Tuesday, August 31, 2010

Book Review: Worried Sick

Getting older?  Starting to hear speeches from your primary care physician about your cholesterol creeping up, your body mass index being too high, or your blood glucose levels putting you on the cusp of prediabetes?  Read this book, and then tell your PCP where to shove her advice. 

In Worried Sick, Nortin M. Hadler, a physician and rheumatologist, makes a strong case for evidence based medicine.  He exposes the very weak base underlying many pharmaceutical interventions and invasive procedures, such as cardiac bypasses and stents, and encourages patients to do two things:  educate themselves and -- this is the tricky one for Americans -- accept their mortality.  As he points out, over time the mortality rate for being human is 100%. 

Dr. Hadler notes that there is a definite biological limit to how long any of us is going to live.  If we're lucky, we'll make it into our 80s, possibly our 90s, but by the time we get there we're going to be carrying a bunch of comorbidities with us, most of which we have no control over.  The big question is whether or not any of the many procedures and drugs that get shoved at us will actually make it more likely that we will get to be a nonagenarian.  For most of us, sadly but realistically, the answer is no.  Also sadly but realistically, almost none of us are willing to admit that.

This point about longevity is a no-brainer:  if average life expectancy for someone alive today is, for example, 78, that means that only half of our birth cohort (all the other people born the same year as ourselves) is going to make it that far.  Granted, there are reasons why that mean may be skewed a little low, but not by much.   

So if all the various procedures physicians, pharmaceutical companies, and surgical device manufacturers push at us don't really prolong life, what about quality?  If I can't live longer, can I at least live better?  That's where it gets tricky.  Is it worth it to go through the pain and prolonged healing of a multiple by-pass?  For people for whom the procedure goes well and healing is rapid, the answer might be yes.  They may not live any longer or have fewer heart attacks than they would without the surgery, but they feel better, so for them getting their chest cracked feels like it was a good choice, even if they do end up filing bankruptcy because they can't pay the medical bills.  But are those people with the good results the rule for the aftermath of the surgery or the exceptions?  Good question.  Personally, and I know that anecdotes don't count as data, having observed several people who survived the surgery but then experienced some very predictable aftereffects from blood clots, if my cardiologist ever suggests slicing me open, he's out of luck.  I might buy into valve replacement, but never bypass -- but that's me, someone else might make a different choice.

Dr. Hadler spends much of the book talking about medicalization -- the process by which we as a culture take something that was normal and turn it into a condition that has to be treated.  Along the way he describes the way the medical community keeps changing the definitions for what's good and bad, making the threshholds for "healthy" ever lower (a process which just coincidentally advantages companies such as Pfizer).  This section really resonated with me.  The normal range for blood glucose in a nondiabetic is 70 to 120; I had a blood glucose test done recently where the result was 103 -- and, lo and behold, I'm now "prediabetic" and I "really should think about taking metformin."  (I'll think about taking metformin the same day I decide I'd like to live with chronic diarrhea; over 50% of metformin patients report that particular side effect.)

This process of adjusting "healthy" down has also happened with cholesterol -- the "normal" range has been moved lower, making it less and less likely the average person will fall into it without pharmaceutical interventions.  It's like they're all forgetting that cholesterol is in the body for a reason -- it's needed for Vitamin D retention, among other things -- and have decided all cholesterol, regardless of whether it's HDL or LDL, is "bad" and has to go.

And weight -- the much hyped explosion of fat in the 1990s occurred not because people suddenly started binging like never before, but because the ranges on the BMI for underweight, normal, overweight, and obese were shifted downward by several points.  People who had been considered in a healthy weight range suddenly found themselves Too Fat, all without gaining a pound.  Result?  Instant Obesity Epidemic.  Does anyone even know what a "healthy" weight is?  We all know what a culturally defined aesthetically pleasing normal weight is, although that shifts over time, too (compare the Gibson girls circa 1900 with the women considered attractive today), but what's actually healthy?  A lot of fat is obviously bad -- no one would argue that those folks having to be removed from their homes with forklifts have embraced health at every size -- but where's the cutoff between no problem and too much?  Overweight old people live longer than thin ones, so where does the argument that losing weight will help you live longer come from?

Dr. Hadler raises these questions, and many others.  He notes the skyrocketing cost of health care in the United States, reminds us that rising numbers of people do not have access to health care at all, and pushes hard for evidence-based medicine.  The U.S. spends more as a percentage of gross domestic product (GDP) than any other industrialized country, but has more uneven outcomes and lower life expectancy. There's obviously a lot of money being wasted when the results are so poor. How many procedures are being done that benefit only Medtronics or Pfizer's bottom line while adding nothing to patient longevity or quality of life?  He recognizes that there are some diagnostic procedures that have become so socially entrenched in our collective conscious that they may be impossible to dislodge -- annual mammograms for all women over 50 regardless of risk factors being the prime example of a procedure that has almost zero benefit but has such a strong constituency you can't get rid of it -- but he encourages readers to not allow themselves to be bullied into spending their money (or their insurance company's) on procedures or drugs that they don't need.

Worried Sick also examines alternative or complementary medicine.  After providing a good overview of the area and the history of practices such as chiropractic medicine, Dr. Hadler's attitude toward chiropractors, herbalists, naturopaths, and others is to advise us, in essence, "If you want to waste your money, go ahead."  He also warns the reader that because the standards for "natural" products do not include much in the way of quality control, you really don't know what you're getting in your ginseng tea or gingko biloba tablets.  The actual herbal content might be very low and it might contaminated (as has been found to be very common in products from China).  Caveat emptor. 

This book covers a wealth of material.  It also includes an extensive bibliography and supplemental readings that further explicate the studies Dr. Hadler cites so the reader knows where to go looking for more information.  It wasn't easy reading, but it was worth it.

Update:  After thinking about it, I feel compelled to add that Dr. Hadler isn't saying that all medical treatment is unwarranted or unproven.  He's saying be an informed patient.  Some procedures are necessary, some drugs do work -- but not all of them, not all the time, and not for everyone.  Do your homework.

Sunday, August 29, 2010

This morning's prize sound bite

"I appreciate Glenn Beck.  He teaches us history that they never taught us in school."

That's one way of putting it. 

Saturday, August 28, 2010

A first

I had to turn off C-SPAN.  Smarmy sleazeball hypocrite Ralph Reed was the featured guest.  All it took was about 3 minutes of his bloviating about morals and people of faith always doing the right thing and I was flipping to HGTV.  If I'd listened much longer, I might have lost my breakfast.

One of Reed's riffs was about the way government should just stay out of helping people, that everything was fine and dandy back when churches and private charities handled making sure the widowed and orpaned and handicapped didn't starve in the streets. 


Although he didn't go as far as Gingrich did back in the 90s (I have a vague recollection of the Newster advocating taking poor kids away from their parents and sticking them in orphanages), I kept thinking that any second Reed was going to wax nostalgic for the good old days of poor farms, county workhouses, and orphan trains. 

Reed did get me to thinking about the whole notion of the "deserving poor."  One reason the government gets involved in creating social safety nets, like disability payments or food stamps, is government can be impersonal.  The bureaucrat who makes you fill out the forms doesn't get to say Yes or No based on whether you're fat or thin, white or Asian, wearing denim and covered with tatoos or dressed in Dockers with a nice neat haircut -- it all comes down to what information goes on the form and your ability to provide the various pieces of required documentation (e.g., a completed "Proof of child in the home" form signed by a neighbor). 

The same isn't true of private charity.  Churches and individuals pick and choose the beneficiaries of their largesse based on subjective criteria -- we feel sorry for the poor sap in a wheelchair so we hand him a $5, we feel contempt for the apparently physically abled person standing with a "homeless please help" sign because we think that surely he or she could get a job.  We'll help a family that falls on hard times if they're members of our congregation; we'll ignore them if they're not.  One person in a community is diagnosed with a devastating disease and collection cans to pay his medical bills pop up at every gas station in town; another person suffers an equally disastrous circumstance, and the collective response is to ignore it.  What makes the difference in the response has nothing to do with the person's actual life story, how they happened to end up on a street corner panhandling, and everything to do with our visceral reaction when we first see them.

There was a reason government got involved in social services to begin with.  The private sector wasn't working.  Unfortunately, Reed and his ilk will never admit that.  


Back around the time of World War I, the S.O.'s grandparents bought a railroad 40 in upper Michigan.  It had been logged over for white pine so qualified as a "stump farm."   Over the following decade, Matt and Susanna patiently cleared the stumps and, because at least half the property was wetland, ditched the swamp. (The lines for the ditches are still visible in aerial photos.) Family folklore says that it took many years to clear all the stumps -- they were still digging them out and using them for firewood in the late 1920s. End result:  not quite 40 acres that were basically wide open cow pasture and hayfield with a little bit of woodlot retained on the rockiest and/or boggiest bits.  The building is the sauna, sitting out in the open, a totally cleared area.  The photo above was taken in about 1953.

This is a view taken a couple years ago of where that sauna was. 
I do have days at the farm when I miss the view of the railroad tracks. 

Friday, August 27, 2010

Sunday, August 22, 2010

What goes around comes around

A few weeks ago I mentioned reading Stephen Ambrose's book about the building of the first North American continental railway back in the 1860s.  One of the things Ambrose describes quite nicely is the extensive use of Chinese labor by the Central Pacific.  The American engineers provided the technology and the engineering expertise; the Chinese provided the muscle.

Flash forward 150 years and an essay by Robert Borosage in a July issue of Progressive Populist on the funding crises in public education, with class sizes rocketing, hours of instruction being cut, and teachers being furloughed:
"This surely is how great nations decline.  Like Rome and Britain before us, Washington now chooses to police the world, even as it cuts back the education of the nation's most vulnerable children. We fight two wars on the other side of the world, spend more defending South Korea from North Korea than the South Koreans do, increase military spending already nearly as great as the rest of the world combined while saying we can't afford vital investments at home.

In April, an iconic article in the New York Times recorded the cost of this folly. The Times reported from Beijing that the Chinese were preparing to bid to build the bullet train from San Francisco to Los Angeles. The director of high-speed rail in China, Zheng Jian, noted that 'We are the most advanced in many fields, and we are willing to share with the US.'

High-speed rail requires financing, very sophisticated technology and advanced engineering - and China is ready to provide the cash, the technology and the high end engineers and skilled technicians. They would hire Americans to assemble the parts and lay the track."
Hire Americans to lay the track.  We can be so proud of ourselves and our insistence on not paying taxes for anything that doesn't involve killing people in other countries- from putting men on the moon to being viewed as a good source of 苦力 labor* in under 50 years.  

[*drudge, coolie, manual laborer]

Saturday, August 21, 2010

Good day in the neighborhood

Mexican Coke is on sale at  Mercado del Pueblo:  $19.99 for a full case when it's usually $1.29/bottle.

Friday, August 20, 2010

The upside of insomnia

Comedy Central doesn't bleep out the fucks at 4 a.m.  Jim Norton uncensored -- if I wasn't wide awake before, I sure am now. 

I'm not sure why I'm awake this early.  I thought it was because the phone was ringing at 3 a.m. and was all set to be annoyed about people drunk dialing wrong numbers, but I must have dreamt it -- when I checked the phone the last call registered by caller ID was from a couple days ago. 

Actually, a drunk dialed wrong number wouldn't bother me too much, at least not as much as the robocalls my cell phone has been getting from one of the local mega-churches.  My minutes (I have a cheap plan with a finite amount) are getting eaten by taped greetings from what sounds like a Stepford wife hoping that she'll see me in church on Sunday.  Christ on a crutch.  If I wasn't an atheist before, that type of mass marketing technique would turn me into one pretty fast.   If you're going to proselytise, people, at least show the same amount of ambition the Jehovahs and the Mormons do and do it in person.  Get out there and start pounding the pavement and ringing doorbells.  Not that either group has much luck when they knock on our door -- our neighborhood tends to get the missionaries who come prepared with the Spanish-language version of the Book of Mormon so the conversations tend to be brief -- but at least they're human. 

Sunday, August 15, 2010

Whatever happened to Tony Danza?

And what does it mean when a person dreams about bus travel?  Is it more or less significant that Tony Danza was also on the bus? 

I've read enough about dream symbolism to know that travel in any way, shape, or form represents a desire to leave one's current situation, whatever that situation might be.  It's actually fairly accurate, too, because I'm impatient in the short term to get the proposed move from this apartment into a renovated one over with (the latest update is that it might, just might, happen sometime around Labor Day, but the manager didn't sound particularly optimistic), and in the long term I'm anxious to get out of Atlanta.  But Tony Danza? 

I'll just chalk it up to a weird connection triggered by having spent some time on the phone last night with the Older Daughter.  She was a fan, sort of, of "Who's the Boss?"  That didn't come up in conversation, but who knows what sort of odd linkages happen in the subconscious.  My friend Teresa was in the dream, too, and I haven't seen her in ages.  Maybe my subconscious is planning a trip to Grand Rapids?

I'm one of those people who usually doesn't remember dreams at all, so when I do, I'm always a little curious as to just what inspired what I do remember.  Usually I can come up with some sort of explanation . . . but Tony Danza? Very strange. 

New depths of stupidity and revisionist history

What's the first thing I hear on C-SPAN this morning?  We shouldn't blame poor former President Bush for anything, because after all when he came into office he had to deal with the aftermath of 9/11 -- which happened on Clinton's watch

Let's see.  9/11 = September 11, 2001.

Bush inauguration = January 20, 2001.

Definitely one of those should I laugh or cry moments. 

That call was followed immediately by someone ranting about Woodrow Wilson taking the country off the gold standard in 1937.  Nice trick, considering that Wilson died in 1924. 

So much for any fantasies a person might cherish about C-SPAN viewers being more literate or knowledgeable than the general public.  Maybe I should stop admitting I watch "Washington Journal" as much as I do.

Saturday, August 14, 2010

Stunning display of cluenessness

I was watching The Ed Show on MSNBC last night, and got to witness one of the all-time most clueless displays of white ignorance and racism I've seen in a long time.  The panel discussion was about Dr. Laura's use of the infamous N word in talking with a caller.  The caller had a legitimate problem, and Dr. Laura responded the way she always does -- blame the victim -- and accused the caller of being too sensitive. 

Dr. Laura also did the usual psuedo-naive white person's lament of "I don't get it.  Why is it wrong for me to say nigger, but black people use it all the time?"  The simple answer, one that doesn't even get into the long and troubled history of race relations in this country, is "For the same reason that the Irish can call each other drunks and Poles can tell Polish jokes without being called bigots, but people outside their ethnicity cannot, you dumb bitch."  But that isn't what floored me about the discussion on The Ed Show. 

No, that honor goes to Heidi Harris, Las Vegas conservative radio talk show host.  In debating whether or not Dr. Laura did something wrong, Harris told Joe Madison (a black progressive with an XM satellite radio show) Dr. Laura doesn't dislike black people.  Madison thought the same thing that I did -- that Harris was going to pull out that tired line about "some of her best friends. . ."  We were wrong.  Harris dropped so far into cluelessness that even my jaw dropped.  Her defense of Dr. Laura?  The woman can't be a bigot -- she has a black employee (a bodyguard). 

Holy fuck.  That's in the same class as "I really like Hispanic people. Our gardener Jose is a gem."  No wonder the right wing comes across as a bunch of tinfoil hat types.  They really are dumb as rocks.

Friday, August 6, 2010


A recent post over at That's Why got me to thinking about kids, diversity, and education.  Back when the Younger Daughter was really young, the S.O. got recruited by Lockheed to work as a  prototype product structures development mechanic.  We found ourselves living in the heart of the San Fernando Valley, close to the crosshairs formed by the intersection of Roscoe and Sepulveda boulevards.  We enrolled the kids in school, and thought, cool, they're going to be able to walk to school for the first time ever -- Noble Avenue Elementary was just a couple blocks away so there'd be no spending an hour on the bus as it meandered around the countryside.

Then we got the letter.

Turned out the Los Angeles Metropolitan Unified School District was finally going to comply with court ordered busing for integration.  Big meeting at the elementary school so parents would learn just what the ramifications of the court order were and how it applied to their kids. 

The room was packed solid, of course, with angry parents saying, in essence, Hell, no.  No way is my kid getting on a school bus to be driven across the valley to god's knows where just so "those people*" can be integrated. 

Well, at least the system for determining who got on the bus was fair:  it went by birth month.  Kids born in the odd months (January, March, May, July, September, November) got to stay at Noble Avenue; kids born in the even months (February, April, June, August, October, and December) would ride the bus.  I hit August and December in the dropping babies lottery; my two got on the bus. 

Of course, out on the other end of the line, in the much wealthier and whiter suburb of Canoga Park, the parents reacted not with resignation but with last minute enrolments at private schools.  End result?  See above photo. 

As for my kids, who got bused out from the inner city school with too many minority students to the predominantly white 'burbs in the interest of diversity, the younger one is the only girl in the back row of the photo.  I've always kind of wondered if her first grade spelling lists included "irony."

*upper middle class white suburbanites

Maybe your paranoia is seeing a problem where none exists?

I heard a moderately amusing on the news today.  Seems a local watchdog group, Jobs for Georgians, is concerned about undocumented workers being hired to work on a major government construction project, the new Cobb County Courthouse.  So they pushed for background checks of the approximately 700 workers on the project.  The sheriff's department says they've investigated over half the workers, and so far this is what they've found:

Two guys with outstanding warrants:  Lambert Williams, 31, for failure to pay child support, and Ray Lee Roberts, 29, for violating probation.

So much for the vast hordes of mojados stealing jobs from honest Americans.

Sunday, August 1, 2010

Weed control revisited

No surprises here

There's been a fair amount of discussion on C-SPAN this morning about corruption in Congress and what a terrible blow it is to Nancy Pelosi that both Charlie Rangel and Maxine Waters are facing ethics problems.  Why?

This is classic media hype, this whole golly gee, what a shocker, someone in Congress has gotten nailed for sleazy behavior and we're all so surprised that this is happening, a sort of breathless naivete like it's never, ever happened before. 

Get real, people.  It happens every term -- some Congress critter who's managed to get re-elected multiple times and has gone for 10, 20, or 30 years with no meaningful opposition back in his or her home district starts confusing holding a political office with being given a lifetime entitlement.  They start thinking the rules no longer apply to them.  They become addicted to the junkets provided by industry lobbyists, they start giving jobs to their relatives, they cut various corners because they figure they can use their positions to intimidate anyone who dares to remind them there are rules.  They abuse their positions by sexually harassing staffers and Congressional pages, they go out and party hard, abusing drugs and/or alcohol because they figure they can hush up any tickets or arrests, and so on.  The longer they're in office, the more brazen the behavior, and eventually they get caught.  And it's nonpartisan -- both parties have experienced the embarrassment of a senator or representative getting caught, sometimes quite literally, with his pants down (does anyone remember Larry Craig?). 

Similarly, every administration ends up with at least a handful of appointees getting nailed for corruption or other criminal activities.  I think the Reagan administration currently holds the record for number of criminal indictments of appointees, beating out Warren G. Harding by a cabinet officer or two, but no administration is totally immune. 

So why the feigned surprise?  Maybe because the media is like the rest of the American populace and has a hard time remembering anything that happened more than a week ago, but more likely because sensationalism sells.  The headline equivalent of "Holy crap! I can't believe this is happening!!" is going to draw a lot more eyeballs than "Long-held suspicions confirmed."

When I look at cases like Rangel and Waters, I see the inevitable result of gerrymandering, of districts being drawn in a way that makes them solidly safe for one party or the other.  It's a lot easier to grow complacent and corrupt if you think there's never going to be any serious opposition to your candidacy.  When I look at the map for the Atlanta area, for example, and see the convoluted lines for District 13, I know it was created to ensure a district that would be reliably one party or the other -- and, as it turns out, it captures the areas around the edges of metropolitan Atlanta that lean Democratic.  (It's currently represented by David Scott. The two districts in the middle, 4 and 5, are solidly Democratic.)  The sad reality is that in any given year, over 90% of incumbents will be returned to office.  We may talk about throwing the bums out, but the advantages of incumbency mean we're rarely able to follow through.  Most changes in Congress this year, at least on the Democratic side of the aisle, despite the posturing the Tea Party and others, are more likely to result from Congress critters deciding on their own to retire (e.g., Stupak in Michigan) than from anything happening in voting booths.