousness. They “don't yet know what mechanism could explain the link” or if a link exists.

 

The fact that they were published in a journal called Blood Advances reinforces how narrow the focus for the studies was. It wasn’t really intended for the general public. Which brings me back to my original question. Why do they bother? 

 

Not to pick on CNN. The same useless information appeared in Forbes, NBC, UPI Health News, Science Focus and others. The pressure to fill airtime and Internet space must be overwhelming. We get such news with its exciting headlines whether it adds any value to our daily lives or not.

Flashback – Why Is Color So Important?

My very first entry of 2013 addressed the power of color in decision-making in areas as different as medication and car buying. The point of these examples was to show how Americans are influenced by superficial characteristics, an indication of problems in the dimension of perspective. These many years later the media and certain groups are again focusing on color differences, particularly skin color, treating it as more important than substance and character. It seems we have made little progress since I wrote this.

[This thought about perspective was inspired by recent medical news about the color of pills and by a slightly older story about the color of cars. Perspective is about distinguishing between what’s important and what’s trivial, hence, living according to real values rather than values imposed by society. People strong in perspective look past external appearances and tend to adopt a lifestyle based on moderation. Common examples of poor perspective include the Black Friday stampedes and the accumulation of debt from buying to satisfy our wants and impulses or to impress others.

A key lesson is that appearances are often deceptive when it comes to judging what's really important.  Nevertheless, examples abound showing how people are overly influenced by external factors, in the following cases by color alone.

The first is a health report that came out earlier this week. Studies show that when the color of medication is changed, there is a greater a tendency for people to stop taking it. This occurred 27 to 50 percent of the time, and it is not a trivial problem. “Failure to take a prescribed medication — a behavior known as non-adherence — costs $290 billion annually in additional health complications, according to the New England Healthcare Institute.” Apparently generic medication, less expensive but identical to the brand name drug, may be manufactured by several companies. They don’t coordinate with each other on the color, nor do they take great pains to maintain consistency within each company.  People look at their pills and don’t recognize them or are confused by the color. Over-reliance on visual cues causes them to make poor decisions about continuing medication.

The influence of something as superficial as color extends beyond the health field. As this article points out, “BuyingAdvice.com [has found] that if a car is not available in the preferred color, 40 percent of drivers will decide to change brands.” With all the factors involved in deciding which car to buy:  safety, reliability, fuel economy, price, warrantee, insurance costs, and others; isn’t it surprising that 40% would switch brands – Ford instead of Toyota or Kia instead of Subaru – just because they can’t find the color they want? This is especially surprising since, when sitting inside a car, it’s very difficult to tell what color the car is! The color is visible only to other people. It could be ugly green or bright pink and you’d never know it until you got out.

When making major decisions, it's critical to put substantial factors ahead of superficial ones. Based on these stories alone, color is one of those external factors that wrongly holds considerable sway in decision making. A good New Year’s resolution might be to try to be less influenced by appearance and other external factors. Maybe we can start with pills and cars and work our way up to people.]

Flashback – Household Germs

[This piece from November 2014 has popped up as a favorite in the past. Perhaps it’s a good  reminder not to get out of the hand-washing habit.]

ABC asks the “shocking” question: What’s the most germ-infested place in your house? The answer, it turns out, is “the towels in your kitchen and bathroom.”

They go on to cite a Kimberly Clark-funded study whose author says, “towels are more likely to be bacteria-ridden than other household items because they are used to wipe hands and surfaces that may have been contaminated by raw meat products.” They are usually damp, a state that further encourages bacterial growth.  

If that's not disgusting enough, it is common knowledge that most home kitchens would not pass the kind of standard health inspection that cafeterias and restaurants are routinely subject to. We certainly don’t wear our hairnets when preparing dinner. How many people keep a thermometer in their refrigerator, clean all surfaces, assign different cutting boards to meat and vegetables or are diligent about chilling foods promptly at the end of each meal? These are standard food safety requirements. But the idea of handling raw meat and then wiping your hands on a kitchen towel before continuing with meal preparation is the kind of practice that would get your favorite eating establishment shut down.

This is not what really caught my attention in the article, though. What I noticed was the use of flu season and the Ebola scare in their introduction to set up the story. Flu and Ebola are viral diseases; they have nothing to do with the bacteria discussion that was the focus of the rest of the story. Like the writer, most people don’t seem to pay much attention to the difference between bacteria and viruses. Germs are germs. If I have a head cold, I call the doctor and ask for antibiotics – the fact that antibiotics act against bacteria and not viruses is not my concern. So we end up with germs that build a resistance to antibiotics, people don’t make the connection and then rely on “science” to fix the problem.

This is all unnecessary when we have easy access to a complete explanation of the differences between bacteria, viruses, fungi and protozoa written for kids! It points out that some bacteria are good, live in your body and help you digest food. It doesn’t mention that some fungi are good – like morel mushrooms. It closes with advice about hand washing with soap and water – nothing fancy needed, using tissues for coughs, sneezes and sniffles, and getting proper immunizations. Yes, it tells kids that immunizations are important and the smart choice. It closes with “eating well, exercising regularly, and getting good sleep” can keep you healthy.

This is great information and advice that many adults should heed. When a reporter for ABC news can so casually mix things up, then report on adults wiping, not washing their hands during food preparation, perhaps we need to take a step back and learn from the science that we expect our kids to understand.

[These issues call for critical thinking, but up in the first paragraph of the original piece, notice the use of the word “shocking.” Other news media favorites include "stunning," “staggering” and “catastrophic.” They can’t just address a question or pass along a fact. It has to be emotionally charged, controversial or both. In the process of presenting news that should call for critical thinking, they intentionally distract with emotional wording.]

Is The News Making Us Sick?

It began one morning with two seemingly unrelated items: a story about mountain climbing on BBC Future and a panel from the comics section of the newspaper.

The BBC article, “The placebo effect is well known for its medical benefits, but there is evidence it could give athletes an edge, too,” began with an experiment where mountain climbers were given oxygen to boost physical performance at high altitudes. In a laboratory simulation, they were first given tanks of oxygen to improve performance. When they were later given empty tanks, their brains expected similar improvement and caused the body to adjust appropriately.

It went on to explain how placebos like this can improve athletic performance in other areas, for example, sugar pills believed to be performance enhancing drugs could have the same effect. 

The effectiveness of placebos applies to many areas. A summary of studies shows that “antidepressants are effective for depression about 31-70% of the time, while placebos are effective 12-50% of the time…. So, while antidepressants appear more effective than placebo, only a fraction of the benefit we see in patients is likely from a direct neurobiological impact of the medication itself.” Effectiveness depends on the amount of faith patients have in the product. Placebos taken as part of a test of more powerful drugs tend to have more powerful effects; and patients often report some of the same side effect as the drug itself.

This led me to another BBC article explaining the opposite effect, sometimes called nocebo. In this example the treatment was merely the words the doctor used. The doctor, talking about serious osteoarthritis, says that he has “bad news,” that the knees are “worn out” and the medicine may “help a bit,” but may damage the stomach lining. The doctor has set the patient up to expect the worst. This kind of presentation can unintentionally cause the brain to deliver the opposite of a placebo effect: less positive, possibly negative, outcomes.

A conclusion is “when prescribing treatments, the doctor should emphasise the positive effects of the medicine, while framing the negative side-effects so they seem less frightening, and being careful not to over-emphasise their risks.” They should be honest, but with an optimistic tone.

This led to yet another BBC article, this one from 2015, about how negative thoughts and ideas can not only make you sick, but actually kill you. This effect applies to any authority figure or respected expert, not just doctors. “In the same way that voodoo shamans could harm their victims through the power of suggestion, priming someone to think they are ill can often produce the actual symptoms of a disease.” Hence, people can die of fright or become sicker based on the message and their faith in the authority of the messenger.

Each of these articles is interesting, but coincidentally they came to my attention on the day I saw “The Flying McCoys” at the bottom of the page of an on-line newspaper. The idea is almost too true and too common to be funny and typical of many news programs.

Based on the information above, what is this doing to the overall health of the American people, this constant barrage of fears and anxiety over the virus and whether opening the economy too soon will be a mistake, the emphasis on the ever increasing number of cases and deaths, the constant skepticism about the actions and predictions of the task force, the criticism of any encouraging remarks – especially if they turn out to be overly optimistic; and for years now, fanning the flames of  divisiveness within the country – all with the express intention of putting us on edge, amplifying the fear and anxiety to get everyone to continue to tune in. 

Remember, placebo, the strong mind-body connection cuts both ways. Between the news media, social media and politicians, it’s surprising we are not all physical and emotional wrecks.

The news can be both addictive and unhealthy. One defense is to watch less. Another is to use critical thinking and see it for what it is, big business trying to attract “eyeballs,” and act accordingly, increase our skepticism, lessen our faith in the source and discount their predictions of a fearful outcome at every turn. 

Another Health Scam

With the coronavirus leading every news broadcast, the networks have begun also to highlight the prevalence of false claims, fake cures and scams. To make the point that this is not new, CBS Sunday Morning (4/26) addressed the history of fake medicines and cure-alls, but was disappointingly vague on some of the current scams, ones people fall for every day, probably from fear of offending both promoters and viewers. They did, however, include a few comments from Dr. Stephen Barrett who pulls no punches in his criticism of modern scams.

In one of his latest investigations into junk medical science, Dr. Barrett addressed a process known as bioresonance hair testing. Practitioners use a device "based on the pseudoscience of radionics to analyze hair samples mailed in by customers" to "detect nutritional deficiencies; overexposure to heavy metals; and food and environmental intolerances” to serve as a “roadmap to better health.” He calls the practice preposterous, in that “hair analysis is not reliable for evaluating the nutritional status of individuals” as well as giving several other reasons why it doesn’t work.

An earlier article on the same subject he warned its use by “chiropractors, nutrition consultants, physicians who do chelation therapy, and other misguided practitioners who claim that hair analyses can help them diagnose a wide variety of health problems and can be used as the basis for prescribing supplements.” 

Since bioresonance is based on radionics, it gets even more “preposterous.” These theories supposedly rely on quantum entanglement, a central principle of quantum physics where information can be transmitted instantaneously at a distance apparently violating the speed of light. Quantum physics is arcane and incomprehensible to non-scientists, yet many questionable products use it to explain action at a distance to add a scientific-sounding aura to their sales pitch. But it's all bogus.

Then it gets more unrealistic. According to this site, “Radionics can be used for humans, animals and agriculture by means of radionic instruments which amplify and 'balance' the subtle energy field of the subject” by using “a photograph, hair snippet or other biological sample.” It works best with a good quality digital photograph because “the image stores the information of the subject and a digital file cannot be contaminated like a biological sample can,” and the light “creates a crystallization of the energy matrix of the subject.” 

Another site says, it’s “a method of healing and diagnosing at a distance using the unique extra-sensory faculties of the operator supported and amplified by a physical instrument, device, geometric pattern, energy or substance.” Since “every person's energy patterns, frequencies, signatures, vibrations or rhythms are as unique to them as their fingerprints,” they can easily detect and help correct any type of “illness, injury, infection, stress, pollution, malnutrition, or poor hygiene.”

In summary, “patients” send a full digital picture or some strands of hair. "Doctors,” using their powers of ESP, run it through their energy detection machine, make a diagnosis based on an individual energy matrix, vibrations and rhythms and recommend supplements to cure what ails them, all using the magic of quantum physics. Remember, the same technique applies to their pets or their houseplants – with a separate charge for each.

But that’s not all! In some cases, their house may be causing the problem due to the presence of “geopathic stress,” which messes with the occupants’ health. That, too, can be cured at a distance by sending a photograph and using the above technique.

This seems so outlandish that I can’t help wondering who would be taken in by it. Then I see the statement that radionics can be a “supplement to other complementary and Subtle Energy therapies especially Homeopathy, Acupuncture, Reiki,” and it all becomes clear.

CBS might mock citizens of the nineteenth century for buying Stanley’s snake oil concoctions or for making a millionaire of Albert Abrams (1864-1924), developer of devices that were the precursors of today’s radionics, but they needn’t look far to find twenty-first-century parallels.

Arthur C. Clark wrote, “Any sufficiently advanced technology is indistinguishable from magic,” but come on, people! These scams are packaged as advanced technology and sold to people who want to believe in magic.

Appropriately Skeptical

From time to time I see an ad from a local doctor promoting stem cell therapy for pain. It includes one endorsement telling how the office was so easy to work with and how the pain went away. For some time now I have been skeptical about the validity of this promotion. I thought stem cell research was not yet in the mainstream of medical practice, and I know that endorsements are not reliable evidence. It seemed suspicious, so I decided to look into it.

The promotional material on line states in part: “Stem cell therapy uses your body’s most powerful and flexible cells to promote natural regeneration in damaged joints.” It claims to be effective for a list of conditions: surgical wounds, tendon damage, severe muscle strain, arthritis, damaged cartilage, torn meniscus and many other joint and soft tissue injuries and conditions.

“The stem cells … come from your own body … a small quantity of bone marrow from your large hip bone.” (Using the recipient’s own stem cells avoids the need for FDA approval.) The on-site lab processes the harvested cells. The doctor then can “precisely inject your stem cell mixture where you need it … where they morph into new cell types” and provide “long-lasting relief” for “many [but not all] patients.”

My first stop was WebMD with a sub-headline reading: “Unproven, Risky Treatments Mislead Patients to Seek Cutting-Edge Therapy.” International Society for Stem Cell Research (ISSCR) “advises patients to seek only stem cell treatments being tested in clinical trials approved by the FDA”… or some approved smaller studies.

There is a lot of information on the site but it is summarized like this: “Every treatment has some risks. So the question comes down to whether the benefits outweigh the risks. And those studies haven't been done yet.” 

This Healthline report from about 18 months ago says that stem cell therapies are being promoted for a wide variety of conditions, but “very few of these applications have any scientific backing, [however] stem cell therapy for knees has been the subject of quite a few promising studies.” It would be a big improvement over knee replacement, but promising studies hardly qualify a procedure for routine outpatient application. They list the cost of this treatment at “approximately $3,000 to $5,000 per knee, depending largely on geographical location.” 

The FDA gives much of the same information. “Stem cell products have the potential to treat many medical conditions and diseases. But for almost all of these products, it is not yet known whether the product has any benefit—or if the product is safe to use.”

Consumer Reports chimes in with a sub-headline: “A new industry is booming. But critics worry that the treatments are ineffective and dangerous.” Here is a very brief summary: “Stem cells are special cells with the potential to repair damaged tissue and organs.” But “not all of them are possessed of equal power.” According to the current scientific consensus, the therapeutic potential of stem cells taken from fully developed tissues, adult cells, is believed to be much more limited. (Does this include marrow from hipbones? I wonder.)

That Consumer Reports piece is a long article with many warnings about the confusion in the field and the inability of regulators to keep up with the proliferation of clinics, both legitimate and otherwise.

Another reason I am skeptical is that the same doctor offers many other questionable services including platelet-rich plasma (PRP), calling it “one of the most powerful natural healing methods available today.” Some conditions include dry eyes, hair loss and erectile dysfunction.

The Pain Science website opinion published earlier this year describes it this way: “injections bathe troubled cells in a concentrated mixture made from your own blood. Hopefully this stimulates healing where it is otherwise failing … but no one really knows for sure yet.” Regardless, it’s not hard to find someone willing to do it for you, but it’s not cheap. “Without any clear evidence of benefit beyond placebo, PRP is now being marketed aggressively as a cure-all for sports injuries.”

I did this research not because I would consider going to a pain specialist unless I was referred by my primary care doctor. I did it just to show how careful we need to be to avoid spending a lot of money on dubious treatments. 

I didn't name this doctor because I'm sure there are similar ads running all over the country. I am not demonizing any doctor who may truly believe in such treatments, but it is a warning to patients everywhere. 

It is nearly always better and safer to be appropriately skeptical.

Walk Faster, Live Longer?

A very interesting article in JAMA a number of years ago requires the application of critical thinking to avoid making a misinterpretation.

 A team of scientists put together a summary of nine studies over the years totaling almost 35,000 subjects over the age of 65, residents of various nursing facilities . Each study was trying to find out whether measuring a person’s walking speed could help predict how much longer they would live.

The data came from the various researchers measuring how fast people walked over a short measured course, between 8 and 20 feet long, using a stopwatch and converting the speed to feet or meters per second. They then followed up years later to see how well the measured speed at the time of the test correlated with how much longer the individuals lived. (The authors refer to it as “gait speed.”)

The published conclusion, when they put the information from all the studies together: “In this pooled analysis of individual data from 9 selected cohorts, gait speed was associated with survival in older adults.” The graphs accompanying the article show this quite clearly, and the findings held true for both men and women and for people of different races. The top group walked the course at 1.6 meters per second, which converts to about 3.6 miles per hour. (For a longer distance this would mean a pace at which someone could walk a mile in about 17 minutes.)

How is this useful? “First, gait speed might help identify older adults with a high probability of living for 5 or 10 more years, who may be appropriate targets for preventive interventions that require years for benefit.” It could help assess whether a particular medical procedure would be worth the risk – there is always a risk, especially for older people. “Second, gait speed might be used to identify older adults with increased risk of early mortality, perhaps those with gait speeds slower than 0.6 m/s.” It is a simple and informative way for “assessing expected survival to contribute to tailoring goals of care in older adults.” Furthermore, it is a simple measurement that can be easily done in a nursing home corridor by non-professionals.

How is this not useful? Correlation is not causation. Someone seeing this article and not using critical thinking might conclude that beginning to walk faster was a way to guarantee longer life. After all, the graphs on the page clearly show that those who walked faster lived longer. Except for the fact that exercise is good for anyone, this conclusion is not necessarily so; it’s not what the analysis shows.

The authors theorize that the correlation exists because, walking “requires energy, movement control, and support and places demands on multiple organ systems, including the heart, lungs, circulatory, nervous, and musculoskeletal systems.” A slower walking speed could indicate some damage or a larger than normal energy requirement for other reasons. Both could be a general indicator of lessened vitality. It makes sense that those who were going to live longer were just capable of walking faster, and did so.

Unfortunately, scientists did not prove that increasing our walking speed will increase our life expectancy. (In fact, people walking faster while texting could easily decrease their life expectancies.) Getting more exercise, including walking, and generally taking care of ourselves will. There is rarely one easy answer. The real secret to good health appeared in this space over five years ago and, unfortunately requires some degree of discipline.

How Sweet It Is!

A couple of things came together over the last few weeks that brought up some interesting questions. The first was this video from John Stossel using the sugar industry as an example of crony capitalism or corporate welfare. The second was the bold print on the side of a bread package announcing that the product contained no high fructose corn syrup (HFCS).

Most of the Stossel video, “Sugar’s Sweetheart Deal,” is about how the industry advertises that they are not subsidized, but government bailouts (using our tax dollars) when the price falls, keep them rich and happy. The government also helps keep the price up with artificial quotas on domestic production and imports. So much of our food costs more, because sugar costs more, and it’s in so many products. 

When I looked at the ingredients on that bread package, the one proudly proclaiming that it contained no HFCS, I was not surprised to see sugar near the top of the list. Perhaps the sugar industry also is behind the bad reputation that most people associate with the cheaper substitute. Is there something behind the halo-effect of “No High Fructose Corn Syrup” or is this another case of hype?

This source gave me a clue: “There isn't enough evidence to say that HFCS is less safe to eat than table sugar, according to the American Medical Association, which has stated that HFSC does not appear to be more harmful than other caloric sweeteners.”

The HealthLine site goes into more detail. “There are only tiny differences between HFCS 55. – the most common type of high-fructose corn syrup – and regular sugar. A major difference is that high-fructose corn syrup is liquid – containing 24% water – whereas table sugar is dry and granulated.” The differences in chemical structure between the fructose and glucose in HFCS and the sucrose in sugar is not significant and “do not affect nutritional value or health properties.” After they are broken down in the digestive system, they end up looking exactly the same.

In a discussion of recipes on howstuffworks.com, they point out that there is a small difference. The HFCS has slightly higher levels of fructose, but the difference is very small and not particularly relevant from a health perspective.

So the package posting no HFCS is not really a reassurance; it only means they used sugar instead. It’s just another advertising trick. Both are about the same thing, neither is particularly good for us, and both should be consumed in moderation.

But what of the packages that say “no sugar” or “sugar-free.” Therein lies another can of worms. Most of the time those products don’t contain HFCS either; they contain artificial sweeteners. But wait! Aren’t artificial sweeteners a kind of slow-acting poison? Some will tell you exactly that.

It turned into another research project. This time I went to Mayo Clinic's site. “Artificial sweeteners are synthetic sugar substitutes. But they may be derived from naturally occurring substances, such as herbs or sugar itself.” They can be “attractive alternatives to sugar” because they contain virtually no calories and do not contribute to dental problems. Artificial sweeteners may also help with weight control and diabetes.

They go on to say: “Artificial sweeteners have been scrutinized intensely for decades.”  Studies from the 1970s “that linked the artificial sweetener saccharin to bladder cancer in laboratory rats” led critics to claim that they are unhealthy and carcinogenic. “But according to the National Cancer Institute and other health agencies, there's no sound scientific evidence that any of the artificial sweeteners approved for use in the United States cause cancer or other serious health problems. Numerous studies confirm that artificial sweeteners are generally safe in limited quantities, even for pregnant women.” 

The sole choices left are the so-called natural sweeteners, such as honey, maple syrup, and molasses. These are popular among the health-conscious crowd, some even calling honey a miracle food. Back to Mayo for this information: "Natural sugar substitutes may seem healthier than sugar. But their vitamin and mineral content isn't significantly different. For example, honey and sugar are nutritionally similar, and your body processes both into glucose and fructose.”

Will all that information change minds? Probably not! Will “No High Fructose Corn Syrup” continue to sell, while people continue to warn their neighbors about the dangers of artificial sweeteners? Most likely! Will foodies be attracted to honey in recipes thinking it contains some health secret? That, too! Critical thinking and simple, solid research where are you?

Those Sore Muscles

Last time I discussed a book I hadn’t read, but based on a couple of reviews, I found some positive things to say about the advice it gave about taking responsibility. (I also threw in some snarky comment about the title.)

This time I want to discuss a book that I actually did read. Published quite recently, it’s called Good To Go, by Christie Ashwaunden. The subtitle is: What the athlete in all of us can learn from the strange science of recovery. It covers a variety of tools and techniques for physical recovery after participating in a sporting event or hard practice session. Examples are taken from professional athletes, Olympic-level competitors and serious sports enthusiasts. The book is an investigation of what works, what has real scientific backing vs. what is based on marketing, hype, and urban myth. It contains many surprises, but reinforces the need for critical thinking, the need to challenge our deeply held beliefs in everything we do.

The introduction states the problem clearly. “The explosion of recovery products and services can seem ridiculous.” Although “everyone intuitively knows what recovery is and how to achieve it,” the industry has found a way to make it much more complicated, expensive and time-consuming than it needs to be or ever has been.

Promoters of these new methods usually use stories rather than scientific facts, and stories told by celebrities or sports stars are most effective. The advertised science behind them is often based on poorly constructed studies with very small sample sizes. Only the ones with positive results see the light of day with the rest (often the majority) filed away. The book investigates many of these products and services to see what really works. I will cover just a few.

One such product with little scientific justification is the sports drink phenomenon, a huge industry with many devoted fans. One expert characterized some of their studies as verging on “comical.” The author takes on the whole idea of hydration, pre-hydration and electrolyte supplements and comes to the conclusion that the best defense against dehydration is to drink when you are thirsty. Any other approach can result in waste or even harm. 

She gives the example of running with her dog. When they get home, she gives her access to a water bowl. The dog decides whether or not to drink. The author has “never needed to inspect the color of the dog’s urine or give her an emergency IV for low fluid levels.” We make it overly complicated, yet hydrate is common advice from all sides every summer.

Similar advice goes for sports nutrition. She gives the example of Usain Bolt, the fastest man in the world, filling up on chicken nuggets during the Olympics. They may not have been the most nutritious meals, but “when your muscles are hungry for fuel, they don’t care where the energy comes from.... What should I eat after exercising? The easiest answer is: whatever your body is hungry for.” 

She also discusses the promotion of such ideas as infrared saunas, explaining that heat is heat, and any magical powers attributed to infrared, such as reducing inflammation, boosting growth hormones, clearing toxins or boosting the immune system are unsupported and have received negative attention from the FDA. Yet marketers and pro athletes push overpriced infrared saunas, cold lasers, massage beds and pajamas, based on the “sciency” sound of it all.

Subsequent chapters talk about sleep and supplements. Sleep is vital for recovery. Keep it uncomplicated; our body helps us figure out how much is enough. I have addressed the problems with supplements many times in the past. (See here and here). They are unregulated, can be dangerous and are poorly researched. They have a reverse approval process compared to prescription drugs. No one has to prove they are safe and effective. The FDA only gets involved when they prove to be harmful, as in the case of ephedra, where a hundred people died taking it to increase energy. “Yet it took the FDA ten years to ban it.”

There is much more to learn from this book. But I found it an excellent example of applied critical thinking with a host of interesting surprises.

The Miracle (?) of Homeopathy

One week ago I compared adults’ belief in psychic abilities to children’s belief in the Easter Bunny. But that is not the extent of these false notions. Another subject that adults love to believe in is miracle cures. It reflects a problem in the areas of discipline, not wanting to do the hard work or stick to a routine, and critical thinking, not wanting to accept evidence over stories. A good example of this is homeopathic medicines.

The theory dates back to the 1700s and is based on the idea that the body can be stimulated to cure itself by means of a like-cures-like reaction. In other words, substances that cause an adverse reaction in a healthy person can (supposedly) cause the body of a sick person to fight against the same condition.

Here is how WebMD explains it. “Red onion makes your eyes water. That’s why it’s used in homeopathic remedies for allergies.” Similarly, they may use poison ivy, white arsenic, crushed whole bees, and various herbs to evoke a beneficial effect.

“Homeopathic doctors weaken these ingredients by adding water or alcohol. Then they shake the mixture as part of a process called ‘potentization.’ They believe this step transfers the healing essence [from the ingredient to the liquid]. Homeopaths also believe that the lower the dose, the more powerful the medicine. In fact, many of these remedies [are so diluted that they] no longer contain any molecules of the original substance.”

The theory sounds a little like vaccinations where a small number of living or dead cells are injected to fire up the body’s immune system, but it’s not the same. Vaccines have something in them. Homeopathic medicines are diluted to the point where they contain only water, plus any contaminants the water carries. Therein lies the problem.

Last summer the FDA released a warning about one particular manufacturer saying, “Consumers and pets who use these products could have an increased risk of serious infection, that could require medical attention, due to the high levels of microbial contamination.” They warned three other companies for violations of (1) inadequate investigation of test results that found high levels of microorganisms, (2) lack of quality oversight of ingredients with potentially toxic effects, including snake venom, and (3) having insects in their ingredients.

The usual disclaimer applies to all these remedies: "Products labeled as homeopathic have not been approved by the FDA for any use and may not meet modern standards for safety, effectiveness and quality." 

It strains credibility that medicine containing not a single molecule of the active ingredient would be effective. The doctor who runs this site calls homeopathy “the ultimate fake,” giving a thorough explanation of his position. So if it does actually work, it must be a miracle. But what does the evidence show?

Here is a headline from Science Direct a few months ago: “A randomized, blinded, placebo-controlled trial comparing antibody responses to homeopathic and conventional vaccines in university students.” Their conclusions from this well designed experiment were four-fold: 

• Homeopathic vaccines failed to elicit an antibody response.
• The antibody response to homeopathic vaccines was similar to placebo.
• In contrast, conventional vaccines showed a robust response.
• These findings suggest homeopathic vaccines should not be licensed.

How does a half-billion-dollar industry react to these facts? They continue to promote their products as “a safe, gentle, and natural system of healing that works with your body to relieve symptoms, restore itself, and improve your overall health. It is extremely safe to use, even with very small children and pets, has none of the side effects of many traditional medications, is very affordable, is made from natural substances, and is FDA regulated.”

Add "holistic" and "alternative" to that sales pitch and people will ignore facts and fall all over themselves trying to obtain some magical relief! Of course, with nothing in it, it is safe and has  no side effects, except possibly from contamination the manufacturer has overlooked. Here’s an idea: skip the trip to the health food store and feed your children and pets tap water. It’s basically the same thing, but even safer. 

Short Subjects

Gluten-free dog food: There are a couple of bad reasons for buying gluten-free dog food and only one good one. But first a little background.

“Gluten is the term for proteins found in wheat, rye, barley and oats. It has glue-like properties, allowing food to stay together. Celiac disease occurs in people with a genetic predisposition and results in damage to the small intestine because of gluten sensitivity. It makes digestion difficult for the affected population.”

The first bad reason is the same one explaining why people buy gluten-free food for themselves. The same website that supplied that explanation above goes on to say, “If you purchase a grain-free dog food, that generally means it’s also gluten-free. A manufacturer might label a grain-free food as also being gluten-free, but that’s marketing for the uninformed.” The only reason they would do that is to sell more product by driving an imaginary competitive advantage. (It might allow them to charge more, too.)

The second bad reason is to assume a gluten-free diet would benefit the pet. “Most dogs do not suffer from celiac disease, so a gluten-free diet is not necessary.” The sole exception is Irish setters that may have inherited a gluten intolerance, but this includes just a few Irish setters. 

The only good reason would be if a dog had celiac disease, confirmed by a vet with blood tests and a biopsy of the intestine. This would be a rare situation even if Irish setters were very common. To make sure I checked for the 10 most popular dog breeds according to the American Kennel Club. Irish setters didn’t make the list.

Then why do we see so many ads and associated material for gluten-free dog food? – The same reason we see gluten-free posted on so much people food – “marketing for the uninformed.”

Workplace Wellness Programs: These became all the rage over the past decade or so, especially within large companies. This website echoes the universal sentiment:

“Considering the improvement to the well-being and productivity of a healthy workplace, and the amount of time we spend at our workplaces, it makes sense to foster workplace wellness programs. Not only does it affect the output of team members, but it makes them feel good in all areas of life—including work.”

Having a suite of such programs makes an employer appear to be progressive and caring while making a wise investment. “One of the signs of a top-notch employer will be a workplace wellness program.”

Top-notch or not, a program that doesn’t work is not a good use of time and money, and according to this NPR health report, that might be the case. Workplace wellness programs, now an $8 billion industry, have received conflicting marks over the years from various studies, but none have been carefully designed enough to rely on – until now. 

Researchers from the University of Chicago and Harvard conducted the first large-scale, peer-reviewed study with a randomized controlled trial design. “They published their findings [last] Tuesday in the medical journal JAMA.” Details of the study can be found by following the link.

In the end, participants self-reported healthier behavior than those not enrolled, such as exercising more or managing their weight better. “But the efforts did not result in differences in health measures, such as improved blood sugar or glucose levels, how much employers spent on health care or how often employees missed work. Their job performance and how long they stuck around in their jobs also seemed unaffected, the researchers say.”

Since a benefit given is nearly impossible to take back, the large number of companies that have them will be forced to assume some hidden return on investment, but the latest scientific data does not really back that up.

Death Threats: Now that the Internet allows people to make death threats without leaving the comfort of their homes or even on the go from their phones, there seem to be more of them – and for more and more trivial reasons. Just last week an Atlanta meteorologist received death threats and other “inappropriate messages” for interrupting the Masters golf tournament to update viewers on tornado watches in the area. Of course a watch is not as serious as a warning, but it’s far more serious than watching golf on TV – except to some who accused the meteorologist of being pretentious and wasting their time. Perspective, anyone?

Irresponsibility: Finding Excuses

Last time I was very pleased to find an example of strong behavior in the dimension of responsibility. The woman attacked by the jaguar at the zoo admitted her part in the incident and hoped that others would learn from her mistake. 

When someone is in the wrong, the common reaction seems to be denial or making excuses. The news lately is filled with celebrities, politicians and their defenders quick to deny a charge, downplay the seriousness of a charge or call attention to all the celebrities or politicians in the past who did the same or worse without ramifications. So it’s OK?

Making excuses covers a multitude of sins, and it serves as a convenient, and often accepted, way  if covering up for behavioral slip-ups in any of the five key dimensions.

One area where this comes into play is when weak behavior in the area of discipline leads to unwanted consequences, for example, lung cancer from smoking, retirement insecurity from failure to save during the working years or obesity.

Along the lines of the latter I found this article on line: “10 Reasons Why Obesity Is NOT About Gluttony and Sloth.” First, the author obviously used the most provocative words possible to describe a situation characterized by a simple lack of discipline, too little exercise or too large portion sizes. Use of the terms gluttony and sloth, boarders on name-calling; they arouse a sense of resentment to prepare the reader to be receptive to a litany of ready-made excuses.

And here they come, all the reasons an unmotivated person can fall back on:

• Obesogenic Environment: where living in an area without sidewalks or safe walking routes coupled with a lack of accessibility to fresh fruits and vegetables along with other environmental factors may add challenges. (People would be thin as rails if only they had sidewalks.)
• Culture of Beauty: drives people toward an unattainable standard, encouraging “self-starvation, exercise abuse, and other eating disorders. It really only serves those who make money off of it.” (This stems from a perspective problem, being manipulated by external values.)
• Mental Health problems “from depression and anxiety to chronic stress and past trauma” can become an issue. “Weight gain can be the result of emotional eating as a way to cope or a result of medications.” (See addiction below for the same excuse in different words.)
• Genetics: While genetics does not predict obesity, over time the combination with other factors may predispose individuals to have obesity issues (though that doesn’t explain why it would suddenly become a factor in the last 50 years.)
• Social Networks: Social influences “play a role in our health behaviors including eating, exercise, weight loss or gain.” (Blame it on your friends.)
• Food Addiction: works like other addictions as “a way to cope with uncomfortable feelings and situations in life.” (Is it realistic to expect life to be comfortable all the time? How easy to forget that life in this century is more comfortable than at any other time in history.)
• Lack of Awareness: too many confusing “messages about what to eat, how to exercise, and ways to lose fat” leave “most of us…scratching our heads.” (But most of these confusing messages come from the purveyors of easy solutions, miracle diet plans and magic answers or from scientists trying to secure funding.)
• Family Income: “Soda is less expensive than water…” (Last I checked water is so inexpensive that I take a shower in it! It falls from the sky! Unless you live in a place like Flint, MI, this argument is as bogus as they come! See here for more about the expensive healthy food myth.)
• Environmental Chemicals in lab experiments alter the metabolism and increasing “the size and number of fat cells in animal exposed to chemicals.” (Blame it on the chemicals, while ignoring the difference between lab experiments and reality.)
• Fat Shame: causes the internalization of society’s fat phobia…creating the most harm. (But change is hard; it doesn’t happen without some discomfort as a motivation. If anything, society has become overly sensitive to the idea of fat shaming and many other attitudes labeled as intolerant.)

So there they are, ready-made excuses to maintain an unhealthy lifestyle. Just spouting off one or two of these (and ignoring the comments in parentheses) is a lot easier than taking responsibility for lapses in discipline.

More Reason to Ban Drug Ads

The last time I wrote a “Don’t Ask Your Doctor” piece was almost three years ago. It was a follow up to the original in November 2012. 

It seems clear that the many drug ads on TV and in magazines with the punch line “Ask your doctor if [fill-in-the-blank drug] is right for you” are merely an attempt by pharmaceutical companies to bypass doctors to increase sales by appealing directly to Americans with a demonstrated weakness in the area of discipline. The companies try to use the patients to put additional pressure on their doctors to prescribe expensive medications. It often interferes with the doctors’ ability to make a proper decision for fear of getting into an unnecessary battle with or ultimately losing a patient.

A common example of this patient pressure that I have run across in the past is the number of people who have gotten antibiotics from their doctors to fight a cold. Antibiotics are not effective for a cold, because it is a viral infection, not bacterial. Doctors know this. It is a waste of money for the patient and a danger to the rest of us as it promotes the evolution of stronger, more drug-resistant viruses.

I am not alone in my objection to these ads. The Washington Times points out that “only doctors have the training about, and knowledge of, such drugs, as well as insight into their patients’ medical backgrounds that may or may not be appropriate for such medications” and that the ads “contribute more confusion than useful information.” The US and New Zealand are the only countries in the world to allow this practice.

The American Medical Association has been calling for a ban on those ads for many years. Their position “reflects concerns among physicians about the negative impact of commercially-driven promotions, and the role that marketing costs play in fueling escalating drug prices.”

And those marketing costs are high! From 1997, when it was first allowed, to 2016 “spending on medical marketing of drugs, disease awareness, health services, and laboratory testing nearly doubled, going from $17.7 billion to $29.9 billion.” The direct-to-consumer portion increased the most, both in amount and proportion of spending from $2.1 billion (11.9% of total spending) in 1997 to $9.6 billion (32.0%),” while the amount spent in journals directed at the doctors decreased.  That spending adds to the cost.

This is doubly important today when we have such strong evidence of how easily patients, and in this case parents, are influenced by misinformation and make such foolish decisions, pressuring their doctors about vaccinations. 

Here is a subject where the science is clear, while warnings and side effects are not buried in the fine print. It’s simple; measles can kill. Vaccinations work.

In 2015, California passed a law eliminating personal belief exemptions for vaccinations that kids must receive before they can attend public school. They can only get a medical exemption from a doctor. Fearful parents are pressuring doctors, causing this medical exemption category to increase by 250% over the first two years of implementation. Some doctors are even cashing in on this unwarranted fear by charging $300 to $500 to write recurring exemptions. The understanding about measles prevention is clear, but there has been an outbreak on the West Coast (and in Europe). These falsified exemptions and parental beliefs endanger not only the kids with fearful parents, but those who cannot be vaccinated due to valid medical exemptions.

This single example casts doubt on the FDA’s original argument for TV ads, that giving consumers more information would lead to better outcomes. It has more likely led to more unnecessary prescriptions and higher drug costs.

Dangers of Detox Plans

It began with the headline: “The Soy Sauce Colon Cleanse That Left a Woman Brain Dead Shows How Dangerous Viral Internet Trends Can Be.” Looking up “Soy Detox Hoax,” I found an interesting mix of news stories about this tragic event and other sites promoting the practice. On one hand there were serious warnings, but every other entry linked to what appeared to be “How To” information.

The Explore Health site called the practice an “extremely dangerous fad.” A 39-year-old woman tried the soy sauce cleanse and went into cardiac arrest on the way to the hospital. She was revived, but drifted in and out of consciousness for several days. She woke up with severe nerve damage, unable to move, swallow, or speak.

According to Fox News, who gave a similar description of the situation, tests showed extremely high levels of salt in her blood, which can draw water away from the brain.

This was not an isolated incident of a soy sauce overdose. Back in 2013, a 19-year-old man drank a quart of soy sauce on a dare. He began twitching and having seizures, then went into a coma and nearly died from an excess of salt in his body. Too much soy sauce is dangerous; a soy sauce cleanse is a bad idea.

But the problem is not limited to soy sauce. Another search, this time for “Dangers of Detox” yielded numerous articles in the mainstream press and on medical and health-oriented websites warning of the practice in general. They date back more than ten years. The danger is not really news!

Most begin by pointing out that the detox fads come and go, usually driven by one or another Hollywood personality. Here is just a sampling of reliable advice.

NBC News had a story back in May 2007, “Experts Warn of Detox Diet Dangers.” Their expert, a gastroenterologist, concludes: “Your body does a perfectly good job of getting rid of toxins on its own…There’s no evidence that these types of diets are necessary or helpful.” Another expert adds that any attempt to flush the bad stuff from your body, the so-called toxins, also flushes out “good bacteria that keep the intestines healthy.”

 From Live Science in November 2014: “There's no scientific evidence that juice cleanses are a sensible approach to better health.”

 In September 2013 a piece about hidden dangers of detox lists as possible side effects: vitamin deficiency, muscle deterioration, heart palpitations, hair loss, depression, abdominal and digestive pain, reduced immune system, skin problems, anemia, and gallstones. 

Harvard Health discussed it in May 2008. “We tend to forget that the body is equipped with a detoxification system of its own” and “can defend itself very well against most environmental insults and the effects of occasional indulgence.” If you're generally healthy, there is no need. If you are experiencing health problems, “visit your doctor instead of a detox spa.”

Journal of Family Practice in August 2011 published a rather technical document for its members about the dangers of colon cleansing. “Patients may look to colon cleansing as a way to ‘enhance their well-being,’ but in reality they may be doing themselves harm.” They emphasized that there are no proven benefits.

There you have it. Many sources tell the straight facts. Under normal circumstances, bodies are built to detox themselves. Colon cleansing or other detox programs or diets are not beneficial with a high probability of causing serious harm. Your body is not full of toxins. Your colon does not need to be periodically cleansed, and doing so does not support, strengthen or promote any natural processes.

With over 10 years of evidence, warnings and examples of cleansing gone wrong, why would anyone try it? One reason is that it appeals to those low on disciple and critical thinking, looking for easy answers and not necessarily fond of science. They trust Hollywood endorsements more than medical professionals.

Unfortunately, the ads and promotions are so easy to find. Mixed in with the numerous links to stories of the brain-dead woman were such headlines as “Best Colon Cleanses for 2018” and “Best Non-GMO Colon Cleanse,” which has a laughable account of a man who lived for over 150 years and fills the rest of the page with endorsements from satisfied customers.