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Musings Report #1 1-2-16 What Can We Do to Improve Our Health in 2016?
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For those who are new to the Musings reports: they are basically a glimpse into my notebook, the unfiltered swamp where I organize future themes, sort through the dozens of stories and links submitted by readers, refine my own research and start connecting dots which appear later in the blog or in my books. As always, I hope the Musings spark new appraisals and insights. Thank you for supporting the site and for inviting me into your circle of correspondents.
What Can We Do to Improve Our Health in 2016?
As a follow-up to my recent essay on global health crises, I wanted to share responses to the essay by two physicians--one in the U.S., the other in Canada. Strikingly, though the two nations' healthcare systems are quite different, the ailments that occupy much of the doctors' time are remarkably similar.
What can we do to improve our health in 2016? Perhaps one answer is: avoid the common chronic conditions mentioned by these physicians.
While the list of potentially positive actions we can take to improve our health is long, the list of what to avoid is not very long. Maybe just avoiding negatives is the simpler strategy.
U.S. Physician:
As an emergency physician I watch in horror the mess that we have collectively gotten ourselves into with our poor health, complex and profoundly wasteful system, and hundreds of rules to ensure safety and reduce liability.
Some rambling anecdotes:
1. at least 50% of the people I see on a given shift are in the emergency department (ED) as a direct result of unhealthy and destructive life situations: Diabesity (diabetes, hypertension, arterial blockages in heart, brain and legs), smoking (chronic lung disease), alcoholism (vomiting blood, pancreatitis, liver disease, chronic brain deterioration), drugs (faking illness to obtain narcotics, withdrawal syndromes, overdoses and seeking admission to rehab).
2. much of disability in the elderly results from the combination of obesity with arthritis --and the resulting deconditioning. All obese inflamed people have pain (hip, back, knees), are short of breath with exercise, and begin to decondition to where climbing a few steps becomes very difficult. At some point, they must go into nursing homes as they cannot care for themselves and they are far to heavy for family to lift. This is not a disease but a downward functional spiral that many do not recognize until very advanced.
3. A special note must go to the Pickwickian hypoventilation syndrome in the morbidly obese: massive layers of fat lie across the chest wall and fill the abdominal cavity restricting breathing movement. The brain slowly adjusts to not being able to exhale CO2 adequately and the person moves into permanent respiratory failure, weakness, cognitive decline, exercise intolerance. I see this everyday I work.
4. The community's poor and uninsured use the ED for primary medical care. The ED is the only place where you can see a doctor without insurance or putting money down. Since many do not have cars, they come in by ambulance. Some are hypochondriacs, many not terribly bright and many very anxious. Others are just very unsophisticated and need "to be checked by a doctor" every time one of the kids vomits, skins a knee or comes into the proximity of a spider. Medical records show an ED visit for someone in the family every 2-3 weeks. They are seen in the highest tech setting possible for the most minor concerns. And time constraint limit patient education opportunities.
5. Depressed, obese, arthritic, unemployed, Mountain Dew and Marlboro consuming people have pain. Often lots of pain. In many locations. And narcotics improve that pain (temporarily) and offers a blessed and blissful (but temporary) relief from depression. Going to the ED to get narcotics is a ubiquitous pass time of the rural poor in Virginia. And of course you have to prepare a good story: "Well. (takes a deep breath) I was up on the roof when my horse kicked the ladder and the tree fell over towards my car which hit the side of the house knocking loose a shingle.....(etc) .... and it hurts REALLY bad." (If you don't believe me I can lie on the floor and scream a bit. Do I need to do that today?) About 15% of patients are probably lying about everything they say.
6. And then there are the RULES. Tens / hundreds of hospital policies and rules to ensure uniformity, reduce liability risk, and conform with government regulation. And the bureaucracy to oversee the application of the rules.
7. Sometimes patients just don't go to work and are told that they "must get a doctors note." They come to the ED, tell a tall tale, have $1,000 -$2,000 worth of tests that are surprisingly normal, and are given an off work note.
Canadian Physician:
I am a family physician in Ontario, Canada with an absolutely conventional medical practice. I practice according to whatever guidelines are handed down by the Powers That Be. For me, it's just a daytime job.
There are three "clusters" of diseases which I see more of, day-to-day, than any others, and which form the bulk of my workload:
1. "Diabesity" - the constellation of conditions which include diabetes, obesity, hypertension, sleep apnea and osteoarthritis, as described above by sand_puppy
2. Low level mental health issues including anxiety, depression, insomnia, work related stress and chronic narcotic dependence (many of these often co-exist in the same patient)
3. Chronic pain. It's often difficult to differentiate genuine chronic pain from chronic narcotic dependence, and I suspect that again, they often co-exist in the same patient.
If I didn't have to deal with any of these issues, I would be working one day a week and doing something more useful with the rest of my time, like practicing a musical instrument, or gardening. I don't think I do much good for most of my patients because they never seem to improve. However, they look to me as being the provider of their health, it doesn't seem to occur to them to take control of their health themselves, so I don't give them a hard time - I just play the role society expects of me as best I can, and wait for what comes next.
In the event of the gasoline supply drying up, the banks closing or the grocery stores emptying, I don't think most of my patients would live very long.
Relatively simple habits can go a long way to helping us avoid chronic illnesses. Best wishes to you all for a healthy and productive 2016.
Summary of the Blog This Past Week
The Global Health Crisis Will Crush the Global Economy 1/1/15
Well-Paid Pandering Pundits and the Fantasy of Reform 12/31/15
The Cultural Contradictions That Have Crippled the Great American Middle Class 12/30/15
If You Want to Limit the Power of the Super-Wealthy, Stop Using their Money 12/29/15
Honey, I Shrunk the Middle Class: Perhaps 1/3 of Households Qualify 12/28/15
Best Thing That Happened To Me This Week
Signed and mailed the book contract to China--am crossing my fingers that my new book will be published in Chinese in 2016...
Market Musings: Wedges, Wedges, Everywhere
What really pops out of the charts I follow are the number of wedges that have been traced out in major markets: S&P 500, gold, oil (WTIC) and the USD.
Wedges can be symmetrical, rising or falling: rising wedges are bearish, falling wedges are bullish, and symmetrical wedges can break big up or down.
Standard technical analysis holds that these wedges tend to follow the existing trend: if the trend is down, wedges break down.
But I don't think this is true often enough to make a rule; we have to look at other technical factors such as MACD, moving averages, etc.
SPX: a number of factors suggest a breakdown rather than a break higher: lower highs, ugly MACD below the neutral line and a sell signal "death cross" of the 20-day MA through the 50-day MA.
USD: The US dollar has become overbought and overloved and this alone suggests it's due for the breather. MACD could go either way, and the 20-day just dropped below the 50-day MA in a death cross.
GOLD: gold's wedge is accompanied by tightening Bollinger bands and a divergent MACD (rising while gold has chopped around). This could go either way, but if theUSD breaks down gold will likely break to the upside.
WTIC OIL: after a long stretch below the 20-day MA, oil is hugging the 20-day MA in a wedge accompanied by rising MACD. Sentiment on oil is almost unioversally bearish, which is the ideal set-up for a strong rally.
These markets are all poised to break higher or lower in a big way soon. Those on the right side of the trade will make some good money--but guessing the direction remains risky until price gives the move away. Any position in these assets should be hedged or taken off the table until the trend has been established one way or the other.
From Left Field
3 Years on Mars! Curiosity Rover's Amazing Journey in Pictures
Nature's Warning Signal: Complex systems like ecological food webs, the brain, and the climate all give off a characteristic signal when disaster is around the corner.
The incredible shrinking middle class -- good review of the Pew data
If You Want to See the Future of Electricity, Look to Africa and India
Singapore and Denmark: Contrasting happiness?--Can sunshine and low income tax make you happy?
Stiglitz: Here's How to Fix Inequality -- impossible "reforms"
Reality Shock: The Highest Property Tax Rates in Cook and Its Collar Counties
It's the Inequality, Stupid -- chart-fest
Opec faces a mortal threat from electric cars: The oil cartel is living in a time-warp, seemingly unaware that global energy politics have changed forever
Paramount Now Streaming 175 Free Movies Online, Including Westerns, Thrillers & Crime Pictures
In the Dirtiest Cities, Air Pollution Forces Life Changes -- no playing outside, air filters everywhere....
Beijing Raises Smog Alert as Airport Cancels 227 Departures
"Gratitude is not only the greatest of virtues, but the parent of all the others." Marcus Cicero
Thanks for reading--
charles |
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