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Programmers and system administrators are mass profession. There were approximately 435K programmers in the USA in 2006. I think number of system administrators are roughly the same so we can speak about the labor army of one million people.
Contrary to superficial impression of individual cubicles and nice environment, IT is actually very unhealthy profession. With a high chance to be unemployed after 50. More often then not, there are periods of considerable stress. Some are caused by catastrophic failures of hardware equipment, some by unrealistic schedules and workloads, some by own errors of particular programmer or sysadmin.
Overtime is common. Job security is deteriorating as outsourcing is rampant. Employment after 50 is not guaranteed. Environment changes way too fast, and not always for good. Fashion rules (remember The Devil Wears Prada). Toxic managers are common (remember Office Space ;-)
So sooner of later a programmer need to face "medical-industrial complex" of the USA. And this is a dangerous "for profit" beast with tremendous appetite which maims and kills annually considerable amount of people. Living under Neoliberalism with its "greed is good" mentality and "homo homini lupus est" slogan is indeed dangerous and requires knowledge of elementary "self-defense". Hippocratic oath no longer applies to medical profession in the USA. Most doctors still follow it, but there real sharks among them (with some ending their careers in jail like regular criminals) and you need to hope for the best but prepare for the worst. Especially rampant abuse is with cardiac stents (Overuse of Cardiac Stents Linked to Patient Deaths) with around a dozen of cardiologists serving jail terms (see for example Stent doctor Salisbury stent doctor sentenced to federal prison )
As USA Today reported (Doctors perform thousands of unnecessary surgeries):
Since 2005, more than 1,000 doctors have made payments to settle or close malpractice claims in surgical cases that involved allegations of unnecessary or inappropriate procedures, according to a USA TODAY analysis of the
U.S. government's National Practitioner Data Bank public use file, which tracks the suits. About half the doctors' payments involved allegations of serious permanent injury or death, and many of the cases involved multiple plaintiffs, suggesting many hundreds, if not thousands, of victims.
Journal of the American Medical Associationreviewed records for 112,000 patients who had an implantable cardioverter-defibrillator (ICD), a pacemaker-like device that corrects heartbeat irregularities. In 22.5% of the cases, researchers found no medical evidence to support installing the devices.
"Don't just take a doctor's word," says Patty Skolnik, who founded Citizens for Patient Safety after her son, Michael, died at 22 from complications in what she says was unnecessary brain surgery. "Research your doctor, research the procedure, ask questions, including the most important one: 'What will happen if I don't get this done?'"
A 1982 study in the journal Medical Care found that a mandatory second opinion program for Massachusetts Medicaid patients led to a 20% drop in certain surgeries, such as hysterectomies, that were considered more likely to be done unnecessarily. A 1997 study in the Journal of the American College of Surgeons looked at 5,601 patients recommended for surgery and found that second opinions found no need for the operation in 9% of the cases. Among those who got the countervailing second opinion, 62% opted not to have the operation.
But many patients simply aren't inclined to question their doctors.
"We expect the physician to know what's best for a patient," says William Root, chief compliance officer at Louisiana's Department of Health and Hospitals. "
We put so much faith and confidence in our physicians, (and) most of them deserve it. But when one of them is wrong or goes astray, it can do a lot of damage."
Chronic stress, overload, long hours, unhealthy diet and other environmental factors deeply and negatively affects the lifestyle of programmers and system administrators. So there is nothing surprising that despite pretty comfortable work conditions many programmers/system administrators suffer from assortments on various diseases. Like other workers who spend long periods in front of a computer terminal typing at a keyboard, programmers are susceptible to:
Additional health problems are typical for those who experience constant stress and/or are typical "diseases of civilization". Among them
Also many programmers/sysadmins works as contractors and either do not have health insurance or have very basic health insurance. This is typical for young programmers and those who are over 50 and were let go on their previous jobs die to outsourcingLow and middle income US citizens spends far more on health care than any other country but gets only mediocre care in return for its investment. The U.S. national average score on 37 separate measures of health care falls far short when compared either to a few centers of excellence within the country, or to other countries, the report from the Commonwealth Fund found. And that's true not only in terms of mortality statistics but also in terms of quality of life.
The main problems with US healthcare are:
A new University of Michigan Health System study of about 8,000 adolescents and young adults shows the degree and duration of carrying extra pounds are important risk factors for developing type 2 diabetes in adulthood.
"Our study finds that the relationship between weight and type 2 diabetes is similar to the relationship between smoking and the risk of lung cancer," says study lead author Joyce Lee, M.D., M.P.H., a pediatric endocrinologist at U-M's C.S. Mott Children's Hospital. "The amount of excess weight that you carry, and the number of years for which you carry it, dramatically increase your risk of diabetes."
The study appears online ahead of print in the September issue of the Archives of Pediatric Adolescent Medicine.
"We know that, due to the childhood obesity epidemic, younger generations of Americans are becoming heavier much earlier in life, and are carrying the extra weight for longer periods over their lifetimes," says Lee. "When you add the findings from this study, rates of diabetes in the United States may rise even higher than previously predicted."
Researchers found that a measure of degree and duration of excess weight (based on the number of years body mass index, a calculation of weight and height, of 25 or higher) was a better predictor of diabetes risk than a single measurement of excess weight. A BMI over 25 is considered overweight and over 30 is considered obese.
Lee and colleagues also found that black and Hispanic compared with white individuals had a higher risk for diabetes, for a same amount of excess weight over time.
For example, individuals with a BMI of 35 (10 points higher than healthy weight) for 10 years would be considered to have 100 years of excess BMI. Hispanics in this group were twice as likely to develop diabetes compared to whites, while blacks in this group had one-and-a-half-times greater risk than whites.
Based on the latest findings, Lee suggests obesity prevention and treatment efforts should focus on adolescents and young adults, especially racial minorities.
Programmers and system administrators can do much better is maintaining their health. And they are naturally equipped for dealing with complex system and thus able to navigate the maze of the USA "medical industrial complex"
A lot of outcomes depends on the level of individual knowledge. Knowledge is power both for avoiding unnecessary procedures (with some causing irreversible damage) , unnecessary overprescribed drugs, and when negotiating with health care providers.
January 22, 2019Early last year, I began to experience some pains in my hands. I associated them with bringing a large turkey back from the butchers. Hadn't taken the car, because parking, but it was heavier than I appreciated and I struggled with the bird as the handles of the plastic bad tore on my fingers. I went to the doctor. Tendons, probably, he said. Most likely be better in a few months.
Then in September, back from a touring holiday in France which had involved a lot of lugging of boxes and cases up and down stairs, the pain was back, worse. I lacked the strength to open cans and bottles. Some movements were fine but turning a knob or using a key sometimes -- ouch!
That's where I am, basically. A few trips to the doctor and the physio later, osteoarthritis it seems. Injections in the thumb joint helped one hand, but less the other. Typing is ok, mostly, but my handwriting is worse. On public transport I steady myself by wrapping my arm around things, since gripping with a hand might hurt. I squeeze a rubber ball from time to time, as building up the muscles supposedly compensates a bit for the damage to the joints.
Not much fun, but could be worse. And only one of many things that comes past your mid fifties (I'm sixty now). I've had more blood tests in the past three years than in the previous thirty put together. Diabetes? No, thank goodness, not yet. Blood pressure is high, if not really dangerously so yet. Swallowing statins every morning, when I remember, to keep the choresterol down.
My father died in the summer of 2017. He was in good form until a week before the end though he'd had his share of health problems over the quarter-century before and a walk to the shops and back would see him needing a rest. We shared conversations to the end. He was lively, still learning German, discussing Edith Wharton. Though we all know that death is coming, a parent going is concrete. You know that will be you soon enough, so better make the best of it and concentrate on what matters.
As I've thought more about the loss of capacity. The aches and pains. The knowledge that there are things you could do but now can't. When you really ought to take more exercise because it is good for your heart and lungs, but when there's every chance that back, knee or hip won't play nicely enough to let you.
I keep returning to an image from a TV programme about John Clare. The picture was of a man on his back with
The grass below -- above the vaulted sky.
When young the vaulting is infinitely distant, and if lucky and not disabled you can vault over obstacles yourself. But age makes the sky close in. In your forties you can see the roof even if you can't touch it. Then, later, if you stretch, your fingers graze the surface. Time comes when you have to be careful not to bang your head. Some while after you stoop and then crouch. The tunnel gets narrower too. There is less space to move and perhaps, eventually, there will be no space at all.Share this:
Don A in Pennsyltucky 01.22.19 at 12:02 pm ( 1 )Statins with dinner. Ask the pharmacist.Matt 01.22.19 at 12:46 pm ( 2 )
Hoping that the pain/stiffness in knuckles since the bicycle accident (2 months ago) continues to self-resolve with OTC anti-inflammatoriesI'm sorry to hear about the hand pain. It's especially bad for people who write for a living. When I was in college, I worked part time in a hospital pharmacy. We used hundreds of bottles of normal saline solution a day. The way that billing worked, each bottle had to have a sticker on it. I'd spend my slow time taking little bottles from a box, pulling a sticker from a strip, putting it on the bottle, and returning it to the box. Within a few months, I could no longer hold a pen or a pencil in my right hand. This was before lap tops, so it was a pretty big problem for a student! I had to refuse to do that task anymore. My hands, which had been strong, still give me trouble from time to time, and get sore easily. It's not fun. I hope yours won't be a persistent problem.JimV 01.22.19 at 12:52 pm ( 3 )It sounds like the tennis elbow I had after a long, hard-fought tennis session in my late forties. At the end I noticed I had a death grip on the racket handle which was difficult to loosen. The next day I was trying to leave a conference room at work which had a spring-loaded door knob. I couldn't turn the knob with my right hand, and had to awkwardly use my left hand. It lasted for several months, to the point where I didn't think it would ever heal, but it did eventually. When I did finally dare to play tennis again, I used a compression band around my right forearm, which seemed to help a lot. I never hit the ball as well as I had that day, though.Cervantes 01.22.19 at 2:36 pm ( 4 )
On the aging thing, I never needed a doctor (that I knew of) until about the age of 67. It has been one darn thing after another since then. (I'll spare the gory details.) I might make 75 but don't expect to see 80 (which of course isn't unusual and more than I deserve). My arm-chair philosophy about it it is that if death (by aging) didn't exist, evolution would have had to invent it, which it did. Otherwise, how can a species adapt to changes in the environment by trying new gene tweaks and combinations, without drastic over-population? For new things to succeed you have to get rid of the old things.It sounds like the arthritis at the base of the thumb is the biggest problem. It was for me. I couldn't even pick up a piece of paper with my left hand without pain, and it ached constantly. There is surgery available for that, which I got, and it worked. It was quite an ordeal, and it took a year to fully recover, but I got the use of my hand back and the pain is gone. I have arthritis in the distal joints of several fingers, but that is much less of a problem.Omega Centauri 01.22.19 at 3:03 pm ( 5 )
The surgery is kind of gross -- they remove the trapezium bone and, in my case, stuff the cavity with a rolled up tendon harvested from the forearm, which eventually ossifies. You will never miss the tendons. Some surgeons use a prosthesis, either a cadaver bone or an artificial product. It's quite painful at first and you have to wear a cast for six weeks, and then undergo rehab, but in the end, for me at least, it was a complete cure. Worth considering.I have chronic several overuse injuries that I used to be able work around athletics wise. But now I'm 67 and they seriously limit the amount of exercise I can get. You adapt and go on. And find other ways to spend your time and energy.Lee A. Arnold 01.22.19 at 4:00 pm ( 6 )
JimV @67. Well if evolution was kind to us we would remain healthy and vigorous then at some random time, boom its over. If the probability of boom was not age dependent, then there would be no difference in one's prospects whether 20 or 90.Mild continuous exercise helps including muscle strengthening over your whole body but never overdo, just daily. I walk about 3.5 miles a day, hit a gym in the middle of the walk and work about 20 weight machines, very light weights.Birdie 01.22.19 at 5:07 pm ( 7 )
"We used to talk about girls. Now we talk about doctors."
-- Mel Brooks, on gathering with his friends.It appears that sacrificing the body is an essential to join in civilized society in any meaningful way. Nobody else thinks overwork/stress injuries/industrial accidents are a big deal, so what's the matter with you, Bub? A serious "life of the mind" demands serious couch-potatoism. We're all playing in the NFL these days, but it doesn't have to be like that.DILBERT DOGBERT 01.22.19 at 5:19 pm ( 8 )Getting old is not for sissies!!!otpup 01.22.19 at 7:29 pm ( 9 )
My mental image of aging comes in two forms. One, is where you start life living in a large mansion of many rooms. Then in middle age you notice that a room is missing. As you age rooms keep disappearing. The next thing you know you are living in a one room hut.
The other is when young you see a clear horizon that seems very very distant. Then you see clouds on the horizon and it seems closer. At my age, 83, I can reach out and touch the fog.
The legs are shot and the pain in my feet is increasing. This time next year I could be in a wheelchair. Other than that life is good.
I encourage my young wife, 72, to keep on keeping on. She has taken that to heart and is riding her horse, skiing, scuba diving and renewing her pilots license. I am keeping on keeping on riding my horse and electric assist bike and living vicariously through my wife's adventures.There are probably nutritional approaches (though your doctor will be unbelieving and vegans will be offended). But osteo-a does give indications of being both immune related and a disease of modernity. Anyway ensure adequate fat soluble vitamins (and related minerals) This may require you to eat more saturated fat than is fashionable. Also glycine, and omega 3's. Eliminate any unnecessary PUFA's.peter 01.22.19 at 9:50 pm ( 10 )Don A @1:Alan White 01.22.19 at 10:56 pm ( 11 )
Statins with dinner + alcohol = indigestion, heart burn and vomiting.
Statins with breakfast + no alcohol = no illness and Cholesterol levels normal.Thanks Chris–this certainly hit home. Since you're only 60 and still working, allow me the presumption of my own data point as one of hope. I'm 65 and just finishing my first year of retirement after nearly 40 years of teaching at a 4/4 branch of the U of Wisconsin. Like you I've experienced some health concerns over the past 15 years including mild hypertension. Since I loved my career (down to the last day in the classroom), I didn't know what to expect when I was gently pushed out of it with a generous buy-out and threats of commuting to teach part of my load (I'd done that for 10 years and detested it). What I discovered is that I had no idea how stressful even a career that one enjoys can be! Within months I had lost 15 pounds and my BP went down, even a bit below normal, with no medication. I've been active my whole life, but clearly being out of the day-to-day grind of academic prep and research made the whole difference. My hope is that when you do retire, you find these same benefits.Chip Daniels 01.23.19 at 1:38 am ( 12 )
One exercise that I've become devoted to is the elliptical machine on my campus, which I still may use as emeritus. It does a great job putting my heart to the test without straining my knees, which feel the effects of 40 years of running.It is a turning point of sorts, that moment when you can actually grasp the length of time ahead of you.
I'm 58 and remember how even into my 30s, the remaining time in my life seemed to stretch away into inconceivable distance. Then somewhere in my 40s, I realized that even if I lived to a ripe old age, I could actually grasp how long that remaining time was.
I could remember forty odd years ago, I could suddenly understand that forty odd years into the future, my memories of midlife would be as fresh and sharp as my memories of kindergarten were.
Jan 21, 2019 | www.nakedcapitalism.com
Posted on January 20, 2019 by Lambert Strether New America (board chair emeritus Eric Schmidt , President the aptronymic Anne-Marie Slaughter ), a nominally center-left Beltway think tank ( funding ) " took up the mission of designing a new social contract in 2007 and was the first organization [anywhere?] to frame its vision in these terms." On May 19, 2016, New America sponsored an annual conference (there was no 2017 iteration) entitled "The Next Social Contract." Elizabeth Warren, presidential contender, was invited to give the opening keynote ( transcript , whicn includes video). Warren shared a number of interesting ideas. I will quote portions of her speech, followed by brief commentary, much of it already familiar to NC readers, in an effort to situate her more firmly in the political landscape. But first, let me quote Warren's opening paragraph:
It is so good to be here with all of you. And yes I will be calling on people. Mostly those of you standing in the back. I always know why people are standing in the back. That's what teachers do.
Professional-class dominance games aside, it's evident that Warren is comfortable here. These are her people. And I would urge that, no matter what policy position she might take on the trail, these policies and this program are her "center of gravity," as it were. Push her left (or, to be fair, right) and, like a bobo doll , she will return to this upright position . So, to the text (all quotes from Warren from the transcript ). I'll start with two blunders, and then move on to more subtle material.
Warren Does Not Understand Uber's Business Model
Or, in strong form, Warren fell for Uber's propaganda. Warren says:
Thank you to the New America Foundation for inviting me here today to talk about the gig economy You know, across the country, new companies are using the Internet to transform the way that Americans work, shop, socialize, vacation, look for love, talk to the doctor, get around, and track down ten foot feather boas, which is actually my latest search on Amazon .
These innovations have helped improve our lives in countless ways, reducing inefficiencies and leveraging network effects to help grow our economy. And this is real growth . The most famous example of this is probably the ride-sharing platforms in our cities. The taxi cab industry was riddled with monopolies, rents, inefficiencies. Cities limited the number of taxi licenses
Uber and Lyft, two ride-sharing platforms came onto the scene about five years ago, radically altered this model, enabling anyone with a smartphone and a car to deliver rides . The result was more rides, cheaper rides, and shorter wait times.
The ride-sharing story illustrates the promise of these new businesses. And the dangers. Uber and Lyft fought against local taxi cab rules that kept prices high and limited access to services .
And while their businesses provide workers with greater flexibility, companies like Lyft and Uber have often resisted efforts of those very same workers to try to access a greater share of from the work that they do. Their business model is, , dependent on extremely low wages for their drivers.
"In part" is doing rather a lot of work, there, even more than "the wealth that is generated," because NC readers know, Uber's business model is critically dependent on massive subsidies from investors, without which is would not exist as a firm. Hubert Horan (November 30, 2016):
Published financial data shows that Uber is losing more money than any startup in history and that its ability to capture customers and drivers from incumbent operators is entirely due to $2 billion in annual investor subsidies. The vast majority of media coverage presumes Uber is following the path of prominent digitally-based startups whose large initial losses transformed into strong profits within a few years.
This presumption is contradicted by Uber's actual financial results, which show while the limited margin improvements achieved in 2016 can be entirely explained by Uber-imposed cutbacks to driver compensation. It is also contradicted by the fact that Uber lacks the major scale and network economies that allowed digitally-based startups to achieve rapid margin improvement.
As a private company, Uber is not required to publish financial statements, and financial statements disseminated privately are not required to be audited in accordance with generally accepted accounting principles (GAAP) or satisfy the SEC's reporting standards for public companies.
The financial tables below are based on private financial statements that Uber shared with investors that were published in the financial press on three separate occasions. The first set included The second set included tables of GAAP profit data for full year ; the third set included summary EBITAR contribution data for .
[F]or the year ending September 2015, Uber had GAAP losses of $2 billion on revenue of $1.4 billion, a negative 143% profit margin. Thus Uber's current operations depend on $2 billion in subsidies, funded out of the $13 billion in cash its investors have provided.
Uber passengers were paying only 41% of the actual cost of their trips; Uber was using these massive subsidies to undercut the fares and provide more capacity than the competitors who had to cover 100% of their costs out of passenger fares.
Many other tech startups lost money as they pursued growth and market share, but losses of this magnitude are unprecedented; in its worst-ever four quarters, in 2000, Amazon had a negative 50% margin, losing $1.4 billion on $2.8 billion in revenue, and the company responded by firing more than 15 percent of its workforce. 2015 was Uber's fifth year of operations; at that point in its history Facebook was achieving 25% profit margins.
Now, in Warren's defense, it is true that she, on May 19, 2016, could not have had the benefit of Horan's post at Naked Capitalism, which was published only on November 30, 2016. However, I quoted Horan's post at length to show the dates: The data was out there; it wasn't a secret; it only needed a staffer with a some critical thinking skills and a mandate to do the research to come to the same conclusions Horan did, and Uber's lack of profitabilty, easily accessible, is a ginormous red flag for anybody who takes the idea that Uber "generates wealth" seriously. How is it that the wonkish Warren is recommending policy based on what can only be superfical research in the trade and technical press? Should not the professor have done the reading?
Warren Does Not Understand How Federal Taxation Works
The second blunder. Warren says:
First, make sure that every worker pays into Social Security, as the law has always intended. Right now, it is a challenge for someone who doesn't have an employer that automatically deducts payroll taxes to pay into Social Security. This can affect both a worker's ability to qualify for disability insurance after a major [injury], and it can result in much lower retirement benefits. , gig workers, 1099 workers, and hourly employees.
It is laudable that Warren wants to bring all workers in the retirement system. But as NC readers know, Federal taxes do not "pay for" Federal spending, and hence Warren's thinking that Social Security will be "fully funded" through "payroll taxes" is a nonsense (and also reinforces incredibly destructive neoliberal austerity policies). I will not tediously rehearse MMT's approach to taxation, but will simply quote a recent tweet from Warren Mosler:
And if Mosler isn't good enough, here's John Stuart Mill on currency issuers:
Again, is it too much to ask that a professor do the reading? After all, MMT gotten plenty of traction, even in 2016. The Sanders staff, for example, could have been helpful to her .
Warren Supports Medicare for All Only Nominally
Warren is indeed a co-sponsor of Sanders' ( inadequate ) S1804. But read the following passages, and you will see #MedicareForAll not where her passion lies:
As greater wealth is generated by new technology, how can we ensure that the workers who support the economy can actually share in the wealth?
(The idea that workers "support" "the" [whose?] "economy," instead of driving or being the economy, is interesting, but let that pass.)
Warren then proceeds to lay out a number of policies to answer that question. She says:
Well, I believe we start with one simple principle. All workers, no matter where they work, no matter how they work, no matter when they work, no matter who they work for, whether they pick tomatoes or build rocket ships, all workers should have some basic protections and be able to build some economic security for themselves and their families. No worker should fall through the cracks. And here are some ideas about how to rethink and strengthen the worker's bargain.
So, she's not just laying out policy for the gig economy (the occasion of the speech); she's laying out a social contract (the topic of the speech). Picking through the next sections, here is the material on health care:
We can start by strengthening our safety net so that it catches anyone who has fallen on hard times, whether they have a formal employer or not. And there are three much-needed changes right off the bat on this.
I hate the very concept of a "safety net." Why should life be like a tightrope walk? Who wants that, except crazypants neoliberal professors, mostly tenured? She then makes recommendations for three policies, and sums up:
These three, Social Security, catastrophic insurance, and earned leave, create a safety net for income.
Hello? Medical bankruptcy ? She then moves on from the "safety net" for income to benefits, which is the aegis under which she places health care:
Now, the second area of change to make is on employee benefits, both for healthcare and retirement. To make them fully portable. They belong to the worker, no matter what company or platform generates the income, they should follow that worker wherever that worker goes. And the corollary to this is that workers without formal employers should have access to the same kinds of benefits that some employees already have.
I want to be clear here. The Affordable Care Act is a big step toward addressing this problem for healthcare. Providing access for workers who don't have employer-sponsored coverage and providing a long term structure for portability. We should improve on that structure, enhancing its portability, and reducing the managerial involvement of employers.
Remember, this is a Democratic audience, and what do we get? "Portability," "access", and reduced "managerial involvement." That's about as weak as tea can possibly get, and this is a liberal Democrat audience. ("The same kinds of benefits that some employees already have." Eeesh.) But wait, you say! This speech iis in 2016, and in 2018, Warren supports #MedicareForAll! For example, " Health care: Supports the "Medicare for All" bill led by Bernie Sanders " (PBS, January 17, 2019). But notice how equivocal that support is. Quoting PBS again, Warren "called that approach 'a goal worth fighting for.'" Rather equivocal! And folliowing the link to that quote, we find it's from a speech Warren gave to Families USA's Health Action 2018 Conference :
I endorsed Bernie Sanders' Medicare for All bill because it lays out a way to give every single person in this country a guarantee of high-quality health care. Everybody is covered. Nobody goes broke because of a medical bill. No more fighting with insurance companies.
There are other approaches as well I'm glad to see us put different ideas on the table.
So, we have a gesture toward #MedicareForAll. But then, Warren, instead of going into detail about how #MedicareForAll would work, immediately backtracks and emits a welter of detail about
minor fixesimprovements, on the order of "portability," "access," and reduced "managerial involvement." (Different details, but still details). Then she moves on to Massachusetts. Read this, and it's clear where Warren's heart is:
Massachusetts has the highest rate of health insurance coverage in the nation. We are the healthiest state in the nation.
That didn't just happen because we woke up one morning and discovered that insurance companies had just started offering great coverage at a price everyone could afford.
We demanded that insurance companies live up to their side of the bargain. Every insurer participating in our exchange is required to offer plans with standard, easy-to-compare benefits and low up-front costs for families. Last year, we had the second-lowest premiums in the ACA market of any state in the country. Massachusetts insurers pay out 92% of the dollars they bring in through premiums to cover costs for beneficiaries not to line their own pockets.
The rules are tough in Massachusetts, but the insurance companies have shown up and done the hard work of covering families in a responsible way. We have more than double the number of insurers participating on our exchanges, compared to the average across the country. They show up, they serve the people of Massachusetts, and they still make plenty of money.
Look, we still have plenty of work to do, particularly when it comes to bring down health spending, but we're proud of the system we have built in Massachusetts, and I think it shows that good policies can have a real impact on the health and well-being of hard working people across the country.
Never mind that Warren can say, virtually in the same breath, that insurance companies "still make plenty of money" and "we have plenty of work to do to bring down health care spending." RomneyCare was the beta version of ObamaCare. We tried it, as a nation, starting in 2009, and here we are. Is that's what Warren wants, fine, but why not simply advocate for it?
Warren Has No Coherent Theory of Change
Except, perhaps, one distinctly slanted toward insiders. " Work hard and play by the rules " is a Clintonite trope, but let's search on "rules" and see what we come up with. More from the transcript:
But it is policy, and regulations, that will determine whether workers have a meaningful opportunity to share in the wealth that is generated.
Here, workers are passive , acted upon by rules, and those who create them. But Warren contradicts herself: "Lyft and Uber have often resisted efforts of those very same workers." Here, workers are active. But if workers are active in the second context, they are also active in the first! Where does Warren think change comes from? The generosity of Uber and its investors? More:
Antitrust laws and newly-created public utilities addressed the new technological revolution's tendency toward concentration and monopoly, and kept our markets competitive. Rules to prevent cheating and fraud were added to make sure that bad actors in the marketplace couldn't get a leg up over folks who played by the rules.
Note the lack of agency in "were added." Warren erases the entire Populist Movement ! She also can't seem to get her head round the idea that workers didn't necessarily play by the existing ruies in order to create new ones. And:
Workers have a right to expect our government to work for them. To set the basic rules of the game. If this country is to have a strong middle class, then we need the policies that will make that possible. That's how shared prosperity has been built in the past, and that is our way forward now. Change won't be easy. But we don't get what we don't fight for. And I believe that America's workers are worth fighting for.
Now, on the one hand, this is great. I, too, believe that "America's workers are worth fighting for." What Warren seems to lack, at the visceral level, is the idea that workers should be (self-)empowered to do the fighting (as opposed to having the professional classes pick their fights for them). Here is Warren on unions:
Every worker should have the right to organize, period. Full-time, part-time, temp workers, gig workers, contract workers, you bet.
Very good. More:
Those who provide the labor should have the right to bargain as a group with whoever controls the terms of their work .
The idea that workers themselves should control the terms of their work seems to elude Warren. This erases, for example, co-ops. More:
Government is not the only advocate on behalf of workers.
"Not the only?" Like, there are lots of others? This seems a tendentious, not to say naive, view of the role of government. More:
It was workers [here we go], bargaining through their unions [and the qualification], who helped [helped?] introduce retirement benefits, sick pay, overtime, the weekend, and a long list of other benefits, for their members and for all workers across this country. Unions helped build America's middle class, and unions will help rebuild America's middle class.
Here, at least, Warren grants workers (partial) agency, but only through the institutional framework of unions . That distorts the history. Granted, "helped introduce" is doing a lot of work, and who they were "helping" isn't entirely clear, but the history is enormously complicated. (Here again, Warren needs to do the reading.) For example, the history of the weekend long predates unions . And "bargaining through their unions" isn't the half of it. Take, for example, the Haymarket Affair . From the Illinois Labor History Society:
To understand what happened at Haymarket, it is necessary to go back to the summer of 1884 when the Federation of Organized Trades and Labor Unions, the predecessor of the American Federation of Labor, called for May 1, 1886 to be the beginning of a nationwide movement for the eight-hour day. This wasn't a particularly radical idea since both Illinois workers and federal employees were supposed to have been covered by an eight-hour day law since 1867. The problem was that the federal government failed to enforce its own law, and in Illinois, employers forced workers to sign waivers of the law as condition of employment.
Fine, "rules." Which weren't being obeyed! More from the Illinois Labor History Society:
Monday, May 3, the peaceful scene turned violent when the Chicago police attacked and killed picketing workers at the McCormick Reaper Plant at Western and Blue Island Avenues. This attack by police provoked a protest meeting which was planned for Haymarket Square on the evening of Tuesday, May 4. Very few textbooks provide a thorough explanation of the events that led to Haymarket, nor do they mention that the pro-labor mayor of Chicago, Carter Harrison, gave permission for the meeting . Most speakers failed to appear . Instead of the expected 20,000 people, fewer than 2,500 attended . The Haymarket meeting was almost over and only about two hundred people remained when they were attacked by 176 policemen carrying Winchester repeater rifles. Fielden was speaking; even Lucy and Albert Parsons had left because it was beginning to rain. Then someone, unknown to this day, threw the first dynamite bomb ever used in peacetime history of the United States. The next day martial law was declared, not just in Chicago but throughout the nation. Anti-labor governments around the world used the Chicago incident to crush local union movements.
This is how workers "helped introduce" the eight-hour day.
Yes, America's workers are "worth fighting for." But they also fight for themselves , and are fought against! Warren's theory of change -- which seems to involve people of good will "at the table" -- cannot give an account of events like Haymarket or why, in the present day, it's Uber's drivers who are also the drivers of change, and not benevolent rulemakers. Warren's views on the social contract are in great contrast to Sanders' "Not me, us."
 Warren is far stronger in areas where she has developed academic expertise than in areas where she has not.
 Google is Google, i.e., crapified, but if Warren has retracted or changed her views on Uber, I can't find it. She was receiving good press for this speech as late as August 2017 .
 Oddly, bankruptcy is where Warren made her academic bones. I'm frankly baffled at her lack of full-throated advocacy on this, especially before a friendly audience.
 Warren, by juxtaposition, suggests that Massachusetts' health insurance coverage causes it to be "the healthiest state in the nation." This post hoc fallacy ignores, for example, demographics and the social determinants of health .
 Warren focuses on health insurance, not health care. I'm nothing like an expert in the Massachusetts health insurance system. However, looking at this chart , I'm seeing all the usual techniques to deny access to care: Deductibles, co-pays, out-of-network costs, and (naturally) high-deductible plans. Health care should be free at the point of delivery. Why is that so hard to understand?
Burritonomics , January 20, 2019 at 5:16 pm
I quickly went over the (188 page!) report referenced in Warren's claim that "Massachusetts has the highest rate of health insurance coverage in the nation. We are the healthiest state in the nation". It should be noted I went in with the expressed purpose of finding something to be snarky about, and I found it.
One of the metrics under "core measures" of clinical care was Preventable Hospitalizations. As it states in the report itself: "Preventable hospitalizations reflect the efficiency of a population's use of primary care and the quality of the primary health care received Preventable hospitalizations are more common among people without health insurance and often occur because of failure to treat conditions early in an outpatient setting". Wow! With such bang up health insurance in MA, one would figure they would do great on this metric. Nope! MA ranks 37th in the country. Many more such examples can be found, I'm sure.
I have a real dislike of these "who's best" lists, regardless of topic. Rarely do they (the aggregated ratings) contain insight beyond that captured by the individual metrics.
lambert strether , January 20, 2019 at 5:24 pm
Massachusetts is #1 on mortality (though they have issues with opioids). They have median US age, so it's not the enormous Boston student population. So they're doing something right, I'm just not sold it's health insurance or, more to the point, health insurers. They do have more physicians (and psychiatrists) per capita.
Joe Well , January 20, 2019 at 8:52 pm
What is "mortality" in this case? I'm curious about this because people often casually say that US health outcomes are worse than in other countries by looking at life expectancy (which I guess is not the same as mortality), and that comparison is rarely done on a state by state basis in the US.
Massachusetts is roughly tied with the other top ten states in life expectancy, which are almost all "blue" states . Worldwide, life expectancy among highly developed countries is roughly similar, within a few years of each other . The US comes out towards the bottom (no. 31), but only by about 1-3 years.
Also amazed just now to see that Asian American and Latino life expectancy are so much higher than for white and black Americans. Does anyone know anything about that? I'm really stunned.
Usually, lower life expectancy for blacks is given as evidence of inequality, but the white-black gap (about 1-2 years) is tiny compared with the black-Latino and black-Asian gap, or for that matter, the white-Latino or white-Asian gap, which are more like 5-10 years. I'm really floored by that.
In general, looking at the numbers just now has shaken my assumptions about poor US life expectancy and also racial disparities and I'm wondering if I'm misinterpreting them.
Joe Well , January 20, 2019 at 9:10 pm
Wow, you learn something new every day.
Apparently there is something called the "Hispanic Health Paradox" that has been studied intensively for over 30 years . The biggest reason seems to be much lower rates of smoking. There also seems to be a filtering effect whereby healthier people migrate to the US. Anecdotally, I'd suggest much lower rates of alcohol and drug abuse, but the article doesn't mention that.
So, why Mass. has a relatively high life expectancy could in part be due to it having one of the earliest and most aggressive anti-smoking movements. I'm guessing historically high smoking rates (up to 50% of adults in the 1950s with huge second-hand exposure) could also account for poorer health outcomes today.
BoyDownTheLane , January 21, 2019 at 12:49 am
One of my favorite pictures (the one I have not yet taken) would have been an elevated shot of the intersection at Longwood and Brookline Avenues (379385 Brookline Ave) at noon on a clear, sunny spring day to see the murmuration of medical staff running between appointments, lunch, rounds, etc.
The intersection is surrounded by arguably some of the finest medical institutions in the Western world (Beth Israel Deaconess, Dana-Farber, Brigham & Women's (where Atul Gawande, author of the book "Better" and the whole entire concept of positive deviance, once held court), Harvard Medical School itself with its etched-in-granite entrace to the Countway Library that reads "Ars Longa, Vita Brevis", and the Harvard School of Public Health.
The murmuration of white coats may be at that moment the greatest single concentrated density of medical excellence at one time. It is easy to scoff. I've been the recipient of bad medicine myself, but also far more high-quality, life-saving medicine. But the public health movement in Massachusetts has been around for a very long time and is supported by and engrained within governmental regulations, oversight and policy. Insurance plans covering most of the state ranked, typically and for years, #'s 1, 2, 3 and more. The Healthcare Effectiveness Data and Information Systems report out results that are painstakingly gathered, audited to improve performance. It is fair to say that a major part of the intersection between computing and medicine was born and is overseen across the river in Cambridge. Organizations that collect or audit data for health plans and providers are screened, trained and certified by NCQA ( https://www.ncqa.org/about-ncqa/ ).
In addition, there are national, regional and state associations devoted to quality improvement and toi improvement of access. The National Association of Community Health Centers (those clinics funded Federally to serve the under-served for free or on a sliding scale) "works in conjunction with state and regional primary care associations, health center controlled networks and other public and private sector organizations to expand health care access to all in need." There are CHC's dotted everywhere around the country (albeit not enough of them), and there is a state association in almost every state. No one can ever be turned away from a CHC, especially for lack of ability to pay; the Federal government underwrites their care.
nothing but the truth , January 20, 2019 at 5:29 pm
govts can call force us to call toilet paper a pound, but i doubt they can make it worth a pound of sterling silver if they pretend that they can produce any amount.
Brooklin Bridge , January 20, 2019 at 5:58 pm
Warren's emphasis on the economic market for health "care?" (insurance companies making plenty of money ) and particularly her whole rant on the superlatives of Massachusetts insurance care (that means, care for insurance companies) , increasingly neglects health and people care as the primary concern of medicine and the people who practice it.
As an average Joe, meaning not part of the medical world, I have come across a surprising number of doctors in both social circumstances as well as health issues of my own and of my extended family, where doctors have complained about the ever worsening constraints imposed on them by insurance companies. I know at least three doctors who retired early because of it and one of them talks about it being a significant problem in keeping highly qualified doctors in general practice. From ever more ridiculously short visits, to constant refusal to cover such and such a drug, to all manner of schemes to improve patients health by overseeing and controlling what the doctor does to finding ways to monitor what the patient does; what he or she takes as medicine and exactly when and how often cutting the doctor out of the loop completely. Improve the patient experience my *ss. It's horrible and it all comes down to ever new ways to reduce coverage to make more money.
Perhaps I'm being a little unjust, but Warren seems fine with this "system" where the gate keepers make, "plenty of money," as long as people are going in and out of doctors' offices in countable droves as if on run-away conveyer belts. I should at least allow that many of her superlative claims are accurate (or somewhat accurate) and that there is fairly wide coverage in this state but nevertheless stress that our excellent medical facilities in Boston proper are due to historical reasons and NOT to RomneyCare.
deplorado , January 20, 2019 at 5:59 pm
Thank you Lambert, for your cogent and discerning analysis as always. I've long ago disabused myself of the notion that E. Warren is more than "lipstick" on the usual "pig", but it was good to have written support for that thesis and I will save it for my reference.
What worries me more though is Sanders's bill and why he wouldn't go all the way? Would you do an analysis of that please will really appreciate it.
Joe Well , January 20, 2019 at 6:10 pm
The vast majority of Massachusetts health plan providers are nonprofit HMOs so I'm baffled by the idea that they are making tons of money since legally they are not supposed to.
The most obvious difference between Mass and the rest of the country is precisely the preponderance of nonprofit health plans (it's not commonly called health insurance here) and nonprofit hospitals. The idea of for-profit health plans and hospitals freaks me out.
It's worth noting that Mass health coverage seems to have gotten worse in recent years, though I don't know how much of that is due to Obamacare. High deductibles, coinsurance, confusing in-network requirements combined with poor documentation and even poorer customer service to tell you what is in-network and what is not. I just got a surprise $370 bill for a provider that supposedly was out of network even though I had checked extensively that they were in-network. That is the first time that has ever happened to me in Mass. Not to mention the confusing and unnerving notices I got the last few months saying I was in danger of losing coverage. A great big ball of Weberian beaureaucratic stress.
bob , January 20, 2019 at 8:04 pm
Non-profit health insurance Company https://www.democratandchronicle.com/story/money/business/2014/04/25/former-excellus-ceo-package-total-m/8155853/ The final retirement package for former Excellus BlueCross BlueShield CEO David Klein likely will exceed -- by millions -- the $12.9 million the company reported to the state in March. $29.8 Million in retirement. Non-profit for who? It's a complete misnomer and a huge problem in the discourse of healthcare. Hospitals are usually non-profits too. They non-profitly charge you $80,000 for a few stitches and some aspirin.
somecallmetim , January 20, 2019 at 10:08 pm
Health Care Economist / Professor Uwe Reinhardt used to comment that in the current system non-profit hospitals (The Sisters of Mercy, with a token nun on their board, in his telling) were subject to the same forces as for profit hospitals.
He also said Massachusetts has the only adult health care system, and the other states are all adolescents.
johnnygl , January 20, 2019 at 9:10 pm
We've got for-profit hospitals Cerberus took the caritas network. The hospitals dominate this state. The rest of us are just living here.
johnnygl , January 20, 2019 at 9:15 pm
Special thanks to the catholic church for selling such an important institution to a monster that guards the gates of the underworld.
I bet it was to cover the costs of child predator priests.
Joe Well , January 20, 2019 at 10:20 pm
Wow, I'd missed that (moved out of state, then came back). Thanks for the update. It looks like the Catholic Church (former owner of Caritas) has further enhanced its legacy in Massachusetts. However, I believe it is still true that the hospital market in Mass. is dominated by nonprofits (albeit greedy nonprofits).
And yes, hospitals and hospital chains (e.g., Partners Healthcare, which is nonprofit) pose huge challenges to managing healthcare costs in Mass. as the numerous Boston Globe investigative series attest, by using their market power to raises prices.
My concern is when the market becomes dominated by for-profit actors, the profit-seeking, which is already bad with nonprofits, becomes even worse, especially in an ultra-expensive market like Greater Boston.
Brooklin Bridge , January 20, 2019 at 6:16 pm
I should add (if my earlier comment get's posted), it's even more surprising how many doctor's seem just fine with all the negative changes being brought about by insurance companies' intrusive quest for control and I don't mean just the ones who say nothing.
That is, some doctors seem to enjoy the vestiges of the glow of community respect and honor that once went with being a doctor all while doing almost nothing other than sheep herding patients through the office in good file while staff (not the good doctor) attend to making the visit digital and storing it away in some cloud.
Tomonthebeach , January 20, 2019 at 7:07 pm
I agree with Warren Mosler that Elizabeth Warren's apparent ignorance of MMT, much less mastery of it, makes here a lame candidate in my book. She needs to get woke pretty quickly or settle for some cabinet appointment.
Anarcissie , January 20, 2019 at 10:10 pm
Is MMT now Scripture?
ChrisAtRU , January 20, 2019 at 10:22 pm
It's more important than 'scripture' it's how sovereign fiat money actually works .
Joe Well , January 20, 2019 at 10:57 pm
You don't even need MMT. When asked how the federal government can pay for something, people can just answer, "the same way we pay for military and intelligence spending." Any politician who won't say at least this is deeply suspicious.
David in Santa Cruz , January 20, 2019 at 7:40 pm
In The Unwinding , George Packer quotes Elizabeth Warren as describing her political views thusly:
"I was a Republican because I thought that those were the people who best supported markets"
I'm glad that she's out there, I'm glad that she's talking, and we need an open and transparent nomination process, but Bernie Sanders remains the only (potential) nominee who comes close to representing my views. Good piece.
emorej a hong kong , January 20, 2019 at 7:50 pm
The transcript could easily have been a speech by Hillary (and even delivered to Goldman Sachs if Hillary had had the foresight to realize that every speech would become known to everybody in the Internet age -- before Russiagate was leveraged into Social media banning of anti-establishment speech).
The speech's date (May 19 2016), was two days after Bernie won the Oregon primary by 14%, and two days before Hillary won the Washington state primary by 5%.
Synoia , January 20, 2019 at 8:07 pm
It was going to be BS directly after this:
New America (board chair emeritus Eric Schmidt
The Eric Schmidt who took Google down the primrose part of spying on everybody. Warren is centrist.
Synoia , January 20, 2019 at 8:11 pm
It was going to be BE after this phrase
New America (board chair emeritus Eric Schmidt,
The Eric Schmidt who took Google doen the path of spying on everybody. He has nothing to offer by centrist rhetoric. It would be very interesting in how much In-Q-Tel invested in Google.
flora , January 20, 2019 at 8:39 pm
Thanks for this post.
And thanks for the reminder that the 8 hour workday and the 40 hour workweek were not 'given' to workers, they were won by workers.
Matthew G. Saroff , January 20, 2019 at 9:48 pm
I made an a similar observation on my blog .
Compare these two quotes on Pharma looting.
Giant companies may hate my Affordable Drug Manufacturing bill but I don't work for them. The American people deserve competitive markets and fair prices. By fixing the broken generic drug market, we can bring the cost of prescriptions down.
If the pharmaceutical industry will not end its greed, which is literally killing Americans, then we will end it for them.
This is a not an insignificant difference
Mike Barry , January 20, 2019 at 10:30 pm
The best is the enemy of the good.
Yves Smith , January 20, 2019 at 11:17 pm
Tell me what about Warren not understanding how federal taxes work, which is fundamental to formulating sound fiscal policy and spending plans, not being serious about fixing our health care system, or praising the predatory gig economy, is "good".
RepubAnon , January 20, 2019 at 11:32 pm
On a side note: self-employed workers pay more out-of-pocket into Social Security than W-2 employees. W-2 employees only pay half the Social Security tax employers pay the other half via a "payroll tax."
The self-employed pay both the employee's half of Social Security, and also pay a "Self-Employment tax" (the employer's half of Social Security). The logic is that if you are both employee and employer, you should pay both halves.
Yves Smith , January 21, 2019 at 12:58 am
This is thread jacking, plus an economist would point out that the employer clearly is paying a net wage that reflects his awareness that he is paying the employer side of the FICA taxes.
Ape , January 21, 2019 at 12:31 am
Or lesser of two evils? There really needs to be a good discussion again about reform versus structural change without Chait-like pretensions. The question isn't just whether we'll get there in time, but whether reform even out runs reaction. Once you take out patriotic myth, it's not obvious whethervthe good in the long term is even worth bothering with.
Glen , January 21, 2019 at 12:47 am
Warren 2020 campaign is DOA. If you want Trump for another four years go with Warren 2020. Bernie would have won.
The Rev Kev , January 20, 2019 at 11:01 pm
I can't help but think that if you are talking about the "Next Social Contract", them you should put something in there that if you have children going hungry then something has gone wrong with your society. Not being snarky here as I believe that a fundamental purpose of society is to protect those in need. An earlier society talked about 'women and children first' and they were not too far off the mark here.
She was invited to talk about the gig economy but in reading her speech I was under the impression that she wants the Federal government to underwrite the costs of workers for corporations to ensure that maybe these workers have food to eat while working for these very same corporations. I suspect that this is the thinking behind letting Amazon workers go for Federal assistance for the sheer basics of life while Amazon makes off like bandits.
No. The way to go is to enforce corporations like this pay a living wage and not to have them count on the country to make up the difference. If they start to protest, then start to talk about looking over their accounts for any discrepancies to make them back off. That's how they got Al Capone you know. Not for being a gangster but for not paying his taxes while doing so. And do the same for mobs like Uber and Lyft and all the other corporations.
BoyDownTheLane , January 21, 2019 at 12:16 am
" Elizabeth Warren is Hillary Clinton reborn, and they're both unlikable, because they're both inauthentic scolds who suffer from hall monitor syndrome. They spent their entire lives breaking every rule they could find while awkwardly fantasizing about running every tiny detail of everyone else's lives ."
Left in Wisconsin , January 21, 2019 at 12:38 am
Sigh. Nail hit squarely on head. The one thing I will say to Warren's credit is that she has learned in some specific ways that the world isn't invariably the pure meritocracy that is so instinctively part of her world view. That said, it seems clear there will always be plenty that she is simply not capable of seeing, so she will always say and support things that are just wrong. She will not be leading the revolution.
Jan 19, 2019 | economistsview.typepad.com
anne , January 15, 2019 at 05:59 PMhttps://prospect.org/article/three-bernie-sanders-bills-arrest-highway-robbery-prescription-drug-marketmulp -> anne... , January 16, 2019 at 04:33 PM
January 14, 2019
Three Bernie Sanders Bills to Arrest the Highway Robbery in the Prescription Drug Market
Allowing foreign imports, authorizing Medicare bargaining, or setting prices at what other nations pay -- all good options
By DEAN BAKER
The prescription drug market in the United States is an incredible mess. From an economic standpoint, everything is wrong. Drugs that would sell for a few hundred dollars in a free market often sell for tens or even hundreds of thousands of dollars because we give their manufacturers patent monopolies. This leads to the sort of distortions and inefficiency that would be expected from tariffs as high as many thousands percent.
From a heath perspective the situation is no better. The huge markups give drug companies enormous incentive to misrepresent the safety and effectiveness of their drugs and to push them for uses where they may not be appropriate. This is a big part of the story of the opioid epidemic.
Cumulatively, it is a huge deal in both economics and health. We spent more than $430 billion (2.2 percent of GDP) on prescription drugs last year. These drugs likely would have cost less than $80 billion in a free market. The difference of $350 billion is almost five times the annual federal budget for food stamps. This is real money.
This is the backdrop for three bills proposed last week by Senator Bernie Sanders, along with Representatives Elijah Cummings and Ro Khanna, to address the high and rapidly rising cost of prescription drugs. The three measures provide alternative paths for reducing drug prices.
The first one, "The Prescription Drug Price Relief Act," would end the patent monopoly for any drug that sold for a price exceeding the median price in five other major countries: Canada, the United Kingdom, France, Germany, and Japan. This would allow large savings since drug prices in these countries are roughly half as much as in the United States. Drug companies would have a choice of either lowering their prices or losing their patent monopoly.
In the latter case, the competition is likely to push the price well below the levels in the five countries. While these nations do regulate drug prices, patent monopolies still let the companies charge a price that is far higher than the price that would exist in a competitive market with generic competition.
The second bill is "The Medicare Drug Price Negotiation Act." This bill would allow Medicare to negotiate collectively for the drugs purchased through Medicare prescription drug insurance. Since this program spends roughly $100 billion annually on drugs, it should have serious bargaining power.
Anyone designing a rational drug insurance program would have required negotiation when the program was created, but rational design was not necessarily the top priority at the time this program was enacted.
Anyone designing a rational drug insurance program would have required negotiation when the program was created, but rational design was not necessarily the top priority at the time this program was enacted. Representative Billy Tauzin, who headed the Energy and Commerce Committee, which structured the Medicare prescription drug legislation, resigned immediately after the bill was signed into law to become head of the pharmaceutical industry's trade association.
The third bill, "The Affordable and Safe Prescription Drug Importation Act," is also an effort to take advantage of the fact that drugs are so much cheaper in other countries than in the United States. This bill would allow people to freely import drugs from other wealthy countries that have safety standards that are comparable to those in the United States.
This bill both highlights the sharp differences in prices between the United States and other countries and calls out one of the big lies used to justify these differences. Allies of the drug industry often claim that we cannot count on getting safe drugs from other countries, implying that countries like Canada and Germany do not protect their populations from unsafe drugs.
This is, of course, absurd. The standards in these countries are every bit as high as in the United States. And, if we think the quality of imported drugs is a problem, we all should already be very worried because many of the drugs and ingredients in drugs sold in the United States are already imported, largely from China. So the idea that we can't be assured of the safety of imported drugs is simply an industry talking point, not a real concern.
Which of these paths for reducing drug costs is best? Importation is probably the most far-reaching, since it should quickly bring our prices down to the level of other wealthy countries. As a practical matter, however, progressives should back anything that moves the debate forward.
We really need to turn the industry on its head, paying for research upfront and then having drugs sold in a free market, like paper plates and shovels. It is absurd to pay for research that has already been done, at the point when people are suffering from serious conditions jeopardizing their health or their life.
No one thinks it makes sense to pay firefighters based on the value of their work when they come to our burning house with our families inside, yet this is essentially how we pay for drug research under the patent monopoly system. In fact, the story is even worse with drugs, since typically we have a third party payer (either an insurance company or the government) who we are trying to get pick up most of the tab.
These bills would not fully solve the problem, but each would be a big step in the right direction. Sanders, Cummings, and Khanna have done a great service in pushing them forward."No one thinks it makes sense to pay firefighters based on the value of their work ..."Plp -> mulp ... , January 18, 2019 at 01:41 PM
We value fire fighters as worthless, by not paying most fire fighters in the US.
After all, requiring the people saving your life to be paid kills jobs, so we end up with unpaid life savvers.
We should appply the same principle to people providing life saving food, the people building the roads needed to deliver life savings, the people making the vehicles used by those providing life saving services.
In fact, no one should be paid to work! Thats free lunch economics!
Dean Baker meantioned nothing about costs, which are always labor costs.
Look, Keynes argued that when there were unemployed workers, and capital is scarce, government should tax and spend to pay workers to build capital.
For drugs, paying unemployed researchers to build capital, eg, life saving drugs, then taxing the drugs produced to repay the cost of developing the drugs, with so many new drugs developed, the private capital in drug factories, etc will produce so many drugs that drug prices fall to total labor costs per unit, plus the drug tax.
We know there are unemployed drugresearchers because NIH always runs out of money to pay all thre recent collage grads seeking grants to fund their hoped for job as a researcher.Mulp what about monopoly profits my friendPlp -> anne... , January 17, 2019 at 08:40 AM
Research could rise and marketing cuts pay for it
Yes there's slack created
In marketing jobs and funding entertainment of courseBernie and Liz are too valuable to waste running foranne -> Plp... , January 18, 2019 at 09:21 AM
The Dem nom
Leave that for a clever weather vane
Like Harris and that jersey senator
The gal from the Bronx
is another Bill Bryan
She is the futureThe gal from the BronxJulio -> Plp... , January 18, 2019 at 09:21 AM
is another Bill Bryan
She is the future
[ Funny and right and especially clever. ]Agreed completely.Christopher H. said in reply to Julio ... , January 18, 2019 at 10:01 AM
Warren, in particular, makes a great senator but I doubt would make a great president.Disagree, unfortunately in the American system the President gets all the attention and can spread the message.Plp -> Christopher H.... , January 18, 2019 at 01:43 PM
Either Bernie or Warren would be good. I'd much prefer Bernie.No problem if they win the POTUS job
Still I'd prefer AOC
Jan 13, 2019 | www.nytimes.com
JB Nashville, Tennessee Jan. 11
@Bill - So you're willing to gamble with your own health and the well-being of any family or loved ones you have and trust in some ambulance chaser against an armada of $3000 suits? Good luck with that.
While I'm often skeptical of our government, I have ZERO faith in any corporation to do right by me.
Their only mission is to make as much money as they can, and even paying out the occasional lawsuit is a reasonable cost of doing business. The only way a capitalist entity can be trusted is if a more powerful authority is looking over their shoulder. The FDA is one of many federal entities standing between us and an indifferent group of shareholders and CEOs.
Jan 11, 2019 | www.nakedcapitalism.com
Health Insurer Greed or Desperation? An Odd Data Point From Cigna Posted on January 9, 2019 by Yves Smith I sometimes give personal Consumerist-type anecdotes about dodgy vendor behavior in case readers have had similar experiences.
Admittedly, health insurers being difficult about paying claims is so common that they fall in the realm of "dog bites man" stories. But the elements of my latest arm-wrestle with Cigna suggest that the insurer is so eager to maximize profit and burnish its financials that it is doing the equivalent of pulling up the sofa cushions to collect change.
I've had this plan a very long time, since the early 1990s. Cigna in theory has not changed the terms (to do so, it would have to notify me and New York State) save approved rate increases. In practice it has, by among other things a few years back requiring that claims be submitted within 120 days of service. That has allowed it to engage in a new form of mischief: simply not processing some claims. No doubt the hope is that consumers won't notice, or will notice too late to get duplicate documentation and resubmit before the 120 days are up.
Mind you, for well over 15 years, I never had a single claim go astray. Now it happens with sufficiently high frequency for it to be implausible that the US Postal Service is losing so many of my letters, when other envelopes virtually never go missing. So every time I submit a claim, I have taken to recording the details necessary to locate the items in Cigna's system, as well as the mailing date.
Last July, Cigna sent a letter about a "pharmacy claim". It was a remarkably content-free document, with no reference to dates of service or any clues to allow a customer to figure out what they might be referring to, particularly since I do not have a pharmacy plan. A "pharmacy plan" is when the doctor sends a scrip to the pharmacy on behalf of a patient, and the pharmacy bills the insurer, with the patient responsible for any co-pay. My plan covers prescription drugs, including ones I get overseas (I've submitted prescription drug claims from England and Australia). I pay for the drugs and I submit for reimbursement. And until the mysterious July letter, I never had any problem with them being paid (provided, of course, Cigna didn't try claiming it had never gotten the claim).
Fortunately, because I keep good records, I could see I had sent in a claim in late June for four dates of service for less than $400 worth of meds total. The only reason the amount was that high was three of the four items were 90 day supplies.
I called Cigna and got a rep who found the four items and confirmed they were in a payment limbo and ought to be paid.
When no check had arrived by September, I called again, had the agent say that there was not reason for the claim not to have been paid, and put it in for reprocessing.
On November 28, with still no payment, I insisted on speaking to a supervisor, which it took an ungodly amount of time to reach. I started making noise about external appeal to New York state (my plan is a New York state regulated plan). She confirmed like everyone else that it should have been paid, and said the check would go out in three to five days.
Two weeks later, nothing from Cigna.
I called again. I got an agent who said the payment is pending.
By this time, steam was pouring out of my ears. I asked again to speak to a supervisor. After a 30 minute wait, I was told one would call me back. I should have known from long experience with Cigna that promises to make calls or follow up are empty, as this proved to be.
I decided to have one last go on the phone before writing the state for an external appeal. I called over the weekend. The agent said that the payment was issued on January 3, but she saw only three of the four drugs in the scans of the claims. Mind you, this was the cheapest scrip, and a shortfall versus what I should have received of about $13 (assuming that check finally arrives). But this is what this incident says about Cigna:
1. Recall that on the first call, and if my recollection serves me right, on at least one of the later calls, I confirmed the dates of the claims. The one that disappeared was the most recent in the date range, making it almost certain that I cited it most if not all calls.
This strongly suggests that the original Cigna hope was that I would not follow up adequately on their bafflegab letter, and when I did, someone went and scrubbed my record to reduce the amount Cigna would have to lay out. This is such a small amount that it would seem hardly worth the effort .which further suggests that Cigna has this sort of records-doctoring highly enough routinized to be able to do it cheaply. 1
2. Cigna has supposedly initiated payment right after the new year. Even though Cigna ought to be on an accrual as opposed to a cash accounting basis, it's not hard to infer that they kicked the payment back into a new fiscal year to flatter some sort of metric. It might not even be a financial reporting metric but some other measure that senior management and/or analysts follow.
As we said at the outset, in terms of abuses, this is small beer. But that's the point. Corporate America has been institutionalizing penny-ante scams like the one Cigna ran on me, knowing in this era when class action suits are virtually dead, that they can grift with no fear of being held to account.
The punditocracy wonders why more Americans aren't worked up about Trump's misdeeds. The great unwashed public is beset with abuses much closer to home.
1 The last agent checked my records for the date of the gone-missing drug claim to see if it had somehow gotten separated from the other three and was being handled separately. She came up empty-handed. Recall that I now have a not-approved, not-noticed-as-required change to my contract of a 120 day submission limit, so disappearing that item so late in the game makes it impossible for me to resubmit that item.
Geo , January 9, 2019 at 4:09 am
The punditocracy wonders why more Americans aren't worked up about Trump's misdeeds. The great unwashed public is beset with abuses much closer to home.
Well said. You're much more thorough and persistent than I am. I'm their target dupe that won't notice such things and just accept that it was my fault when I do notice. Very insightful read. Thanks so much!
WestcoastDeplorable , January 9, 2019 at 3:17 pm
Sorry to read of your problems, but Insurance companies aren't the only category screwing with the details; I recently transferred a balance to U.S. Bank on one of those "zero interest for 12 month" deals. In about 2 months after the transfer, all the sudden I get a late notice from them, then realize I didn't receive a statement (which was about 10 days late). And they laid a $39 charge on the account, which I was able to get waived with a trip to my local bank. Little did I realize this "late pay" also resulted in nixing the "zero interest" deal, and they levied the full interest on the balance.
Needless to say, I transferred the balance elsewhere, but seems to me lots of companies are gaming the mailing of statements to pad their coffers.
campbeln , January 9, 2019 at 3:53 pm
I had a good one with Macy's we bought a ton of stuff for the new house back here in the US and got the 0% interest for 12 months on their credit card for the first purchase or some-such. What the lady at the counter did was to run 2 separate transactions on the card so the second, much smaller, transaction fell outside of the "first purchase" and incurred the minimum monthly interest charge. Over the course of the 12 months, I'd have been in a slight deficit thanks to these additional charges, so I paid the damned thing off in full and threw it in the drawer.
So Macy's went from having a part-time AmEx card user to one that never uses it all because they didn't want to uphold their own promo Picking up pennies in front of a steamroller
Barbara , January 9, 2019 at 5:55 pm
Some years ago, I got such a 0% offer from a bank which issued one of my credit cards. This one was for existing debt and lasted until the debt was paid off. I was happily paying off my debt in reasonable monthly installments. After I paid my 6th monthly installment, I got a letter from the bank saying that they needed to raise the interest rate and would appreciate if I would concede. They added that if I continued to insist on 0%, as was my right to do, my credit card would be discontinued on the last payment. I chose to continue the 0% deal and, as promised (the only promise they kept), my credit card was cancelled thereafter.
Fast forward several years, I regularly get credit card offers from said company. Needless to say, I don't think much of people (or businesses – corporations are people too!) who renege on deals. You can guess what is not in my wallet!
The Rev Kev , January 9, 2019 at 4:18 am
Excuse for for asking but just to clarify a point. When you send mail to Cigna and you say that you record the details, are you talking about certified mail and registered mail then? The reason that I ask is that by using the same in Oz, it has saved both my daughter and I individually over a thousand dollars each when the recipient tried at first tried to deny receiving what we sent until confronted with tracking numbers that can be checked online.
Arthur Dent , January 9, 2019 at 9:15 am
More and more I am going to tracking numbers with signature required for things that have any sort of value.
The joy of focusing on shareholder value is that all other stakeholders are subservient to it. Ultimately, the sheer greed of the corporations is likely to force the general population to demand a government-run single-payer system where at least they can vote the politicians out of office instead of having unaccountable executives making their lives miserable. The inability to repeal the Affordable Care Act was just the first shot across the bow.
Spent more time in Canada over the past few weeks. Everybody I spoke to up there is utterly baffled by what is going on in the US and is seriously wondering if the US is officially insane. They cannot understand why we continue to live down here. BTW – many of these people are white people over 50 with military backgrounds and little to no college in the demographic that would have been probably voting for Trump in the US.
Octopii , January 9, 2019 at 1:05 pm
Have considered moving but they don't want us up there.
Yves Smith Post author , January 9, 2019 at 9:44 am
It takes $3+ per envelope to send something certified and a half hour tax on my time to go to the post office.
And sending a letter certified does not prove what was in the letter. It's useless from an evidentiary standpoint. Cigna could claim the envelope had no claims in it, or that the claims were "unscannable" (another "dog ate my homework" they've tried now and again). It's useless in proving a submission.
monday1929 , January 9, 2019 at 4:22 pm
Yves, you might try video-taping the mailing process, including video showing the papers as legible etc as they are sealed in envelope and handed over postal counter and showing tracking numbers.
Include in the envelope a letter explaining you will post video on you-tube if they claim "unscannable" or that envelope was empty.
United Healthcare broke dozens of promises to "call back"- they never ONCE did so. Hopefully not to far off topic, I would like to keep NC updated on current complaint with NY Office of Professional Discipline regarding a dentist who possibly hid about 100 bad (as in semi-criminal) Yelp reviews by establishing a phony company name and shifting reviews there. So far, after one month not a peep from Port Chester regional office where referred to.
beth , January 9, 2019 at 7:35 pm
Alert to United Healthcare Medicare Supp. retirees. I'm sure the UH did this not just to me but to all of those who carelessly pay all bills sent to them. When I signed up for AARP United Healthcare insurance, the rep told me that he would have to accept a check for the first month and then had to put me on a ckg acct withdrawal plan. I had never done that before and didn't like the idea. It turned out that that saved me in the long run for two reasons. First they billed me for the first month after accepting my check. I did not pay it and by the time I received it they had already taken money out for the second month. I am sure there are many seniors who just paid the bill anyway. Slick trick & sick trick.
And then a year later I was finally diagnosed with my genetic disease after all these years. I began getting the only medicine specifically for this disease which since it is an orphan drug is expensive. They rejected the first bill from the provider and told them I was not a member of the plan. I was thrilled that I had had the money taken out of my acct. so they could not say the check was late.
Kradek , January 11, 2019 at 12:25 am
Why won't these companies let us email the claims? Cheaper for all, content and dates verifiable
run75441 , January 9, 2019 at 11:00 pm
Green Card works in court and I have used it with Ocwen
flora , January 9, 2019 at 11:17 pm
By 'green card' do you mean the usps certified return receipt green card?
vlade , January 9, 2019 at 4:33 am
Hmm.. I haven't seen "the cheque will be issued" excuse for ages now, courtesy of pretty much all European payments being direct and settled on T+1 latest.
I guess having netflix and Facebook (the "great innovations" coming out of the US) is more important to a number of US residents than a working payments system like say the EU has.
mle detroit , January 9, 2019 at 10:12 am
I've been trying unsuccessfully to decode your first sentence. What is this payments system, where can a neophyte learn about it, does the UK use it, and what how Brexit affect it?
Kpl , January 9, 2019 at 4:36 am
When bad behaviour and fraud go unpunished this is what one should expect.
Disturbed Voter , January 9, 2019 at 5:27 am
Stick to your guns, and make them meet your business performance metrics!
Heath insurance is inherently un-profitable in the long run, unless service is denied.
oh , January 9, 2019 at 3:58 pm
Not really. Denial of claims is yet another way for them to pad their profits.
Louis Fyne , January 9, 2019 at 6:32 am
cigna bought express scripts and the deal closed in december.
it could be cost-cutting-induced incompetence. it could be intentional revenue padding. could be both.
and ya, compared to the daily/weekly neoliberal microaggressions, no wonder why after 3weeks a lot of people shrug when it comes to the government shutdown
Spring Texan , January 9, 2019 at 11:06 am
Love your phrase "neoliberal microaggressions." We need to start using that more!
rd , January 9, 2019 at 12:22 pm
This government shutdown is going to get very interesting as the Trump Administration tries to expand what are "essential services" requiring workers to come in without pay. So far it hasn't interfered with my travels because the TSA and ATC workers are all there working without pay. I believe tax refunds are going to be declared "essential" so those workers will be called back to process them without pay. This will likely be occurring in numerous other areas as the Administration gradually discovers that government workers actually do something.
Thad Allen had an interesting interview on NPR this morning as he discussed the Coast Guard working without pay: https://www.npr.org/2019/01/09/683501454/coast-guard-members-may-have-to-work-without-pay-during-shutdown
The GOP may have finally figured out how to pay for tax cuts: you still provide the services but you don't pay the workers!
Octopii , January 9, 2019 at 1:08 pm
Reminds one of the old Soviet saying, "They pretend to pay us and we pretend to work."
ambrit , January 9, 2019 at 1:10 pm
This dynamic is beginning to resemble the joke attributed to Lenin. "The Capitalists will sell us the rope with which we hang them."
I cannot think of a better way to energize a general strike than this.
Oh , January 9, 2019 at 4:02 pm
The TSA is just a pretend act anyway. It's all for show.
Larry , January 9, 2019 at 7:01 am
Perhaps the plan is to fatigue customers over small amounts to condition them to give up appeals over larger disputes.
Homard Mard Hankee Ospetsua , January 9, 2019 at 7:05 am
For most of the year 1982, I worked as a parlegal for a workmen's comp law firm representing petitioners (the sick or injured workers). Almost all of the cases we handled were from workers whose disability checks had stopped after six weeks. Always six weeks. That's the point at which the insurer would stop sending the checks and the worker would call us. Then, someone (like me) from the law firm would call the insurer. There would be one of a a stock set of about half a dozen responses, ranging from "my desk is so messy haha, but I know I saw that check in these papers somewhere" to "we don't have the proper medical documentation" (even though of course there needed to be medical documentation for them to send the first 6 weeks' worth of checks). After one or two phone calls from us, the checks would begin to flow again in a week or two (including checks for any week that the insurer had missed).
Oh, and 95% of these cases were from workers whose first language wasn't English.
The theory of the folks who'd been at this business for awhile was that, by having a built-in delay at the six-week mark, the insurers were making a little extra interest.
cnchal , January 9, 2019 at 7:17 am
> . . . in terms of abuses, this is small beer . . .
Tens of millions of small beers ends up being a gigantic vat of beer for Davos Man running Cigna. This is the result of Davos Man purchasing laws to prevent class action suits, which was paid for by stealing small beers from the peasants for decades.
I do pity the human capital at Cigna. Their worth to Davos Man is how well they steal small beers, the more they steal the higher in the organization they go, aspiring to be the next Davos Man.
Brenda Pawloski , January 9, 2019 at 8:33 am
If you are able to send your pharmacy claims online and keep an electronic copy, you can resubmit easier, faster and more often. I have done this with Cigna. I agree it is odd how they choose to ignore random claims, but it happens enough that it seems to be intentional.
BRUCE STONE , January 9, 2019 at 8:36 am
Have you tried sending the mailed correspondence by priority mail? Like Certified Mail–you get a tracking number– and documentation of delivery–but it's half the cost and my insurer will routinely refuse to accept certified mail to the claim's PO box number.
They can't refuse to participate in the priority mail tracking systems -- and it's as good in court as certified mail–although it does lack the signature credo from return receipt.
Also–my insurer routinely loses my docs and has a similar time limit on claims–but I have successfullly re-submitted based on documenting the previous sent item and the tracking data from USPS–most such systems require them to accept a resubmit when you can prove you sent it within the timeframe .
Yves Smith Post author , January 9, 2019 at 9:47 am
See the comment above. Won't help. Only proves I sent a letter in, not what was in the letter. They can say they got the earlier letter but the claim was not in it or was unscannable.
Questa Nota , January 9, 2019 at 8:54 am
Expecting reimbursement is a pre-existing condition and is not covered by the Plan for which you have eligibility. Refer to paragraph x.xx in section q.qq of user agreement #.##.
Yves Smith Post author , January 9, 2019 at 9:48 am
Not germane. Please don't offer irrelevant comments.
Kiwi , January 9, 2019 at 10:35 am
The comment was a joke
mle detroit , January 9, 2019 at 10:17 am
Good one, QN. Hope you didn't get scorched when you poked the Dragon.
RMO , January 9, 2019 at 4:39 pm
"You've chosen the 'never pay" plan option which clearly states (in this microdot that also serves as a period at the end of paragraph 4) that no claims you make will be honored. It's a good choice if you never get sick. Oh I hate to see a grown man cry Rev So get out of my office!" (adapted from the Pythons)
beth , January 9, 2019 at 7:40 pm
Do I sense a little hostility? Maybe you can be more explicit with what you are angry about.
Medical Quack , January 9, 2019 at 9:25 am
Well I gave a speech last year to a big doctors group about a lot of this and have written about it for years, it's called the Healthcare Algo Cartel. What folks can't see and don't want to believe is that there's tons of quants (called non traditional actuaries in healthcare) modeling policies and finding new areas every day where coverage for certain items can be "scored" to reduce the amount the insurer will pay.
I just don't know how long you all want to keep living in virtual perceptions and not realize this has been going on for years, just like the stock market, algos and their query results are running everything, and folks are too busy on Facebook or screaming at a box (Alexa) to take time out and learn up. Cigna is basically emulating United Healthcare and using the same models, but they don't own a PBM like United does or they don't own a bank like United does (an industrial bank). That bank by the way holds a lot of HSA money and United a couple years ago bought all the Wells Fargo HSA accounts, that's how they grow.
Nobody mentions an exit fine either for Cigna and Express Scripts. There's 5 years left for Cigna to be required to OptumRX as a PBM, contract signed with Catamaran, which OptumRX bought. Those folks with OptumRX as their PBM with Cigna have 5 more years before a switch to Express Scripts can be facilitated unless Cigna takes out another bond sale to pay it off.
People need to learn up and see what's going on, insurers are big data people and nobody seems to get that but just hang around long enough and more will come out about United Healthcare and what they and Apple are doing together, you already have United pimping Apple watches and all Apple employees are given an Optum Bank HSA account with one scratching the others back already.
Cigna by the way has Express Scripts hitting the big coupon savings route to compete, you can search that one up. Did you know that if you use a coupon to save money on your RX that that money can't be applied against a deductible? Time to learn up folks and see what the healthcare algos are doing, they're denying your care and access and there's more MBA quants on their way to be hired at insurers to model even more ways to profit by "scoring" consumers into oblivion, it's how you don't qualify done by queries and predictive models. The more complex they make it, the more insurers profit off of consumers not understanding the game and we don't have the ability to fight back (we don't have the algos and computer code).
Kris Alman , January 9, 2019 at 12:21 pm
The Cigna-Express Scripts merger is brilliant financial engineering to further consolidate insurance companies with PBMs in the fight between them and PhRMA over price gouging.
The coupons that you can get through Good Rx is a scheme of Express Scripts. https://www.biopharmadive.com/news/express-scripts-goodrx-roll-out-cost-savings-program/442197/
Now that Trump has signed bills lifting pharmacist 'gag clauses' on drug prices, the pharmacist can point you in the direction of drugs cheaper than your co-pays, which you pay-out-of-pocket and can't claim toward your deductible. What a win for Cigna/ExpressScripts!
Yves, I can't believe you have been so patient with Cigna! Complain to your insurance division. Though, I will add that while this may work at the individual level, it does nothing to create systemic changes.
JerryDenim , January 9, 2019 at 12:48 pm
Sorry to be so dense, but can you elucidate a bit more on "scoring" and how health insurance companies are using your personal data they've purloined or surreptitiously obtained to deny care? If you're not self-insured but receiving subsidized insurance through an employer plan are you still affected by "scoring"?
I would never knowingly register any health monitoring device with a health insurer or employer and I've always thought those who do are foolish, but recently I was considering buying an Apple Watch solely for the express purpose of being able to surf while being on call for my job. I believe there may be other waterproof, cellular-enabled wrist devices in the consumer space now besides Apple, but they all seem to be equipped with health monitoring sensors as well. I would never voluntarily register such a device with any programs in exchange for discounts, but it seems like linking a watch/wrist-phone to my cell phone account would be an iron identity shackle. I would really like a tiny robust cell phone reciever to screen calls while I'm in the water, which has the ability to increase my quality of life, but I don't want my heart rate and vitals logged and sold. I modified a song lyric a couple of decades ago to coin my own phrase; "Never mind what you're buying, it's what you're selling" – It becomes more true each passing year.
jfleni , January 9, 2019 at 9:31 am
RE: Health Insurer Greed or Desperation? An Odd Data Point From Cigna.
The "Nitty-gritty" A Scam wrapped in a Swindle, with a Fraud right on top!
Run -do not walk – to Medicare for ALL!
jefemt , January 9, 2019 at 9:58 am
Not fun to do the work, but imagine a few million Cigna clients at $13.00 a pop. Will pay for attorneys and accountants.
As to Priority Mail/ tracking/proof, why do we tolerate such a byzantine battle-prone system? Think of the man-hours Yves and countless others spend on running down this hors*#t. If she and others (doc offices/ care providers?) billed Cigna and others at a reasonable but market-based hourly rate for the collective man-hours spent on claims, Cigna et al would be out of business.
Its a level of complexity that is completely unnecessary. Our complacency, tolerance, and acceptance is pretty astounding. Must be the very real primacy of the threat and fear that personal health prompts. Immoral to lever off of this. Care versus insurance. Insuring a mortal being. Ridiculous premis only Wall Street could concoct. And we buy it because markets, capitalism, rugged individualism, American Exceptionalism.
Doc friends and family consistently state 35-40% of their costs, staff deals with billing, coding, reimbursement. There is huge savings to be gained in the process if we would go to a single payor system.
But you all know that- preaching to the choir.
I am still trying to figure out how to tie personal health choices, like diet and exercise, moderate alcohol use, etc.. and some incentivized skin-in-the game, some 'pain' disincentivises folks from over-using single payor and insisting on the highest dollar cost latest most expensive treatments -- how can this be institutionalized?
But , no need to reinvent the wheel- countless other nation-states have figured it out. For a nation of business-persons, we appear to be, as my old dad used to say, dumberthanwhaleshit
hunkerdown , January 9, 2019 at 12:04 pm
If they're overusing the system, what's the underlying reason? Probably loneliness or neurosis, either treatable on an outpatient basis as a mental/community health matter. If they demand heroic treatments or frivolous diagnostics , what's the underlying reason? Probably the consumer model of medicine and direct-to-patient marketing of interventions, also easily treatable (through restriction of advertising) and known to work well in other nation-states. If they eat crap, what's the underlying reason? The standard American diet is a consequence of national policy to grow grain instead of vegetables, which can be changed slowly and with effort as a public health hazard. If they don't exercise, what's the underlying reason? Built environments and lifestyles that are hostile to pedestrian traffic, which is not necessarily such an easy problem to solve due to the private interests and investments in the status quo, but whose opposing public interests would grow much stronger under a single-payer system.
Yet, all of these solutions, however difficult and world-changing they might be, are more effective over the long term and less resentment-inducing than having citizens pay to be individually scourged as a service in the name of individual incentive.
Yves Smith Post author , January 9, 2019 at 3:10 pm
The overwhelming majority of people do not elect to overconsume medical care.
People who don't exercise often don't have the time or money to do so (gym membership). Do not say "Anyone can run." Running on pavement is knee replacement futures. And there are people like me who could never jog even when young.
The ones that do fall into a few categories:
1. Ones with "lifestyle" diseases, like diabetes due to overweight/poor diet and smoking-related diseases. Problem is that these are typically the result of stress. Very hard to get off cigarettes and harder if you are subject to stress/use nicotine as a performance drug. Obesity significantly due to American portion sizes. too many refined carbs, and again, stress. And once people get fat, it is very hard for them to take and keep the weight off. I have managed to do so by virtue of seriously undereating for 40 years (<1200 calories/day, and that includes when I was exercising vigorously pretty much daily). Most people can't do that for social reasons. It is hard to be a meager eater when you are eating with other people.
2. People who are already have a problem and have been marketed to to demand tests and treatments. The classic version of this is doctors prescribing antibiotics to people with flus. The patients demand a treatment and the MD does not want to get in an argument. More extreme is patients not wanting to hear that there aren't any good options for what they have and shopping for an MD who will intervene anyhow. Another is all those new pricier drugs marketed on TV "Ask your doctor about..."
beth , January 9, 2019 at 8:15 pm
The best information about obesity is still the UCSF researcher Robert Lustig. He now has his own website but it not organized well to my taste and fails to keep the best long lectures there. Actually the best information in the shortest time is his first lecture that has been seen millions of times by geeks like me is "Sugar: The Bitter Truth" a one hour and 29 minute lecture he did in 2009. Youtube cuts it up and wants me to pay for it. But each time I have seen it has been on UCTV or UCSF. For those of us who want to understand the science this one is a must. There is good videos after that, but this is the foundational scientific information.
I can't give you a link because Google and the sugar industry makes it maddingly hard to find and moves it around.
flora , January 9, 2019 at 9:46 pm
It's a very good presentation. Thanks for the reminder. From UCTV:
bob , January 9, 2019 at 3:21 pm
"I am still trying to figure out how to tie personal health choices some incentivized skin-in-the game "
You're trying to noeliberalize it. "How do we build in the need for 18 layers of very well paid bureaucrats who deal out spite, and lack of care, as part of their job descriptions?"
I can't imagine any more 'skin in the game' than all of the skin, and literally all of the person.
Do you ghouls even read what you write?
k. , January 9, 2019 at 9:59 am
As someone who managed a medical billing office in the 80s and 90s I can assure you that insurance companies losing claims is nothing new. That's why the advent of electronic billing to Medicare and Medicaid and BCBS and others was so wonderful. Finally, Medicare stopped "losing" all those claims we offices had to refile all of the time.
Sometimes it helped me to envision the office I was sending the paper claim to, imagining a constant turnover of new employees who didn't know what they were doing, or throwing away a stack of bills at the end of the day because they hadn't met their quota.
It's like borrowing "your" money longer, not paying what's owed in a contract.
EoH , January 9, 2019 at 10:38 am
Thanks for sharing.
This seems reminiscent of bank ATM fee scams. A dollar here, $2.50 there – systemwide – and soon you're talking about real money. It also matters whose budget the costs or income are shifted to, which is often a highly-competitive internal game. Same with the now ubiquitous and easily incurred penalty charges, which banks use to generate the outlandish returns they now consider their due.
Coincidentally, I was recently helping a friend with her latest medical bill. Always good sport if it's not your bill. It was "only" for about a thousand dollars. Her insurer paid the amount, minus her deductible.
The hospital system sent her a follow-up bill for the same service. It was for the deductible the insurer did not pay – routine – AND for another thousand dollars, which was not.
Here's the hospital's argument: It had billed the insurer and the patient only a thousand dollars. But the insurer considered bills for up to two thousand dollars for that service. Having, in effect, underbilled the insurer, the hospital added the difference between its first bill and the maximum amount the insurer would consider.
But the hospital did not bill the insurer for the higher amount, only the patient. That routine also happily avoided any reasonable and customary cap the insurer and hospital had agreed to.
The hospital does this routine systemically. Its "customer service" operators have a canned response for outraged patients: You'll pay it in the end and we'll dock your credit score in the bargain. Film at eleven.
Steven Hoel , January 9, 2019 at 10:39 am
I have found this letter (or to be used as script to be read over the phone) to be 100% effective so far. I suspect it gets kicked up to a supervisor who wants to get rid of the crazy customer:
"To: "Big Corporation"
Regarding Inv #
You have issued your fourth notice. Please note that this is now my third notice to you of whom to bill. If I must spend more time on this issue, I will be billing out at $200 per hour in ½ hour increments. Sending a further notice without contacting "XYZ Healthshare" for payment will indicate acceptance of my terms.
This blood work was for my annual Physical. I am covered under "XYZ Healthshare" and they cover one physical per year.
Please submit above referenced invoice for payment to:
P.O. Box 1234
Anytown USA 12345
Insured: John Doe
Policy # 123456789
It is not acceptable to simply send me another payment notice when you are not billing as I instructed. I will send my billable hours in return and submit a copy to my attorney.
NotTimothyGeithner , January 9, 2019 at 10:44 am
The punditocracy wonders why more Americans aren't worked up about Trump's misdeeds. The great unwashed public is beset with abuses much closer to home.
jrs , January 9, 2019 at 12:56 pm
Of course Trump's misdeeds are becoming abuses much closer to home, having one's government closed becomes real impractical even on the day to day level.
Spring Texan , January 9, 2019 at 11:08 am
Wow, this makes me very happy I work for a self-insured employer which unfailingly pays bills in good faith. Awful.
California Bob , January 9, 2019 at 12:10 pm
I was with United Healthcare in the private sector for years, with good coverage and no serious issues (PPOs only). When I went on Medicare, I stayed with AARP-endorsed UHC; I figure the last thing UHC would want is a bunch of angry retirees with time on their hands. So far, so good.
Jimmie Q , January 9, 2019 at 5:40 pm
I don't know about that. I've not been able to login to the AARP/UHC website for 2 months.
They admit that there is a problem. After 2 months I'd say they are correct.
You'd think they would go back to the last working version of their log-in software.
What kind of testing was performed before inflicting this crap on their users. None, by the looks of it.
It's pretty obvious when you can't login. How stupid are these people ?
Oregoncharles , January 9, 2019 at 12:17 pm
Not medical, but a similar penny-ante scam that we encountered from a car rental, which I will name: it was Dollar/thrifty – they're the same company. Ironically, we were happy with their service, given the price, UNTIL we turned the car in at the Indianapolis airport. The agent claimed the system was down, so couldn't give me a receipt; foolishly, and feeling time-pressured, I walked away without one (don't do that).
The company first claimed the car had not been turned in, then discovered that it had been re-rented the next day, so charged us for an extra day. I refused to pay it, since an agent had agreed that our boarding passes from the airline proved when we'd turned it in. In fact I got the credit card company to reverse the extra amount (their service was exemplary). Attempts to clear it up on the phone led to hangups at their end, and ultimately they sent the $50 difference to collection. When I got a call, I started yelling about it being a fraudulent charge and making legal threats; never heard from them again – not worth it for such a small amount. I felt that principle was involved.
And now the oddity: Dollar/Thrifty belongs to Hertz, but we've had no trouble renting from Hertz. Go figure.
JerryDenim , January 9, 2019 at 1:21 pm
One scam I've seen Hertz attempt on me twice, was claiming a car wasn't returned completely full, like 1/16th shy of full, then they proceed to charge you for a full tank of gas (15, 20 gallons or whatever that means based on the vehicle) at some outrageous price like $9.00 a gallon. It's a scam that is always going to add up to over a hundred dollars. It's a quick, vicious one-time burn (sharp practice as Yves would say) they try to pull on customers they figure may never rent from them again anyway. Algos I'm sure. Always document, document, document with rental cars. Cell phone cameras are great in this regard. Photos of the odometer with gas gauge displayed work great for refuting such charges.
beth , January 9, 2019 at 8:32 pm
I was definitely scammed by Dollar/Thrifty. I have switched to using Enterprise but they sometimes don't have an airport location. So far so good. I usually take only one trip a year.
Oregoncharles , January 9, 2019 at 12:21 pm
Afterthought: Insurance is a service business, which would normally depend on providing reasonably good service – granted, in this case Yves is locked into an old contract, so they might be trying to get rid of her.
I wonder if this sort of behavior means they see the political handwriting on the wall, figure the business can't last much longer, and are trying to extract the last dime, because it IS the last?
EoH , January 9, 2019 at 3:13 pm
Standard business model. Nothing special.
I question whether insurance is any longer a service, at least for the customer. Health insurance used to be a business that offered a reasonable service, service tracking and payment processing for employers, who purchased the service for their employees as a form of deferred compensation, in exchange for a reasonable fee.
The model seems to have changed to one of open and notorious self-dealing. The intermediary has become a principal, and no fee and no level of profit is too great. The intermediary makes decisions that look to the lay person like practicing medicine – not seemingly in the interest of savings its employer customers money, but it making it for themselves. The model is a major reason for the extraordinary cost of medical care in the US.
Synoia , January 9, 2019 at 12:26 pm
Small claims court?
ambrit , January 9, 2019 at 12:57 pm
That would be a tax on her time, she has to physically show up in court for the 'trial', and money, as in, filing fees. A small claims judgement does not guarantee payment. That could take a second suit. (I had to go for a second filing to get my judgement paid.)
This is a systemic problem. The remedy in that elusive "perfect world" is to change the system.
AdamK , January 9, 2019 at 12:55 pm
"Corporate America has been institutionalizing penny-ante scams "
Don't get me started. 24 hour fitness sold membership for super sport facilities at a higher price promoting the deal that gives free towels to members while at the gym. 3 years after, towels are gone. Price was raised several times, and there is no difference between regular facility and super sport. No one complained. They simply got the news and adjusted. Saying something is not considered appropriate, so we continue to pay more and more and getting less and less.
ambrit , January 9, 2019 at 1:05 pm
Same dynamic used for Internet services, telecom services and cable services. Life is legally an "ethics free zone" today.
Reminds me of one of the more vulgar posters I once saw. A mid range shot of a woman's "private parts" with a 'tattoo' above the mons pubis saying; "Abandon all hope, ye who enter or exit here."
WheresOurTeddy , January 9, 2019 at 2:32 pm
"The political crisis we are facing is simple. American commerce, law, finance, and politics is organized around cheating people." – Matt Stoller
JerryDenim , January 9, 2019 at 1:10 pm
This story is strangely similar to the battles I used to wage years ago with Sallie Mae to pay down my student loan principal ahead of schedule. I would send checks that would never be cashed. If they ever were the amount would always be applied to interest and never principal. Tons of emails, phone calls and letters stretching out over months all about one check or another.
"Oh you sent the check to that address? No that's all wrong, try this one." "Oh, no, you have to write a letter stating you want the amount to be applied to principal. Oh, you did already? Oh, well send one to this department at this address instead and your next one should be be applied to principal."
Absent an aggressive regulator corporations can play infuriating games like this for years until the consumer gives up or lawyers up. Lawyering up is no guarantee of victory and doesn't make financial sense for small penny-ante grievances. Most people stuck dealing with hassles like these don't have the money to lawyer up anyway and corporations know it. I remember back in 1995 when my phone service was changed without my permission and I received an outrageous bill. I placed one phone call to the FCC that lasted a few minutes and I received a $250 credit and my phone service was free for the next year. I miss those days.
"The punditocracy wonders why more Americans aren't worked up about Trump's misdeeds. The great unwashed public is beset with abuses much closer to home."
Absolutely. It's really tough for working class Americans to shed a tear for Central American border jumpers having a rough go of things with ICE when their own government refuses to protect them from thousands of small capitalist depredations that they are subjected to on a daily basis.
tongorad , January 9, 2019 at 1:11 pm
Corporate America has been institutionalizing penny-ante scams like the one Cigna ran on me
I received an errant charge when I chose to cancel my account with a phone-carrier giant. Lots of time on the phone speaking to different people, demanding to be sent an invoice/bill.
In the end, I just paid. I was losing sleep over it.
I have a feeling that these kinds of extractions are commonplace.
What a world
beth , January 9, 2019 at 8:41 pm
If we are discussing scams, I had an earthlink account for about a year when I noticed that rather than billing me monthly, they were billing me every 20 days and when I noticed it, they said they would refund my money at my request.
And what do you think happened?
M Morrissey , January 9, 2019 at 1:20 pm
File a complaint with your state insurance department. Most departments have dedicated staff who will follow up on such issues. If you one of many victims, it can lead to a "Targeted Market Conduct Examination" of the company.
Once that happens, the insurer will readily settle claims such as yours because besides fines, the impact of an examination damages their reputation. Also, if there is a pattern of misconduct, the complaint information is shared between the 50 states, who may also initiate targeted examinations. Don't get mad–get even.
monday1929 , January 9, 2019 at 6:06 pm
You are kidding, right?
And ."damage their reputation"- thank you, I needed a laugh.
JBird4049 , January 9, 2019 at 1:37 pm
The more people are in need of medical care the less likely they are to have the time, energy, or even money to maintain their records, read all their letters and emails, and write and call enough times to finally get their money. The sicker are the less likely you will get paid. Truly vulture capitalism.
Dan , January 9, 2019 at 1:57 pm
I tend to agree that these 'billing mistakes' are a conscious strategy on the part of insurers. For several years Kaiser (Northern California) would attempt to bill me $15 every time for routine physical visits (which my physician had requested!). Routine physicals, of course, are meant to be free under the ACA. Every time the receptionist would request payment in advance, I would decline an tell them that the appointment should be free. They then would proceed to bill me by mail, and I had to spend time calling them to resolve the issue. Unlike Yves' experience with Cigna, Kaiser customer service was always friendly and promptly resolved the 'error'.
Since we changed from a Covered California plan to a small business plan this practice appears to have stopped, at least for me. Nonetheless, this annual ritual was a ridiculous tax on my time, and I wonder how many people who were less informed/hostile to their insurer than I am have just paid these false and illegal fees up front. The consistency of this practice over a period of years makes it hard for me to believe that there is really error involved, as opposed to a subtle fraud by the insurer.
monday1929 , January 9, 2019 at 6:13 pm
It is never an "error", and it is always in their favor (proof it is not an error).
They target the sickest, least likely to fight back. There is an MBA somewhere who wrote an algorithm designed to screw the old and sick. My nightmare with United "healthcare" (why are they allowed to call themselves or imply they are healthcare providers?) was on behalf of someone else who never could have fought these scammers.
tiebie66 , January 9, 2019 at 3:31 pm
So, they legislate to permit disruption against you and not against them, but year after year – figuratively speaking – you send the same people back there. The system is beyond reform, is that not clear by now? Vote for anyone –except– a Democrat or Republican. It would create upheaval at first, like spring cleaning, but it is as necessary. If you are too timid to make changes, you will only get weaker and weaker until you are too weak to resist. Don your yellow jackets!
But on a different level – where does this originate? My sense is that it is a failure of education. The nation can neither read, nor write, nor think. This makes for easy victims. Do teachers really deserve better pay? Is teaching not a 'calling' rather than a career? Should teachers not do better? But perhaps the failure of education is also, in part, institutionalized?
Big Tap , January 9, 2019 at 4:55 pm
Speaking of insurance scams some involve a PPO type policy. More and more often I'm told at the time of service of a doctors visit to pay up front. With a PPO policy you usually don't know exactly what you owe till after the insurance company tells you what your co-pay is and then you're billed. When you pay up front bring overcharged intentially is the scam. Getting a refund of your own money can time consuming.
Pft , January 9, 2019 at 6:49 pm
Not only health insurance. Good luck if your house burns down and you want them to honor the contract in a timely fashion. They hold off until you accept less hoping you hate living in 2nd rate accomodations enough to cave. My sisters contract called for full replacement of all contents regardless of age. She paid a hefty premium for that. They held out for months offering less saying some of the contents were older and not worth the replacement cost which is what she wanted to avoid by paying the extra premium for the upgrade. Came to an agreement somewhere between but took 15 months before she could move back in.
EoH , January 9, 2019 at 7:37 pm
There is the basic problem that with almost every medical service, the customer does not know the price until the bill(s) show up in the mail. (Nor have they any training or experience that would enable them to choose alternative treatments or vendors.) Only later still does an insured customer find out what portion of that bill is her responsibility. And that's without errors and intentional mis-billing, which are common.
The usual conservative refrain that patients need more skin in the game studiously ignores that patients always have all their skin in the game, even though no one tells them the game or the rules until it's too late. It is an environment that could only make predatory behavior flourish.
Katherine , January 9, 2019 at 9:57 pm
This is one of the most unsettling posts I have read on NC since becoming hooked about 6 months ago.
cat sick , January 10, 2019 at 2:44 am
Live a healthy lifestyle and self insure
I am sure not dealing with insurance companies is a sure way to lower stress levels and therefore require much less healthcare.
As a fairly healthy 50 year old I find that even though I have access to a good free first world healthcare system (Singapore ), never using it and paying doctors direct for all my needs is the way to go and probably costs me 10% of what a US citizen might pay for an insurance policy.
When I am in the US and so many people you meet have "meds" that they take on a daily basis it leads me to believe that not only are the insurance companies in on the scam but also the doctors and drug companies plying people with drugs that in most cases probably make them worse off
The first $20 of care I would reccomend is to buy one copy each of "how not to die" and "the case against sugar" read these and then do all you can to avoid both insurance companies and doctors .
Jan 09, 2019 | www.zerohedge.com
Authored by Michael Snyder via The Economic Collapse blog,
If the U.S. health care system was a country, it would have the fifth largest GDP on the entire planet. At this point only the United States, China, Japan and Germany have a GDP that is larger than the 3.5 trillion dollar U.S. health care market. If that sounds obscene to you, that is because it is obscene. We should want people to be attracted to the health care industry because they truly want to help people that are suffering, but instead the primary reason why people are drawn to the health care industry these days is because of the giant mountains of money that are being made. Like so many other things in our society, the health care industry is all about the pursuit of the almighty dollar, and that is just wrong.
In order to keep this giant money machine rolling, the health care industry has to do an enormous amount of marketing. If you can believe it, a study that was just published found that at least 30 billion dollars a year is spent on such marketing.
Hoping to earn its share of the $3.5 trillion health care market, the medical industry is pouring more money than ever into advertising its products -- from high-priced prescriptions to do-it-yourself genetic tests and unapproved stem cell treatments.
Spending on health care marketing nearly doubled from 1997 to 2016, soaring to at least $30 billion a year , according to a study published Tuesday in JAMA.
This marketing takes many different forms, but perhaps the most obnoxious are the television ads that are endlessly hawking various pharmaceutical drugs. If you watch much television, you certainly can't miss them. They always show vibrant, smiling, healthy people participating in various outdoor activities on bright, sunny days, and the inference is that if you want to be like those people you should take their drugs. And the phrase "ask your doctor" is usually near the end of every ad
The biggest increase in medical marketing over the past 20 years was in "direct-to-consumer" advertising, including the TV commercials that exhort viewers to "ask your doctor" about a particular drug. Spending on such ads jumped from $2.1 billion in 1997 to nearly $10 billion in 2016 , according to the study.
As a result of all those ads, millions of Americans rush out to their doctors to ask about drugs that they do not need for diseases that they do not have.
And on January 1st, dozens of pharmaceutical manufacturers hit Americans with another annual round of massive price increases.
But everyone will just keep taking those drugs, because that is what the doctors are telling them to do. But what most people never find out is that the pharmaceutical industry goes to great lengths to get those doctors to do what they want. According to NBC News , the big drug companies are constantly "showering them with free food, drinks and speaking fees, as well as paying for them to travel to conferences".
It is a legal form of bribery, and it works.
When you go to most doctors, they will only have two solutions to whatever problem you have drugs or surgery.
And since nobody really likes to get cut open, and since drugs are usually the far less expensive choice, they are usually the preferred option.
Of course if doctors get off the path and start trying to get cute by proposing alternative solutions, they can get in big trouble really fast
Today's medical doctors are not allowed to give nutritional advice, or the American Medical Association will come shut them down , and even if they were, they don't know the right things to say, because they weren't educated that way in medical college. So instead, M.D.s just sling experimental, addictive drugs at symptoms of deeper rooted sicknesses, along with immune-system-destroying antibiotics and carcinogenic vaccines.
That's why any medicine that wrecks your health is easy to come by, just like junk food in vending machines. The money isn't made off the "vending" products, the money is made off the sick fools who are repeat offenders and keep going back to the well for more poison it's called chronic sick care or symptom management. Fact: Prescription drugs are the fourth leading cause of death in America, even when "taken as directed."
Switching gears, let's talk about hospitals for a moment.
When you go to the hospital, it is often during a great time of need. If you are gravely ill or if an accident has happened and you think you might die, you aren't thinking about how much your medical care is going to cost. At that moment you just want help, and that is a perfect opportunity for predators to take advantage of you.Trending Articles "A Soft Coup Against Donald Trump Is Underway" Declares
Turkey is going on the attack against John Bolton following his weekend antics in the Middle East, which most recently
Just consider the example of 24-year-old Nina Dang. She broke her arm while riding her bicycle in San Francisco, and so she went to the emergency room.
The hospital that Facebook CEO Mark Zuckerberg donated so much money to definitely fixed her arm, but later they broke her bank account when they hit her with a $24,000 bill
A bystander saw her fall and called an ambulance. She was semi-lucid for that ride, awake but unable to answer basic questions about where she lived. Paramedics took her to the emergency room at Zuckerberg San Francisco General Hospital, where doctors X-rayed her arm and took a CT scan of her brain and spine. She left with her arm in a splint, on pain medication, and with a recommendation to follow up with an orthopedist.
A few months later, Dang got a bill for $24,074.50 . Premera Blue Cross, her health insurer, would only cover $3,830.79 of that -- an amount that it thought was fair for the services provided. That left Dang with $20,243.71 to pay , which the hospital threatened to send to collections in mid-December.
Most Americans assume that if they have "good health insurance" that they are covered if something major happens.
But as Dang found out, you can still be hit with crippling hospital bills even if you have insurance.
Today, medical debt is the number one reason why Americans declare bankruptcy. Because of the way our system is set up, most families are just one major illness away from financial ruin.
And this kind of thing is not just happening in California. The median charge for a visit to the emergency room nationally is well over a thousand dollars , and you can be billed up to 30 dollars for a single pill of aspirin during a hospital stay.
Our health care system is deeply broken, and it has been designed to squeeze as much money out of all of us as it possibly can.
Unfortunately, we are stuck with this system for now. The health care industry is certainly not going to reform itself, and the gridlock in Washington is going to make a political solution impossible for the foreseeable future.
the_river_fish , 3 minutes ago linkConsuelo , 9 minutes ago link
Healthcare has displaced Retail as the largest employer in the United States
https://thistimeitisdifferent.com/healthcare-us-january-2019css1971 , 10 minutes ago link
The ghost of Ted Kennedy that keeps on giving...
He played an outsized role in the trashing of the doctor/patient relationship.LawsofPhysics , 10 minutes ago link
Most big hospital ERs negotiate prices for care with major health insurance providers and are considered "in-network." Zuckerberg San Francisco General has not done that bargaining with private plans, making them "out-of-network." That leaves many insured patients footing big bills.
Constrain supply. Increase the price.
That was the purpose of the 1973 HMO act. It was at this point, that US medical costs began to escalate far beyond the rest of the world.
LawsofPhysics , 21 minutes ago link
Considering the demographics of the country and the fact that fraud is the status quo now, this should not surprise anyone.
That's a tough question considering we don't really know how much is flowing to the military industrial complex. My guess healthcare spending is in second place.
Jan 08, 2019 | jessescrossroadscafe.blogspot.com
Stocks and Precious Metals Charts - Risk On Again - Distractions from the Real Problems and Issues
"On April 3, Nina Dang, 24, found herself in a position like so many San Francisco bike riders -- on the pavement with a broken arm.Within so many of the corporate dominant monopolies like Healthcare, Banking, Pharmaceuticals, some companies seem to be free to do just about whatever they wish in billing consumers.
A bystander saw her fall and called an ambulance. She was semi-lucid for that ride, awake but unable to answer basic questions about where she lived. Paramedics took her to the emergency room at Zuckerberg San Francisco General Hospital, where doctors X-rayed her arm and took a CT scan of her brain and spine. She left with her arm in a splint, on pain medication, and with a recommendation to follow up with an orthopedist.
A few months later, Dang got a bill for $24,074.50. Premera Blue Cross, her health insurer, would only cover $3,830.79 of that -- an amount that it thought was fair for the services provided. That left Dang with $20,243.71 to pay, which the hospital threatened to send to collections in mid-December..."
Sarah Kliff, A $20,243 bike crash: Zuckerberg hospital's aggressive tactics leave patients with big bills
"Monopolies hurt the public and the republic alike; the job of policing that power must be taken seriously."
Healthcare in the US is bordering on insane when it comes to billing practises and lack of practical recourse or common sense, with Big Pharma running a close second. But the Banks are not all that far behind.
I have met many, many dedicated professionals in the healthcare industry, but like most participants they are just being swept along because they have little practical recourse or power. To speak up is to be punished, and severely.
A simple law that states that when a patient is brought into a hospital emergency room for treatment, their private insurance and the treatments must be provided at the network rates in their insurance policy, or at the prevailing rate for a Medicare patient, whichever is lower. And any uncollectible services to be written off or compensated by government will be done at the Medicare rate and not at some ficitonal billing statement.
I believe that New York State has a law requiring ER and Hospital doctors to accept private insurance for patients as if they are in-network. This includes those 'consultations' which happen during a hospital stay by doctors who accept no insurance and who charge whatever they feel like charging for some service, of which provider or price the patient is never informed beforehand.
The real solution is of course universal healthcare, which has been implemented for years by every major developed nation but the US. This will not happen for the same reason that we are seeing no movement towards meaningful reform in Pharma or Banking. And you know exactly why, unless you have been living in a bubble or are willfully blind.
Stocks managed to extend their rally today despite some setbacks.
We will see what Trumpolini has to say about our 'crisis' at the southern border this evening, and the trade war, and probably whatever else crosses his mind. My only certainly is that it will not involve any meaningful reform in healthcare, finance, insurance, or pharmaceuticals.
Have a pleasant evening.
Oct 24, 2015 | The Guardian
"Phoning in sick is a revolutionary act." I loved that slogan. It came to me, as so many good things did, from Housmans, the radical bookshop in King's Cross. There you could rummage through all sorts of anarchist pamphlets and there I discovered, in the early 80s, the wondrous little magazine Processed World. It told you basically how to screw up your workplace. It was smart and full of small acts of random subversion. In many ways it was ahead of its time as it was coming out of San Francisco and prefiguring Silicon Valley. It saw the machines coming. Jobs were increasingly boring and innately meaningless. Workers were "data slaves" working for IBM ("Intensely Boring Machines").
What Processed World was doing was trying to disrupt the identification so many office workers were meant to feel with their management, not through old-style union organising, but through small acts of subversion. The modern office, it stressed, has nothing to do with human need. Its rebellion was about working as little as possible, disinformation and sabotage. It was making alienation fun. In 1981, it could not have known that a self-service till cannot ever phone in sick.
I was thinking of this today, as I wanted to do just that. I have made myself ill with a hangover. A hangover, I always feel, is nature's way of telling you to have a day off. One can be macho about it and eat your way back to sentience via the medium of bacon sandwiches and Maltesers. At work, one is dehydrated, irritable and only semi-present. Better, surely, though to let the day fall through you and dream away.
Having worked in America, though, I can say for sure that they brook no excuses whatsoever. When I was late for work and said things like, "My alarm clock did not go off", they would say that this was not a suitable explanation, which flummoxed me. I had to make up others. This was just to work in a shop.
This model of working long hours, very few holidays, few breaks, two incomes needed to raise kids, crazed loyalty demanded by huge corporations, the American way is where we're heading. Except now the model is even more punishing. It is China. We are expected to compete with an economy whose workers are often closer to indentured slaves than anything else.
This is what striving is, then: dangerous, demoralising, often dirty work. Buckle down. It's the only way forward, apparently, which is why our glorious leaders are sucking up to China, which is immoral, never mind ridiculously short-term thinking.
So again I must really speak up for the skivers. What we have to understand about austerity is its psychic effects. People must have less. So they must have less leisure, too. The fact is life is about more than work and work is rapidly changing. Skiving in China may get you killed but here it may be a small act of resistance, or it may just be that skivers remind us that there is meaning outside wage-slavery.
Work is too often discussed by middle-class people in ways that are simply unrecognisable to anyone who has done crappy jobs. Much work is not interesting and never has been. Now that we have a political and media elite who go from Oxbridge to working for a newspaper or a politician, a lot of nonsense is spouted. These people have not cleaned urinals on a nightshift. They don't sit lonely in petrol stations manning the till. They don't have to ask permission for a toilet break in a call centre. Instead, their work provides their own special identity. It is very important.
Low-status jobs, like caring, are for others. The bottom-wipers of this world do it for the glory, I suppose. But when we talk of the coming automation that will reduce employment, bottom-wiping will not be mechanised. Nor will it be romanticised, as old male manual labour is. The mad idea of reopening the coal mines was part of the left's strange notion of the nobility of labour. Have these people ever been down a coal mine? Would they want that life for their children?
Instead we need to talk about the dehumanising nature of work. Bertrand Russell and Keynes thought our goal should be less work, that technology would mean fewer hours.
Far from work giving meaning to life, in some surveys 40% of us say that our jobs are meaningless. Nonetheless, the art of skiving is verboten as we cram our children with ever longer hours of school and homework. All this striving is for what exactly? A soul-destroying job?
Just as education is decided by those who loved school, discussions about work are had by those to whom it is about more than income.
The parts of our lives that are not work the places we dream or play or care, the space we may find creative all these are deemed outside the economy. All this time is unproductive. But who decides that?
Skiving work is bad only to those who know the price of everything and the value of nothing.
So go on: phone in sick. You know you want to.
friedad 23 Oct 2015 18:27
We now exist in a society in which the Fear Cloud is wrapped around each citizen. Our proud history of Union and Labor, fighting for decent wages and living conditions for all citizens, and mostly achieving these aims, a history, which should be taught to every child educated in every school in this country, now gradually but surely eroded by ruthless speculators in government, is the future generations are inheriting. The workforce in fear of taking a sick day, the young looking for work in fear of speaking out at diminishing rewards, definitely this 21st Century is the Century of Fear. And how is this fear denied, with mind blowing drugs, regardless if it is is alcohol, description drugs, illicit drugs, a society in denial. We do not require a heavenly object to destroy us, a few soulless monsters in our mist are masters of manipulators, getting closer and closer to accomplish their aim of having zombies doing their beckoning. Need a kidney, no worries, zombie dishwasher, is handy for one. Oh wait that time is already here.
Hemulen6 23 Oct 2015 15:06
Oh join the real world, Suzanne! Many companies now have a limit to how often you can be sick. In the case of the charity I work for it's 9 days a year. I overstepped it, I was genuinely sick, and was hauled up in front of Occupational Health. That will now go on my record and count against me. I work for a cancer care charity. Irony? Surely not.
AlexLeo -> rebel7 23 Oct 2015 13:34
Which is exactly my point. You compete on relevant job skills and quality of your product, not what school you have attended.
Yes, there are thousands, tens of thousands of folks here around San Jose who barely speak English, but are smart and hard working as hell and it takes them a few years to get to 150-200K per year, Many of them get to 300-400K, if they come from strong schools in their countries of origin, compared to the 10k or so where they came from, but probably more than the whining readership here.
This is really difficult to swallow for the Brits back in Britain, isn't it. Those who have moved over have experiences the type of social mobility unthinkable in Britain, but they have had to work hard and get to 300K-700K per year, much better than the 50-100K their parents used to make back in GB. These are averages based on personal interactions with say 50 Brits in the last 15 + years, all employed in the Silicon Valley in very different jobs and roles.
Todd Owens -> Scott W 23 Oct 2015 11:00
I get what you're saying and I agree with a lot of what you said. My only gripe is most employees do not see an operation from a business owner or managerial / financial perspective. They don't understand the costs associated with their performance or lack thereof. I've worked on a lot of projects that we're operating at a loss for a future payoff. When someone decides they don't want to do the work they're contracted to perform that can have a cascading effect on the entire company.
All in all what's being described is for the most part misguided because most people are not in the position or even care to evaluate the particulars. So saying you should do this to accomplish that is bullshit because it's rarely such a simple equation. If anything this type of tactic will leaf to MORE loss and less money for payroll.
weematt -> Barry1858 23 Oct 2015 09:04
Sorry you just can't have a 'nicer' capitalism.
War ( business by other means) and unemployment ( you can't buck the market), are inevitable concomitants of capitalist competition over markets, trade routes and spheres of interests. (Remember the war science of Nagasaki and Hiroshima from the 'good guys' ?)
"..capital comes dripping from head to foot, from every pore, with blood and dirt". (Marx)
You can't have full employment, or even the 'Right to Work'.
There is always ,even in boom times a reserve army of unemployed, to drive down wages. (If necessary they will inject inflation into the economy)
Unemployment is currently 5.5 percent or 1,860,000 people. If their "equilibrium rate" of unemployment is 4% rather than 5% this would still mean 1,352,000 "need be unemployed". The government don't want these people to find jobs as it would strengthen workers' bargaining position over wages, but that doesn't stop them harassing them with useless and petty form-filling, reporting to the so-called "job centre" just for the sake of it, calling them scroungers and now saying they are mentally defective.
Government is 'over' you not 'for' you.
Governments do not exist to ensure 'fair do's' but to manage social expectations with the minimum of dissent, commensurate with the needs of capitalism in the interests of profit.
Worker participation amounts to self managing workers self exploitation for the maximum of profit for the capitalist class.
Exploitation takes place at the point of production.
" Instead of the conservative motto, 'A fair day's wage for a fair day's work!' they ought to inscribe on their banner the revolutionary watchword, 'Abolition of the wages system!'"
Karl Marx [Value, Price and Profit]
John Kellar 23 Oct 2015 07:19
Fortunately; as a retired veteran I don't have to worry about phoning in sick.However; during my Air Force days if you were sick, you had to get yourself to the Base Medical Section and prove to a medical officer that you were sick. If you convinced the medical officer of your sickness then you may have been luck to receive on or two days sick leave. For those who were very sick or incapable of getting themselves to Base Medical an ambulance would be sent - promptly.
Rchrd Hrrcks -> wumpysmum 23 Oct 2015 04:17
The function of civil disobedience is to cause problems for the government. Let's imagine that we could get 100,000 people to agree to phone in sick on a particular date in protest at austerity etc. Leaving aside the direct problems to the economy that this would cause. It would also demonstrate a willingness to take action. It would demonstrate a capability to organise mass direct action. It would demonstrate an ability to bring people together to fight injustice. In and of itself it might not have much impact, but as a precedent set it could be the beginning of something massive, including further acts of civil disobedience.
wumpysmum Rchrd Hrrcks 23 Oct 2015 03:51
There's already a form of civil disobedience called industrial action, which the govt are currently attacking by attempting to change statute. Random sickies as per my post above are certainly not the answer in the public sector at least, they make no coherent political point just cause problems for colleagues. Sadly too in many sectors and with the advent of zero hours contracts sickies put workers at risk of sanctions and lose them earnings.
Alyeska 22 Oct 2015 22:18
I'm American. I currently have two jobs and work about 70 hours a week, and I get no paid sick days. In fact, the last time I had a job with a paid sick day was 2001. If I could afford a day off, you think I'd be working 70 hours a week?
I barely make rent most months, and yes... I have two college degrees. When I try to organize my coworkers to unionize for decent pay and benefits, they all tell me not to bother.... they are too scared of getting on management's "bad side" and "getting in trouble" (yes, even though the law says management can't retaliate.)
Unions are different in the USA than in the UK. The workforce has to take a vote to unionize the company workers; you can't "just join" a union here. That's why our pay and working conditions have gotten worse, year after year.
rtb1961 22 Oct 2015 21:58
By far the biggest act of wage slavery rebellion, don't buy shit. The less you buy, the less you need to earn. Holidays by far the minority of your life should not be a desperate escape from the majority of your life. Spend less, work less and actually really enjoy living more.
Pay less attention to advertising and more attention to the enjoyable simplicity of life, of real direct human relationships, all of them, the ones in passing where you wish a stranger well, chats with service staff to make their life better as well as your own, exchange thoughts and ideas with others, be a human being and share humanity with other human beings.
Mkjaks 22 Oct 2015 20:35
How about don't shop at Walmart (they helped boost the Chinese economy while committing hari kari on the American Dream) and actually engaging in proper labour action? Calling in sick is just plain childish.
toffee1 22 Oct 2015 19:13
It is only considered productive if it feeds the beast, that is, contribute to the accumulation of capital so that the beast can have more power over us. The issue here is the wage labor. The 93 percent of the U.S. working population perform wage labor (see BLS site). It is the highest proportion in any society ever came into history. Under the wage labor (employment) contract, the worker gives up his/her decision making autonomy. The worker accepts the full command of his/her employer during the labor process. The employer directs and commands the labor process to achieve the goals set by himself. Compare this, for example, self-employed providing a service (for example, a plumber). In this case, the customer describes the problem to the service provider but the service provider makes all the decisions on how to organize and apply his labor to solve the problem. Or compare it to a democratically organized coop, where workers make all the decisions collectively, where, how and what to produce. Under the present economic system, a great majority of us are condemned to work in large corporations performing wage labor. The system of wage labor stripping us from autonomy on our own labor, creates all the misery in our present world through alienation. Men and women lose their humanity alienated from their own labor. Outside the world of wage labor, labor can be a source self-realization and true freedom. Labor can be the real fulfillment and love. Labor together our capacity to love make us human. Bourgeoisie dehumanized us steeling our humanity. Bourgeoisie, who sold her soul to the beast, attempting to turn us into ever consuming machines for the accumulation of capital.
patimac54 -> Zach Baker 22 Oct 2015 17:39
Well said. Most retail employers have cut staff to the minimum possible to keep the stores open so if anyone is off sick, it's the devil's own job trying to just get customers served. Making your colleagues work even harder than they normally do because you can't be bothered to act responsibly and show up is just plain selfish.
And sorry, Suzanne, skiving work is nothing more than an act of complete disrespect for those you work with. If you don't understand that, try getting a proper job for a few months and learn how to exercise some self control.
TettyBlaBla -> FranzWilde 22 Oct 2015 17:25
It's quite the opposite in government jobs where I am in the US. As the fiscal year comes to a close, managers look at their budgets and go on huge spending sprees, particularly for temp (zero hours in some countries) help and consultants. They fear if they don't spend everything or even a bit more, their spending will be cut in the next budget. This results in people coming in to do work on projects that have no point or usefulness, that will never be completed or even presented up the food chain of management, and ends up costing taxpayers a small fortune.
I did this one year at an Air Quality Agency's IT department while the paid employees sat at their desks watching portable televisions all day. It was truly demeaning.
oommph -> Michael John Jackson 22 Oct 2015 16:59
Thing is though, children - dependents to pay for - are the easiest way to keep yourself chained to work.
The homemaker model works as long as your spouse's employer retains them (and your spouse retains you in an era of 40% divorce).
You are just as dependent on an employer and "work" but far less in control of it now.
Zach Baker 22 Oct 2015 16:41
I'm all for sticking it to "the man," but when you call into work for a stupid reason (and a hangover is a very stupid reason), it is selfish, and does more damage to the cause of worker's rights, not less. I don't know about where you work, but if I call in sick to my job, other people have to pick up my slack. I work for a public library, and we don't have a lot of funds, so we have the bear minimum of employees we can have and still work efficiently. As such, if anybody calls in, everyone else, up to and including the library director, have to take on more work. If I found out one of my co-workers called in because of a hangover, I'd be pissed. You made the choice to get drunk, knowing that you had to work the following morning. Putting it into the same category of someone who is sick and may not have the luxury of taking off because of a bad employer is insulting.
Sep 18, 2012 | medicalxpress.com
Circulation: Cardiovascular Quality and Outcomes , an American Heart Association journal.
The study in Brisbane, Australia, is the first in which researchers examined the association between daily average temperature and "years of life lost" due to CVD. Years of life lost measures premature death by estimating years of life lost according to average life expectancy .
The findings are important because of how the body responds to temperate extremes, the growing obesity trend and the earth's climate changes, said Cunrui Huang, M.Med., M.S.P.H., the study's lead researcher and a Ph.D. scholar at the School of Public Health and Institute of Health and Biomedical Innovation at Queensland University of Technology (QUT) in Brisbane, Australia.
Exposure to extreme temperatures can trigger changes in blood pressure, blood thickness, cholesterol and heart rate, according to previous research.
"With increasing rates of obesity and related conditions, including diabetes, more people will be vulnerable to extreme temperatures and that could increase the future disease burden of extreme temperatures," Huang said.
Dec 12, 2018 | www.ianwelsh.net
- markfromireland permalink April 24, 2016
Ian – off topic for which apologies.
I thought you might be interested in the Guardian article:
The truth is this is a rigged, cheap food system that has two prices: the one you pay now and the one we all pay later. It's a story that repeats with carrots, apples and peas, meat, milk and cheese. Even breakfast cereal. At some point we need to ask ourselves, why do we support such a destructive food system?
- NP permalink April 24, 2016
I made the following remarks to a friend the other day.
The internet economy began in 1995. By the year 2000, the internet economy was in shambles, largely because it was based on a lot of Wall Street fuckery as all bubbles are. It's now the year 2016 and the economy has been garbage ever since.
The internet is perhaps the most transformative technological achievement ever, but the economic benefits (such as they were) only lasted for 5 years. Now, if anything, it's used as a way to further wealth inequality by accelerating the outsourcing of "knowledge work" and enabling a perverse idea of what it means to have a "sharing economy."
- Peter Van Erp permalink April 24, 2016
I'm an architect, and I began my career just before computers became widespread. At weekly job meetings, the general contractor would bring a couple page typed report on the job status. When computers came in, the report jumped to a hundred pages. More "information", but far less actual understandable information.
"People have weird ideas about the Middle Ages. In many respects they were often better to live in than the Renaissance/Reformation/Enlightenment."
I no longer remember the exact quote, but a great error in history was to mistake the setting sun on the middle ages for a rising sun of the rennaissance.
Dec 09, 2018 | www.bloomberg.com
A flood of surprise hospital bills could start arriving in U.S. mailboxes as early as January unless two giant for-profit health care companies resolve a dispute over whether thousands of doctors remain in patients' insurance networks.
America's biggest health insurer, UnitedHealthcare, is pitted against one of the country's largest employers of doctors, Envision Healthcare, in a massive contract fight over prices that Envision's 25,000 emergency doctors, anesthesiologists and other hospital-based clinicians charge.
A contract impasse would mean that UnitedHealthcare's 27 million privately insured patients could face expensive, unexpected doctor bills as of Jan. 1 when Envision doctors would become out-of-network.
Envision has already been criticized for its billing practices in situations where its doctors don't participate in patients' health plans. A Florida man got a bill for $2,255 from an Envision subsidiary after being treated by an out-of-network emergency doctor in 2014 for a facial injury, according to a lawsuit he filed earlier this year.
In another case, a California woman went to an in-network hospital for abdominal pain and found she needed emergency gallbladder surgery. The operation was covered, but she faced $4,447 in bills from Envision for two trips to the emergency department.
A judge dismissed the Florida case, and the case in California is in settlement talks.
Dec 03, 2018 | www.nakedcapitalism.com
The evidence of social decay in America is becoming more visible. As other countries continue to show increases in life expectancy, the US continues its deterioration.
Life expectancy in the US fell to 78.6 years in 2017, a o.1 year fall from 2016 and a 0.3 year decline from the peak.
From CNN :
Overdose deaths reached a new high in 2017, topping 70,000, while the suicide rate increased by 3.7%, the CDC's National Center for Health Statistics reports.
Dr. Robert Redfield, CDC director, called the trend tragic and troubling. "Life expectancy gives us a snapshot of the Nation's overall health and these sobering statistics are a wakeup call that we are losing too many Americans, too early and too often, to conditions that are preventable," he wrote in a statement.
While this assessment is technically correct, it is too superficial in seeing the rising rate of what Angus Deaton and Ann Case called "deaths of despair" as a health problem, rather than symptoms of much deeper societal ills. Americans take antidepressants at a higher rate than any country in the world. The average job tenure is a mere 4.4 years. In my youth, if you changed jobs in less than seven or eight years, you were seen as an opportunist or probably poor performer. The near impossibility of getting a new job if you are over 40 and the fact that outside hot fields, young people can also find it hard to get work commensurate with their education and experience, means that those who do have jobs can be and are exploited by their employers. Amazon is the most visible symbol of that, working warehouse workers at a deadly pace, and regularly reducing even white collar males regularly to tears.
On top of that, nuclear families, weakened communities, plus the neoliberal expectation that individuals be willing to move to find work means that many Americans have shallow personal networks, and that means less support if one suffers career or financial setbacks.
But the big driver, which the mainstream press is unwilling to acknowledge, is that highly unequal societies are unhealthy societies. We published this section from a Financial Times comment by Michael Prowse in 2007, and it can't be repeated often enough :
Those who would deny a link between health and inequality must first grapple with the following paradox. There is a strong relationship between income and health within countries. In any nation you will find that people on high incomes tend to live longer and have fewer chronic illnesses than people on low incomes.
Yet, if you look for differences between countries, the relationship between income and health largely disintegrates. Rich Americans, for instance, are healthier on average than poor Americans, as measured by life expectancy. But, although the US is a much richer country than, say, Greece, Americans on average have a lower life expectancy than Greeks. More income, it seems, gives you a health advantage with respect to your fellow citizens, but not with respect to people living in other countries .
Once a floor standard of living is attained, people tend to be healthier when three conditions hold: they are valued and respected by others; they feel 'in control' in their work and home lives; and they enjoy a dense network of social contacts. Economically unequal societies tend to do poorly in all three respects: they tend to be characterised by big status differences, by big differences in people's sense of control and by low levels of civic participation .
Unequal societies, in other words, will remain unhealthy societies – and also unhappy societies – no matter how wealthy they become. Their advocates – those who see no reason whatever to curb ever-widening income differentials – have a lot of explaining to do.
And this extract comes from a 2013 article, Why Are Americans' Life Expectancies Shorter than Those of People in Other Advanced Economies?
Let's talk life expectancy.
The stats first. They tell a clear story: Americans now live shorter lives than men and women in most of the rest of the developed world. And that gap is growing.
Back in 1990, shouts a new study published last week in the prestigious Journal of the American Medical Association, the United States ranked just 20th on life expectancy among the world's 34 industrial nations. The United States now ranks 27th -- despite spending much more on health care than any other nation.
Americans, notes an editorial the journal ran to accompany the study, are losing ground globally "by every" health measure.
Why such poor performance? Media reports on last week's new State of U.S. Health study hit all the usual suspects: poor diet, poor access to affordable health care, poor personal health habits, and just plain poverty.
In the Wall Street Journal, for instance, a chief wellness officer in Ohio opined that if Americans exercised more and ate and smoked less, the United States would surely start moving up in the global health rankings.
But many epidemiologists -- scientists who study health outcomes -- have their doubts. They point out that the United States ranked as one of the world's healthiest nations in the 1950s, a time when Americans smoked heavily, ate a diet that would horrify any 21st-century nutritionist, and hardly ever exercised.
Poor Americans, then as now, had chronic problems accessing health care. But poverty, epidemiologists note, can't explain why fully insured middle-income Americans today have significantly worse health outcomes than middle-income people in other rich nations.
The University of Washington's Dr. Stephen Bezruchka has been tracking these outcomes since the 1990s. The new research published in the Journal of the American Medical Association, Bezruchka told Too Much last week, should worry Americans at all income levels.
"Even if we are rich, college-educated, white-skinned, and practice all the right health behaviors," he notes, "similar people in other rich nations will live longer."
A dozen years ago, Bezruchka published in Newsweek the first mass-media commentary, at least in the United States, to challenge the conventional take on poor U.S. global health rankings.
To really understand America's poor health standing globally, epidemiologists like Bezruchka posit, we need to look at "the social determinants of health," those social and economic realities that define our daily lives.
None of these determinants matter more, these researchers contend, than the level of a society's economic inequality, the divide between the affluent and everyone else. Over 170 studies worldwide have so far linked income inequality to health outcomes. The more unequal a society, the studies show, the more unhealthy most everyone in it -- and not the poor alone.
Just how does inequality translate into unhealthy outcomes? Growing numbers of researchers place the blame on stress. The more inequality in a society, the more stress on a daily level. Chronic stress, over time, wears down our immune systems and leaves us more vulnerable to disease.
The Wall Street Journal has more detail on the breakdown of the further decline in US life expectancy , and also points out how other countries are continuing to show progress:
Data the Centers for Disease Control and Prevention released on Thursday show life expectancy fell by one-tenth of a year, to 78.6 years, pushed down by the sharpest annual increase in suicides in nearly a decade and a continued rise in deaths from powerful opioid drugs like fentanyl. Influenza, pneumonia and diabetes also factored into last year's increase.
Economists and public-health experts consider life expectancy to be an important measure of a nation's prosperity. The 2017 data paint a dark picture of health and well-being in the U.S., reflecting the effects of addiction and despair, particularly among young and middle-aged adults, as well as diseases plaguing an aging population and people with lower access to health care
Life expectancy is 84.1 years in Japan and 83.7 years in Switzerland, first and second in the most-recent ranking by the Organization for Economic Cooperation and Development. The U.S. ranks 29th..
White men and women fared the worst, along with black men, all of whom experienced increases in death rates. Death rates rose in particular for adults ages 25 to 44, and suicide rates are highest among people in the nation's most rural areas. On the other hand, deaths declined for black and Hispanic women, and remained the same for Hispanic men .
Earlier this century, the steady and robust decline in heart-disease deaths more than offset the rising number from drugs and suicide, Dr. Anderson said. Now, "those declines aren't there anymore," he said, and the drug and suicide deaths account for many years of life lost because they occur mostly in young to middle-aged adults.
While progress against deaths from heart disease has stalled, cancer deaths -- the nation's No. 2 killer -- are continuing a steady decline that began in the 1990s, Dr. Anderson said. "That's kind of our saving grace," he said. "Without those declines, we'd see a much bigger drop in life expectancy."
Suicides rose 3.7% in 2017, accelerating an increase in rates since 1999, the CDC said. The gap in deaths by suicide widened starkly between cities and the most rural areas between 1999 and 2017, the data show. The rate is now far higher in rural areas. "There's a much wider spread," Dr. Hedegaard said.
"This is extremely discouraging," Christine Moutier, chief medical officer of the American Foundation for Suicide Prevention, said of the suicide-rate increase. Studies show that traumas such as economic difficulties or natural disasters, along with access to lethal means including guns and opioid drugs, and lack of access to care can affect suicide rates, she said. More accurate recording of deaths may also have added to the numbers, she said.
Japan leads the pack in life expectancy and pretty much every other measure of social well being. Yet when its financial bubbles were bigger than the ones in the US pre our crisis, and it's on its way to having a lost three decades of growth. On top of that, Japan has one of the worst demographic crunches in the world, in terms of the aging of its population. So how it is that Japan is coping well with decline, while the US is getting sicker in many ways (mental health, obesity, falling expectancy)?
It's easy to hand-wave by saying "Japanese culture," but I see the causes as more specific. The Japanese have always given high employment top priority in their economic planning. Entrepreneurs are revered for creating jobs, not for getting rich. Similarly, Japan was long criticized by international economist types for having an inefficient retail sector (lots of small local shops), when they missed the point: that was one way of increasing employment, plus Japanese like having tight local communities.
After their crisis, Japanese companies went to considerable lengths to preserve jobs, such as by having senior people taking pay cuts and longer term, lowering the already not that large gap between entry and top level compensation. The adoption of second-class workers (long-term temps called "freeters") was seen as less than ideal, since these workers would never become true members of the company community, but it was better than further reducing employment.
Contrast that to our crisis response. We reported in 2013 that the top 1% got 121% of the income gains after the crisis. The very top echelon did better at the expense of everyone else. Longer term, lower-income earners have fallen behind. From a 2017 MarketWatch story, quoting a World Economic Forum report: "America has experienced 'a complete collapse of the bottom 50 percent income share in the U.S. between 1978 to 2015.'"
There is a lot of other data that supports the same point: inequality continues to widen in America. The areas that are taking the worst hits are states like West Virginia and Ohio that have been hit hard by deindustrialization. But the elites are removed in their glamorous cities and manage not to notice the conditions when they transit through the rest of America. They should consider themselves lucky that America's downtrodden are taking out their misery more on themselves than on their betters.
The Rev Kev , November 30, 2018 at 6:30 am
God, this is so depressing to read. The worse aspect of it is that it never had to be this way but that these deaths were simply 'collateral damage' to the social and economic changes in America since the 1970s – changes by choice. This seems to be a slow motion move to replicate what Russia went through back in the 1990s which led to the unnecessary, premature deaths of millions of its people. Dmitry Orlov has a lot to say about the subject of collapse and there is a long page in which Orlov talks about how Russia got through these bad times while comparing it with America as he lives there now. For those interested, it is at-
What gets me most is how these deaths are basically anonymous and are not really remembered. When AIDS was ravishing the gay community decades ago, one way they got people to appreciate the numbers of deaths was the AIDS Memorial Quilt which ended up weighing over 50 tons. It is a shame that there can not be an equivalent project for all these deaths of despair.
Yves Smith Post author , November 30, 2018 at 6:47 am
There were pictures in the Wall Street Journal article I didn't pull over due to copyright issues, but it did show people commemorating these deaths Captions:
People in Largo, Fla., hold candles at a vigil on Oct. 17 to remember the thousands who succumbed to opioid abuse in their community.
More than 1,000 backpacks containing belongings of suicide victims and letters with information about them are scattered across a lawn during a demonstration at the University of Tennessee at Chattanooga on March 22.
But to your point, these seem isolated and are not getting press coverage at anywhere near the level of the AIDS crisis.
Carla , November 30, 2018 at 1:24 pm
Great post, Yves, thank you! One suggestion: might you consider putting the last word in quotes, as in "betters" ?
Spanish reader , November 30, 2018 at 1:35 pm
It focuses too much on peak oil. As if the social collapse of the United States (and the Soviet Union) was some kind of natural consequence of resources dryinf out instead of a premeditated looting.
Eclair , November 30, 2018 at 2:24 pm
Orlov's posts on how Russians survived the collapse is a small masterpiece. I read it a couple of years back and it affected me greatly. I just reread it, thanks, Rev Kev, and it seems even more relevant now.
Small gems: Money becomes useless: items or services that can be swapped are paramount. Bottles of alcohol, fresh homegrown veggies (and pot), I re-fashion your old suit and you fix my broken window.
Social networks keep you alive. Know and be on good terms with your neighbors. Communal gardens keep you fed.
War-hardened men (and the women who love them), who thrive on violence abound. They will either be hired as security or rove about as free-lancers. A community is better able either to hire them, or defend against them.
Our ancestors lived and thrived without: central heating, electric lights, hot and cold running water, flush toilets, garbage collection, the Internet. We can too; it just takes forethought and planning. Densely packed cities without these amenities are hell.
Cultivate an attitude of disdain for the 'normal' things that society values, especially if you are a middle-aged male; career, large house and SUV, foreign vacations, a regular salary. Enjoy contemplating nature. When the former disappear, you have the latter to fall back upon. And consider a second career as a recycler of abandoned buildings, or a distiller of potatoes. (Think of all the Medieval structures built from crumbling Roman edifices.)
Russians, in many ways, had more resilience built in to their system: housing was State-owned, so there was less homelessness. Private automobiles were relatively rare, but public transportation was wide-spread and remained in good-running order. Minimal universal health care existed.
Cease from trying, futilely, to change the System. Ain't gonna happen. Instead, prepare to survive, if only just, the coming dismantling.
Steve H. , November 30, 2018 at 7:24 am
> Once a floor standard of living is attained, people tend to be healthier when three conditions hold: they are valued and respected by others; they feel 'in control' in their work and home lives; and they enjoy a dense network of social contacts.
"Sapolsky: We belong to multiple hierarchies, and you may have the worst job in your corporation and no autonomy and control and predictability, but you're the captain of the company softball team that year and you'd better bet you are going to have all sorts of psychological means to decide it's just a job, nine to five, that's not what the world is about. What the world's about is softball. I'm the head of my team, people look up to me, and you come out of that deciding you are on top of the hierarchy that matters to you."
iirc, there was a perspective of some economists that infinite groaf could be carried by the creative, emergent, and infinite wants of homo sapiens. But that creates compounding deprivations, never enough time, money, resources. With the 2:1 ratio of loss aversion, what is compounded are bad affects.
That 'dense network of social contacts' means smaller groups with symmetric interactions. The multiple dominance heirarchies is the healthy version of creative emergence, but supplying needs, not creating wants.
rd , November 30, 2018 at 9:02 am
I think that one of the most valuable tools used by government in the Great Depression was the CCC, WPA, and TVA set of programs that provided jobs to people while they created valuable infrastructure and art. How many of those people could go back to the dams or state parks and tell their spouses and kids that "I helped build that." During a time of despair, it was a way of making people believe they had value.
Today, it would be viewed as a waste of money that could be better spent on the military or another tax cut for the wealthy.
Wukchumni , November 30, 2018 at 9:24 am
I'd mentioned some wrongheaded policies of Sequoia NP of 90 years ago yesterday, and they seem ridiculous in retrospect, and we no longer treat natural places as ad hoc zoos, where everybody gets to see the dancing bears @ a given hour.
Our methodology as far as our rapport with fire was just as stupid, but we've really done nothing to repair our relationship with trees and the forests they hang out in.
There's an abundance of physical labor needed to clear out the duff, the deadfalls and assorted debris from huge swaths of guaranteed employment until the job is done, which could take awhile.
There's really few graft possibilities though, we're talking chainsaws, Pulaskis, never ending burn pile action and lots of sweat equity. If KBR wanted to be in charge of backcountry camps housing crews, that'd be ok, they'd be doing something useful for a change.
False Solace , November 30, 2018 at 12:33 pm
Yes, why do you think video games appeal so much to young males? Because of the pixels? What these gamers are really after is the ability to excel in a niche hierarchy. It doesn't (usually) appeal to females as much as more traditional kinds of success but it serves a psychological need.
divadab , November 30, 2018 at 8:13 am
A traitorous ruling class that has sold out its workers in favor of foreign workers.
And it's very lucrative – the Walton's fortune was made by being an agent of communist Chinese manufacturers. In direct competition with US manufacturers. Does this not seem like treason to you?
Phillip Allen , November 30, 2018 at 9:10 am
The word 'communist' in relation to the Chinese government and party is void of content. 'Communist' in the current Chinese context is legacy branding, nothing more. Its use in this comment is inflammatory, as is the too-loose bandying of 'treason'. The Waltons are loyal to their class (however fierce their disputes may be with rival oligarch factions), and since the state exists to serve the interests of their class, how can they be traitors to the state?
divadab , November 30, 2018 at 10:34 am
"Communist" is what they call themselves. They're totalitarians. Which is what most people think "communist" means – because all countries that called themselves communist used authoritarian rule. Methinks you might be a marxist idealist. Offended by the misuse of your ideal State word by totalitarians.
Similarly, I used "treason" in the sense of acting against the interests of the citizens, not in the sense of a crime against the state. You clearly believe the state to be representative of only the ruling class. And I don't disagree wrt the USA and its imperial machine. Which would make the State treasonous, according to the sense of the word I used.
NotTimothyGeithner , November 30, 2018 at 10:51 am
One could always say communism is an end point developed through a process preceded by socialism and before that capitalism which replaces feudalism. The idea being Chinese Communists, the rich Chinese have bug out spots for a reason, believe Mao and the Soviets moved too quickly skipping a Marxist historical epoch.
The Communist Party officially is always a vanguard for the future society not the Communist society. Phrases such as "under communism" aren't Soviet features as much as they are propaganda from the West.
When the Reds were the only game in town, the greedy class joined the CCP, but since 1991, they skipped signing up, leaving believers in control. What the party congress believes is probably important.
As far as branding goes, all Communists are branded because the are all vanguard parties, not parties of blocs or even current populations. Star Trek is the only communist society. The Soviet thinkers definitely wrote about what an Ideal society would look like, the nature of work, and self and societal improvement.
Overthrowing a long established government shouldn't be done for light and transient reasons, and Xi has seemed to be concerned with the demands of the party congress. The party at large doesn't have a single voice to rally behind which makes it difficult to overthrow a government.
rob , December 1, 2018 at 7:01 am
the word is "communist". The gov't isn't anything of the sort these days. Isn't the chinese gov't of today "fascist". just like the national socialists of the german stripe? They are the state that may be lord over controller of private institutions, and ruler of other state institutions, all intermixed into what is "the chinese economy". They allow the private wealth creation in a controlled sense. that is state function serving private wealth. and if you are a party loyal, private wealth may come to you some day too.
It is just another part of the world trend "everyone is turning into full fledged fascists"
No wonder people in the states are dying earlier.. to get back on topic
Polar Donkey , November 30, 2018 at 8:29 am
Last night, my wife and I took our boys to meet Santa at my older son's school. Elementary school in Mississippi. The town is an outer suburb of Memphis. A mile east of the town you are in rural Mississippi. I noticed 2 or 3 parents with visible drug addiction issues. These folks were still people. Want their kids to see Santa and have a better life. The country doesn't care.
Janie , November 30, 2018 at 9:49 am
I'll guess that you're near Byhalia. Happy memories of visiting family there from late forties through sixties. Wonder what its like now – how the economic changes have affected it.
Polar Donkey , November 30, 2018 at 7:41 pm
Byhalia is a little further down highway 78. Kids from Byhalia drive up to Olive Branch to go to a McDonald's and other fast food. Things may be changing because they just completed an outer interstate loop that passes close by Byhalia. Byhalia was just in news a couple months ago because a kid died during a football game. People were up in arms about no doctor at game and a 30 to 40 minute drive to closest hospital. There aren't any doctors offices in Byhalia. Then toxicology report came back. Kid had cocaine in his system. Holly Springs and Byhalia area are big drug smuggling area. Close to Memphis and it's distribution network, but across state line in poor rural Mississippi. NBA players linked to this area and smuggling networks.
Wukchumni , November 30, 2018 at 8:44 am
I'm always amazed @ the suicide by gun numbers, as it strikes me as a not so fool proof way of checking out, exacerbated by perhaps dying slowly in a painful way?
Oh, and bloody, very much so.
Fentanyl seems an easier way out, you just drift into the ether and leave a presentable corpse for everybody you knew, who all wonder if they could have done something to stop it from happening, posthaste.
NotTimothyGeithner , November 30, 2018 at 10:10 am
It's cheap and fairly efficient, and the drug way out can be tricky. Silent film legend, Lupe Valez, is the famed example of suicide by drugs gone wrong. She still died but not on her own terms because the sleeping pills she took didn't react well with her last meal.
How many people have tried to check out and had it not work is something to consider.
Martin Finnucane , November 30, 2018 at 2:28 pm
Re Lupe Valdez: probably not true, at least according to the Wikipedia page . Not that it affects your point too much, I guess.
timbers , November 30, 2018 at 8:44 am
The level of denial people are capable of can be daunting.
1). My dentist who I think is Republican told me when I brought up Medicare for all said "I don't think we can afford Medicare for all." This was not an immediate response to my raising the topic, but something he told me after several visits and having thought about what I had said and around the time Sanders got media coverage introducing a Medicare for all bill (I was getting a crown and required many visits). Talking to your dentist can be a one sided conversation for obvious reasons, but I thought "don't you mean we can't afford NOT to have Medicare for all?"
2). A co-worker of mine who is African American. When I said U.S. life expectancy is falling, this is a sign of extreme policy failure and should affect how we rate the ACA (read that here, of course!) replied "You're assuming health has an impact on life expectancy." I was stunned and didn't know what to say for a second and finally said "yes, absolutely."
TroyMcClure , November 30, 2018 at 9:47 am
These are the types that are more than happy to hand the place over to the next Bolsonaro if only to protect the status gap between themselves and those beneath them.
False Solace , November 30, 2018 at 12:42 pm
They also "hand the place over" when the Bolsonaro types tell everyone they have the solution and the opposition party is tainted by austerity and corruption.
Massinissa , November 30, 2018 at 12:49 pm
"You're assuming health has an impact on life expectancy"
I have absolutely no idea how I would respond to this either. Was this comment by this person some kind of built in knee-jerk response to criticism of the ACA/Obama?
timbers , December 1, 2018 at 9:09 am
Opps I meant to write "You're assuming health CARE has an impact on life expectancy."
In response to your question, I think so, yes.
jrs , November 30, 2018 at 1:03 pm
actually you are assuming health coverage, even if it was real coverage for what one needed, has that much of an impact on life expectancy and from what I've read it probably doesn't compared to things like poverty *regardless* of health coverage. Because the greatest link to say heart attacks is with poverty (not diet etc.)
At this point though it doesn't even make sense to talk about the ACA circa now and say it's Obama's ACA, it wasn't that great to begin with. But Trump has made it worse.
Left in Wisconsin , November 30, 2018 at 2:06 pm
My dentist who I think is Republican told me when I brought up Medicare for all said "I don't think we can afford Medicare for all."
When I brought up Medicare for All to my dentist, after listening to him describe some of his ER work where he claims to routinely see people who have intentionally damaged their teeth in order to obtain painkillers (which he is not allowed to proscribe to them regardless), he said he would never want to have the kind of inferior health care they have "in Europe." He seemed genuinely surprised when I reported that my wife had done most of a pregnancy in Italy in the mid-90s and got pre-natal care that was better than anything she ever got in this country.
My dentist is definitely a Repub. And he socializes with other medical professionals, which I presume gives him a very distorted image of the health care system. I often hear him railing against the idiotic dictates of insurance companies and he seems genuinely proud that, unlike the inscrutable and BS pricing of hospitals, dentists have to have straightforward pricing because many people do pay 100% out of pocket (so he says).
This is a part of the 10% that is going to be very hard to reach. But I tell him socialists need dental care too and so he will always have work even after we take over.
Tom Stone , November 30, 2018 at 9:27 am
Suicide can be a rational and sensible choice.
Bluntly, if the quality of your life is shitty and not going to improve why stick around?
That the reason so many people's lives are bad enough that they decide death is preferable to life is societal doesn't change their circumstances.
If you are old and sick, barely surviving financially or in poor health and unable to afford care suicide might look like your best alternative.
The "Hemlock Society" has been around for quite a while, that its membership is growing in the short term says a great deal about America.
In the Land of Farmers , November 30, 2018 at 12:15 pm
Suicide is never rational. It is arrogance that one could weigh the pros and cons of suicide like they think the have all the pertinent information. The only truth is that we have no idea what happens when we die or if there is some kind of experience that continues in a form that might not be a personal consciousness. Also, why don't you see the decision to die is made under duress and therefor invalid like signing a contract with a gun pointed at your head? There were several times in my life that I determined "the quality of [my] life is shitty and not going to improve [so] why stick around", but yet, I became better off going through the struggle. As a result I have made others lives better with the understanding I have gained going through the Shaman's journey.
By considering suicide you are considering trading a known (suffering) for an unknown (Death). In what way can that be considered rational?
The sad fact is that we spend our whole lives avoiding suffering and never take the time to understand it. Opioids, all drugs, are a route to avoid suffering, to avoid looking at our trauma. Materialism is about avoiding our suffering. Suicide is materialistic because it supposes there is a mind that we can stop.
But even in the Buddhist centers I visit it has turned away from the spiritual and people go there not to understand their suffering, but rather only to escape it.
American society does not have an economic problem, it has a spiritual problem.
Eclair , November 30, 2018 at 2:48 pm
I respect your view that suicide is an arrogant act and that suffering is an unavoidable part of life. I totally agree with the latter philosophy. You suffer, and you wade through it and come out on the other side as a better person. Forged in fire, so to speak.
Plus, I am, by nature, an optimist. There is always something to look forward to, every morning.
But, a few years ago, I suffered a cascade of bodily failures, whose symptoms were at first ignored, then misdiagnosed, resulting in my taking medications that made me worse off. At one point, for two months, I had constant nerve pain (comparable to having teeny barbed wire wrapped around my torso and and being zapped by an electric charge every few seconds.) Plus back pain. I could not eat, and when I did, I vomited. I lost 20 pounds. I could not sleep for more than hour at a time, and that hour happened only once a day. I walked only with the aid of two walking sticks. I was totally constipated for a month (gross, but this condition just adds to one's misery.) There was no end in sight and my condition just kept worsening with each round of new medication.
I did not seriously contemplate suicide. But I did give some thought to what I would do if I had to face life without sleep, without food, without the ability to walk, and death came up as one of the better solutions. Fortunately, I changed doctors.
In the Land of Farmers , November 30, 2018 at 6:10 pm
I empathize with your struggles, and I have contemplated suicide myself, but contemplating death is part of the shaman's journey. I do not think that suicide is arrogant, I think it is a misunderstanding.
IMHO, medical doctors will disrupt this journey. They should be consulted but with the understanding that they know very little about the balance of the body and what is needed to heal.
Truth is, we will die. The greater the suffering the easier to find out "who" that is suffering.
sangweq , November 30, 2018 at 10:35 pm
"Life teaches you how to live it, if you live long enough.".
witters , November 30, 2018 at 7:44 pm
"Suicide is never rational" is an arrogant assertion.
Massinissa , November 30, 2018 at 12:53 pm
Even if it *is* a 'rational' choice, that is because the system is absolutely broken and must be changed.
In the Land of Farmers , November 30, 2018 at 1:33 pm
I get in fights with my therapist all the time about this. She is always advocating for ME to change when I feel if she wants to help us all she should be helping us change the system.
jrs , November 30, 2018 at 1:58 pm
Well roles like therapist are part of what props up the system and they get paid for precisely that.
I mean if we are just living our lives we see that things are both individual and systematic. And some things are strongly systematic (economic problems), and others probably have a significantly personal component (phobias etc.). And so we have to exist with both being true, but if we are drowning in economic problems the rest doesn't matter. But therapists have a specific role to individualize all problems. But if people are just doing therapy to get stuff off their chest, who can blame them. Enough people are, although it's not how therapists like to see their role.
Ojia , November 30, 2018 at 9:34 am
Lifespan dropping, mortality going up
Are we tired of winning yet???
Jason Boxman , November 30, 2018 at 9:58 am
The only real visible sign of decay on the train to DC from Boston is Baltimore, which nearly appears bombed out.
NotTimothyGeithner , November 30, 2018 at 11:34 am
The train goes right by Chester, Pa, and you can see decay along the tracks all along BosWash. Except for Biden, a corrupt tool who hasn't figured out how to cash in, the elites don't take the train.
Tomonthebeach , November 30, 2018 at 1:07 pm
Remember the Kingsman movie where the president was going to let all the dopers die? Think Trump.
Not only is the WH response to the opioid problem merely cosmetic, they (and NIH) refuse to link it to the economics of human obsolescence. How convenient. As jobs die, the workers do too – less welfare burden. That is fascist thinking, and it is evident today.
Finally, let us recall that all public health leaders are Trump appointees – i.e., incompetent. CDC too refuses to link suicide to the economy. It's bad politics. They can do this because there are no national standards for reporting deaths as suicides or even drug overdoses. It is entirely up to the elected coroner. Thus 10s of thousands of suicides are reported as natural or accidental either intentionally to ease the grief of family members or because they lack the manpower to investigate suspicious deaths. Note the bump in accidental deaths. Driving your car into a concrete abutment or over a cliff might be an accident, but more often than not, the driver was pickled (Irish courage) and the death was intentional.
So, until we do a better job of measuring the causes of death, the administration can continue to blame the deaths on moral weakness rather than its cruel economic policies.
djrichard , November 30, 2018 at 2:19 pm
Well we might not be thriving, but our empire is thriving. And the empire has a simple message for us: embrace the suck.
How is it legal , November 30, 2018 at 2:20 pm
Sadly, I believe if suicide attempts were taken into account, the picture would even look far bleaker, and likely include far more Metro areas. In those Metro areas there are likely far less gun/rifle owners (reportedly the most successful method), far quicker ambulance response times, and significant expenditures have been made, and actions taken, to thwart attempts on transit lines and bridges, along with committing suicidal persons to locked down psychiatric facilities (which then adds further financial burden, significant employment issues, and possibly ugly, forced medication side effects); while doing absolutely nothing whatsoever to address the causes.
What a sickening blotch on the US , with such wealth and power – sovereign in its own currency – that it's citizens are increasingly attempting and committing suicide because they can no longer afford to live in any manner that's considered humane. That, while its Fourth Estate deliberately obscures the deadly problem – which cannot be cured by forcing Pharma™, Therapy™, and Psychiatric Confinement™ at it, when a predatory crippling of economic stability is the entire cause – and refuses to hold the Government and Elites accountable.
Bobby Gladd , November 30, 2018 at 3:36 pm
I would commend to all Beth Macy's riveting book " Dopesick : Dealers, Doctors, and the Drug Company that Addicted America ."
Equal parts nicely written investigative reporting and painful personal stories. I'd thought that the "opioid epidemic" meme was hyperbolic. I was wrong.
WorkerPleb , December 1, 2018 at 5:32 pm
This happened in Russian and Eastern European countries too didn't it?
Nov 25, 2018 | www.theguardian.comThe Implant Files investigation reveals damage caused by poor regulation and lax testing rules
• Why we're examining the implants industry
Patients around the world are suffering pain and many have died as a result of faulty medical devices that have been allowed on to the market by a system dogged by poor regulation, lax rules on testing and a lack of transparency, an investigation has found.
Pacemakers, artificial hips, contraceptives and breast implants are among the devices that have caused injuries and resulted in patients having to undergo follow-up operations or in some cases losing their lives.
In some cases, the implants had not been tested in patients before being allowed on to the market.
In the UK alone, regulators received 62,000 "adverse incident" reports linked to medical devices between 2015 and 2018. A third of the incidents had serious repercussions for the patient, and 1,004 resulted in death.
In the US, the Food and Drug Administration (FDA) has collected 5.4m "adverse event" reports over the past decade, some from manufacturers reporting problems in other parts of the world.
These included 1.7m reports of injuries and almost 83,000 deaths. Nearly 500,000 mentioned an explant – surgery to remove a device.
The figures come from research by 252 journalists from 59 media organisations in 36 countries, which has uncovered a litany of problems in the global $400bn (£310bn) industry.
Examples of failure in the market include:Replacement hips and vaginal mesh products sold to hospitals without any clinical trials. Patients relying on faulty pacemakers when manufacturers were aware of problems. Complications with hernia mesh that ruled one of Britain's top athletes out of competing for years. Regulators approving spinal disc replacements that later disintegrated and migrated in patients. Surgeons admitting they were unable to tell patients about the risks posed by implants because of a lack of central registers. Patients in Australia being given devices that the regulator has approved on the basis they have been approved in Europe.
The findings raise concerns about the level of scrutiny devices undergo before and after they go on the market, and whether regulators detect and act upon findings quickly enough.
Information about problems with devices is, in many countries, kept under wraps, making it difficult for patients to research procedures that have been recommended to them.Interviews with patients and doctors have revealed flaws in how the medical devices industry is regulated.
Prof Derek Alderson, the president of the Royal College of Surgeons, said there had been enough incidents involving flawed devices to "underline the need for drastic regulatory changes", including the introduction of mandatory national registries for all implantable devices.
"In contrast to drugs, many surgical innovations are introduced without clinical trial data or centrally held evidence," he said. "This is a risk to patient safety and public confidence."
The Guardian and organisations including the BBC , Le Monde and Süddeutsche Zeitung, coordinated by the International Consortium of Investigative Journalists (ICIJ), have trawled through thousands of documents, many obtained through freedom of information (FoI) requests, to unearth some of the biggest problems.
Alongside interviews with patients and doctors, these have revealed flaws in the way the industry is regulated that are unlikely to be fixed by rules due to come into force in Europe.
Among the concerns raised by the Implant Files project are that manufacturers are in charge of testing their own products after faults have developed – and are allowed to shop around for approval to market their products, without declaring any refusals.
The Guardian has also heard about doctors who have close industry ties or seem eager to be early adopters of the latest devices to enhance their professional standing.
Plans for tougher EU rules have been watered down after industry lobbying, according to a huge trove of documents uncovered by the project.
Nov 09, 2018 | www.moonofalabama.org
likbez , Nov 6, 2018 6:57:47 PM | linkb wrote:
The pain in my right shoulder is much better now, and I can somewhat use my arm again.
The issue isn't serious but likely just a reaction to constant overuse under not ideal ergonomic circumstances. I was told to refrain from typing and using the mouse for another day or two or until I feel no more pain at all.
This is way too optimistic. This issue usually is chronic and subside very slowly, often when you lost any hope that it can be eliminated. Typically pain lasts at least one month, and often half a year even with medication and physiotherapy.
Typically this is the first sign of a chronic condition that is very difficult to cure. I think that switching to your left hand for the mouse is a must and should be the first adjustment step.
One treatment that works for me is to put your hands on a thick peace foam bed cover. Cut a part corresponding to the area of the table where you mouse and keyboard are located, then cut the hole in it for keyboard and mousepad. Or just cut two strips which is simpler, but they tend to slide.
After then put your hand on foam why typing and using the mouse. This damping of vibration (or whatever) provided by 4-5 cm thick foam help to eliminate pain pretty effectively.
Also, you might benefit from getting Microsoft Natural Ergonomic Keyboard 4000 for Business ($37 on Amazon) as well. It is cheap and helps in such conditions. It allows to increase the angle between your elbow and provides reverse tilt for the keyboard.
I also tried a dozen of creams and physical therapy methods. Looks like Aspirin-containing cream (for example, Aspercream) works better.
Among exercises that might work (but did not work for me, at least did not produce significant effects), I would mention self-massage (look at youtube videos) as well as the exercise of rotating a plastic tube (you can buy a special on Amazon, or use those used for swimming) with two hands in opposite directions, and squeezing a tennis ball while walking.
The key here is that they help to provide adequate attention to this serious problem so even when they are useless, they re helpful by keeping you alert to the problem ;-)
rjj , Nov 8, 2018 2:45:57 AM | linkb, stopped using anti-ergonomic move-around-on-pad mouse in 1990s. pains and hand spasms went away when I switched to trackballs. big ball kensingtons were great but they were expensive and broke down easily -- possibly due to cheetos fines ... could have been mayonnaise. anyway have used low end logiteks for 20 years.
Nov 07, 2018 | www.zerohedge.com
Authored by Sara Tipton via ReadyNutrition.com,
Recent studies have shown that 90% of Americans use digital devices for two or more hours each day and the average American spends more time a day on high-tech devices than they do sleeping: 8 hours and 21 minutes to be exact. If you've ever considered attempting a "digital detox", there are some health benefits to making that change and a few tips to make things a little easier on yourself.
Many Americans are on their phones rather than playing with their children or spending quality family time together. Some people give up technology, or certain aspects of it, such as social media for varying reasons, and there are some shockingly terrific health benefits that come along with that type of a detox from technology. In fact, more and more health experts and medical professionals are suggesting a periodic digital detox; an extended period without those technology gadgets. Studies continue to show that a digital detox, has proven to be beneficial for relationships, productivity, physical health, and mental health. If you find yourself overly stressed or unproductive or generally disengaged from those closest to you, it might be time to unplug.DIGITAL ADDICTION RESOLUTION
It may go unnoticed but there are many who are actually addicted to their smartphones or tablet. It could be social media or YouTube videos, but these are the people who never step away. They are the ones with their face in their phone while out to dinner with their family. They can't have a quiet dinner without their phone on the table. We've seen them at the grocery store aimlessly pushing around a cart while ignoring their children and scrolling on their phone. A whopping 83% of American teenagers claim to play video games while other people are in the same room and 92% of teens report to going online daily . 24% of those users access the internet via laptops, tablets, and mobile devices.
Addiction therapists who treat gadget-obsessed people say their patients aren't that different from other kinds of addicts. Whereas alcohol, tobacco, and drugs involve a substance that a user's body gets addicted to, in behavioral addiction, it's the mind's craving to turn to the smartphone or the Internet. Taking a break teaches us that we can live without constant stimulation, and lessens our dependence on electronics. Trust us: that Facebook message with a funny meme attached or juicy tidbit of gossip can wait.IMPROVE RELATIONSHIPS AND BE MORE PERSONABLE
Another benefit to keeping all your electronics off is that it will allow you to establish good mannerisms and people skills and build your relationships to a strong level of connection. If you have ever sat across someone at the dinner table who made more phone contact than eye contact, you know it feels to take a backseat to a screen. Cell phones and other gadgets force people to look down and away from their surroundings, giving them a closed off and inaccessible (and often rude) demeanor. A digital detox has the potential of forcing you out of that unhealthy comfort zone. It could be a start toward rebuilding a struggling relationship too. In a Forbes study , 3 out of 5 people claimed that they spend more time on their digital devices than they do with their partners. This can pose a real threat to building and maintaining real-life relationships. The next time you find yourself going out on a dinner date, try leaving your cell phone and other devices at home and actually have a conversation. Your significant other will thank you.BETTER SLEEP AND HEALTHIER EATING HABITS
The sleep interference caused by these high-tech gadgets is another mental health concern. The stimulation caused by artificial light can make you feel more awake than you really are, which can potentially interfere with your sleep quality. It is recommended that you give yourself at least two hours of technology-free time before bedtime. The "blue light" has been shown to interfere with sleeping patterns by inhibiting melatonin (the hormone which controls our sleep/wake cycle known as circadian rhythm) production. Try shutting off your phone after dinner and leaving it in a room other than your bedroom. Another great tip is to buy one of those old-school alarm clocks so the smartphone isn't ever in your bedroom. This will help your body readjust to a normal and healthy sleep schedule.
Your eating habits can also suffer if you spend too much time checking your newsfeed. The Rochester Institute of Technology released a study that revealed students are more likely to eat while staring into digital media than they are to eat at a dinner table. This means that eating has now become a multi-tasking activity, rather than a social and loving experience in which healthy foods meant to sustain the body are consumed. This can prevent students from eating consciously, which promotes unhealthy eating habits such as overeating and easy choices, such as a bag of chips as opposed to washing and peeling some carrots. Whether you're an overworked college student checking your Facebook, or a single bachelor watching reruns of The Office , a digital detox is a great way to promote healthy and conscious eating.IMPROVE OVERALL MENTAL HEALTH
Social media addicts experience a wide array of emotions when looking at the photos of Instagram models and the exercise regimes of others who live in exotic locations. These emotions can be mentally draining and psychologically unhealthy and lead to depression. Smartphone use has been linked to loneliness, shyness, and less engagement at work. In other words, one may have many "social media friends" while being lonely and unsatisfied because those friends are only accessible through their screen. Start by limiting your time on social media. Log out of all social media accounts. That way, you've actually got to log back in if you want to see what that Parisian Instagram vegan model is up to.
If you feel like a detox is in order but don't know how to go about it, start off small. Try shutting off your phone after dinner and don't turn it back on until after breakfast. Keep your phone in another room besides your bedroom overnight. If you use your phone as an alarm clock, buy a cheap alarm clock to use instead to lessen your dependence on your phone. Boredom is often the biggest factor in the beginning stages of a detox, but try playing an undistracted board game with your children, leaving your phone at home during a nice dinner out, or playing with a pet. All of these things are not only good for you but good for your family and beloved furry critter as well!
Nov 03, 2018 | www.moonofalabama.org
time2wakeupnow , Nov 3, 2018 4:28:28 PM | link
I'm a longtime computer tech and have suffered on and off from serious carpal tunnel syndrome - or whatever they call it these days. After trying all kinds of remedies, one of my clients/friends suggested that I try and retrain myself to use my dominant hand and use other non-dominant arm (left) for the cursor and laptop trackpad.
It was really awkward and very frustrating at first, but after a week or so of attempting this, it slowly started to become easier - even though I still resorted to the other very painful hand from time to time. It did take me almost a month of these right to left handed retraining efforts to finally attain some level of comfort and relative ease - to the point where I didn't reflexively resort to switching hands when the going (clicking) got tough.
A couple of months down the line, I became quite fluent with my non-dominant hand: to the point where I considered myself somewhat semi-ambidextrous, and the excruciating pain that I had earlier experienced with my dominant hand slowly began fading away. I'm typing this very post with my left hand.
Technology is sometimes a great and very useful tool that we all engage in nearly everyday, or more. But the downsides are many, and in the physical body realm, it's slowly taking it's toll on all of us in countless ways. Just this morning, I read an article on Slashdot titled: Are touchscreens Robbing a Generation of Surgeons of Their Dexterity?
I'm currently typing this very post with my now, semi-dominant left hand.
uncle tungsten , Nov 3, 2018 5:22:05 PM | link@b #1donkeytale , Nov 3, 2018 5:42:34 PM | link
Try deep tissue massage first. It is one of the best remedies for most aches and really helps the entire system. A one hour deep tissue session is great every 6 months :)Anton,Anton Worter , Nov 3, 2018 5:59:18 PM | link
Sudden, sharp pains should be checked out especially if they persist for a time, although I agree with you getting sucked into the vortex of the medical industrial complex in our absurd "free market" healthcare system can be both very expensive and a huge investment of time, especially if you are unlucky enough to find the wrong physician.
b is in Europe I believe where there is less (or hopefully, no) profiteering by doctors.33
What b is experiencing in repetitious stress syndrome myalgia. It's very painful, and it down not go away. Most especially, getting looped on pain meds is a great way to *permanently* have myelitis and myalgia, and have to run to the medicine closet for your opioids every two hours for the rest of your life.
I sent b a detailed message that didn't get posted, so I'll repeat what I just said above. Change over to your left hand immediately. Immobilize your arm at the writing desk with a sling, while in the evening, you begin strengthening therapy with weights, then pull-ups.
The pain in the arm can last for months if ignored, but the hospital is the very *last* place you want to go. Just start using your left hand on the mouse, and start doing exercise, weight training and yoga. The lessons of the masters.
Or, get hooked on meds for the rest of your life, like my friend with the twitching eyelids, who, after he was told he didn't have cancer, should just take 'this prescription' twice a day, and now if he misses his pill, his whole body is wracked with pain, he has no appetite and can't sleep.
caucus99percentspan y divineorder on Sat, 10/27/2018 - 1:52pm Millions young and old, caught up in the struggle for Healthcare and now there's a consensus.
Yesterday we caught the bus downtown to the Dragon Room in the Santa Fe Plaza area for Happy Hour to meetup with friends we hadn't seen in a year. Heh. As happens with we seniors, part of the time was spent catching on health issues.
Our friend is facing knee replacement surgery with complications. Carpenter property manager by day, musician by night, he was worried about how things would turn out. But at least he had coverage through his wife's employment. Millions still don't have healthcare, and many who do, face denial of coverage and worse.
It clearly is a huge issue for some in the upcoming midterms.
Senior or no, perhaps you, too are worried about how things will turn out?.
Medicare Advantage vs. Medicare for All https://t.co/EFG1G4QKCS
-- Alice Marshall (@PrestoVivace) May 31, 2018
For those who followed the healthcare debacle during Empty Suit era it has been gratifying to see the coverage and movement toward single payer.
But there are still serious obstacles.
Dr. @awgaffney details the barriers to #SinglePayer reform: "Obstacle number one is the corporate opposition, obstacle number two is the potential that #MedicareForAll could be co-opted or sort of mutated into a lesser thing." https://t.co/E4xTSBPx2E via @businessinsider
-- PNHP (@PNHP) October 26, 2018
Here's another link for those who want to educate themselves on MA vs IMFA.
Over the last few decades, insurers participating in Medicare Advantage have schmoozed Congress into compensating them with more money per person than is allocated to traditional Medicare. Don McCanne of Physicians for a National Health Program writes:
"Each year the administration, whether Democratic or Republican, uses quirky arcane rules to ensure an adequate revenue buffer so that private insurers can compete favorably with the traditional Medicare program by offering lower premiums and cost sharing and expanded benefits Once a critical mass has enrolled in private plans, Congress will gradually reduce the relative value of the voucher-equivalent, reducing the government component of the funding of Medicare by shifting more costs to the Medicare beneficiaries."
We see this happening right now, with top leaders of Republican Party expressing a strong interest in cutting Medicare. In response, physician advocates argue that the private Medicare Advantage HMOs should be isolated as a source of wasteful government spending, and that benefits offered by these plans should be expanded into traditional Medicare. Physicians for a National Health Program (PNHP), the doctor-led think tank for single payer policymaking, has been putting forward a strong case against Medicare Advantage for some years.
PNHP points to a number of studies that show the Medicare Advantage HMOs cherry pick healthy patients and lemon drop expensive, unhealthy ones. This is done through narrow coverage networks and poor access to specialized care , driving patients with heavy medical burdens into traditional Medicare where they can choose their own providers. A 2015 Brown University study showed that of Medicare Advantage patients who had long-term stays in nursing homes, 17% switched to traditional Medicare the next year. The report's lead author, Momotazur Rahman, told NPR news that there are incentives, including "steep cost-sharing as patients need more expensive care" and "limitations on expensive treatments",that because sick patients to drop out of Medicare Advantage plans. A 2017 Government Accountability Office (GAO) report found that of 126 Medicare Advantage plans, 35 plans saw disproportionally high numbers of sick enrollees dropping out into traditional Medicare.
In 2017, a Kaiser Family Foundation (KFF) study found one out of every three Americans enrolled in Medicare Advantage plans were given narrow physician networks. It concluded that plans offering broader networks tended to have much higher premiums than narrow-network plans. KFF also found that one out of every five plans do not include a regional academic medical center in their networks, and estimated that 40% of Medicare Advantage networks included top-quality cancer centers.
The Medicare Advantage insurers can also increase their profits by upcoding the severity of the diseases that their patients have. HMOs are paid per capita based on the number of patients they cover. The payments are also risk adjusted according to the severity of the illnesses of those covered: the more severely ill, the higher the compensation. So it is to the Medicare Advantage plans' advantage to upcode, to make patients seem sicker. Investigations by the Center for Public Integrityand the work of academics show that there is both direct and indirect evidence of massive upcoding in Medicare Advantage, costing the government and taxpayers tens of billions of dollars.
While Medicare Advantage is not an efficient or an equitable means of offering care to senior and disabled Americans, it's important to look into some of the benefits that satisfied patients (who tend to be healthy) are grateful for. All of these benefits would be offered (and enhanced) through a national health insurance system like National Improved Medicare for All (NIMA).
Sorry for leaving out the extensive hot links in the above quote.
So as before its a crapshoot that the Dems and their Repub buds won't screw this up for us.
My wife C99er jakkalbessie and I rode our pedal assist bikes down the Arroyo de Chamisa Urbano to the grocery store this morning, and it is one beautiful fall day here in
The City Different. Leaves are changing, there's a little snow up on the mountains east and west. Such a glorious day to be alive, and able to pedal around still!
I got to get my butt in gear and get ready for MOHS surgery. Spending too much time out in the sun, I guess.
Running through my mind are thoughts like " How much will I have to end up paying? Will my Medicare Advantage Employer group coverage try to deny it?"
What if I were like millions, with no coverage at all? My brother has a much larger problem on his face and no insurance what so fcking ever.
It's all but guaranteed that Trumpco will finally strangle ACA to death and soon. And then there's the worry about how corpadems can fck everything up.
What are people going to do? All the best to you and yours, good health to all.
Of course its not just we mouldy odies that care about this sheet.
AP-NORC/MTV Poll: Young people back single-payer health care https://t.co/pnBGhCq0Pq
-- Health Care For All (@HCASFV) October 26, 2018
Young Americans called health care a very important issue in deciding how to vote. Sixty-two percent of those who will be old enough to vote in the midterms rated it as such. That's the most who said the same of any issue in the poll, including... https://t.co/K2oMRAXPRz
-- Big Easy Magazine (@bigeasy_mag) October 27, 2018
More power to us all.
Wish me luck! Hoping to be in the 94% success rate for this surgery. Divineorder.
Oct 27, 2018 | www.nytimes.com
By Gretchen Reynolds
Oct. 24, 2018
Ten minutes of mild, almost languorous exercise can immediately alter how certain parts of the brain communicate and coordinate with one another and improve memory function, according to an encouraging new neurological study. The findings suggest that exercise does not need to be prolonged or intense to benefit the brain and that the effects can begin far more quickly than many of us might expect.
We already know that exercise can change our brains and minds. The evidence is extensive and growing.
Multiple studies with mice and rats have found that when the animals run on wheels or treadmills, they develop more new brain cells than if they remain sedentary. Many of the new cells are clustered in the hippocampus, a portion of the brain that is essential for memory creation and storage.
The active animals also perform better on tests of learning and memory.
Equivalent experiments examining brain tissue are not possible in people. But some past studies have shown that people who exercise regularly tend to have a larger, healthier hippocampus than those who do not, especially as they grow older. Even one bout of exercise, research suggests, can help most of us to focus and learn better than if we sit still.
But these studies usually have involved moderate or vigorous exercise, such as jogging or brisk walking and often for weeks or months at a time.
Whether a single, brief spurt of very easy exercise will produce desirable changes in the brain has remained unclear.
EK NY Oct. 26Grace Portland Oct. 26
Those of you with walkers: do you really need them? I think seniors are being coerced to use them lest we fall.Reply RecommendRosemarie North Kuala Lumpur Oct. 26
@EK This is interesting to learn. For general aging problems, there are lots of things to do before going to a walker. I don't have balance problems at this point but I'm careful. What I do now to prevent falls is strength training in my legs (which ultimately helps prevent shuffling) and balance poses or exercises like standing on one leg. (I know from experience that I can restore my balance in a couple of days of one-legged standing.)
In dicey situations like ice, mud, uneven terrain, I use one or two trekking poles or even some kind of locally-available walking stick: nothing is going to ever keep me from using these kinds of walking aids.
Finally there's the habit of mindfully keeping one's eyes on the ground while walking: absolutely necessary in some places, but sometimes even in first-world cities when sidewalks might be buckling here or there due to a nice tree canopy (a recent fall, no serious repercussions, reminded me of that!) If you do this you can get a pretty decent pace going. The rule is: stop moving first before looking around.Reply 1 RecommendNWwell Portland, OR Oct. 25
I wonder if 10 minutes of relative rest were what made the difference, in these hectic, over-stimulated times.NWwell.weebly.com Portland, OR Oct. 25
A lot of these articles make me narrow my eyes in disbelief. What about the energy it takes the average American to get up from the couch, shuffle towards the kitchen, reach for a bag of Doritos, walk back, sit down, open the bag, eat its contents, all the while clicking on the remote? I don't see how a 10 minute stroll for healthy young adults is more difficult than that.Reply 4 RecommendB.D. Champaign, IL Oct. 24
@NWwell I forgot to finish my thought - though I'd walked 6 miles yesterday - hm. If such a minute amount of activity led to noticeable improvment in cognition then we'd all be super geniuses. A ten minute walk to a healthy young adult is not even exercise. It's below the threshold I would consider physical activity. I don't know what the conclusion from all this is. I'm confident that being physically active is the single most important thing one can do for their health, physical and mental. Any amount is better than nothing. The more the better, up to a point. But I doubt that 10 minutes of, basically breathing, make you better than ...10 other minutes of, basically breathing. This makes no sense.Doris Los Angeles 1m ago
Would like to have seen some non-author commentary. The time it would take between exercise and fmri, it seems to imply that any 10-minute exercise would matter for quite a while after exercise occurred. So if any subjects walked to the study building, they may also have residual effects!
I also wonder whether fmri, which measures oxygenated blood, has previously shown exercise or deep breathing differences? Does everything light up more when there is just more oxygen in the system in a sudden fashion? Would people in casinos with pumped-in oxygen be similar in effects? Finally, it would be great to rule out effects of arousal and things like excitation transfer. Right now it leaves open the possibility that showing horror movies might also lead to better memory for our young people, though that has less savory policy implications :)joan sarasota Oct. 24
@B.D. I have similar questions. I work in a creative field, and for many years my experience (and that of others I know) has been that ideas can be encouraged to arrive in two ways: (1) after aerobic exercise and (2) in a hot shower. I always thought it had something to do with oxygen. In neither case does the effect last more than an hour or so. That seems very different from "exercise to make your brain work better all day long." (Not that I'm arguing against exercise.) It would be helpful to have more details about how this study worked.Raindrop US Oct. 25
@Karen B, not so bizarre if one is 77 with heart failure and very painful osteoarthritis. But worry not, I'm in the pool 4 or 5 days a week for far longer than 10 minutes. Probably takes me 10 minutes to get to the pool with my walker to park right next to steps into the pool.
My real point is think about others before you label their behavior bizarre, especially in these divisive days.J David La Oct. 24
Many elderly people do not have much stamina or a safe place to walk with a walker, or because it is dangerous when the sidewalks are icy, wet, or snowy. Many people in American cities do not have a safe place to walk due to crime. Many children in suburbs are forbidden from playing outside by their parents because of overblown fears of abduction. There are many reasons other than moral failing for why people do what they do.Phyllis Mazik Stamford, CT Oct. 24
well, i walk on my treadmill about 30 mn/day about 2.2mph...i figure that's good enoughReply 10 Recommendtpw Plainfield Massachusetts Oct. 26
Immediately thought of students who could use some exercise to combat rigor mortis. Get the blood circulating. Also, kids need a decent diet, otherwise the body screams out for help and then people often turn to substance abuse instead. Years ago, people ate home cooked meals and walked to school. Good food and exercise costs very little and we should access the free stuff. (Junk food and drugs are costly in many ways.)
A sound mind in a sound body
Oct 27, 2018 | www.nytimes.com
Although declines in running and other activities are unavoidable, they may be less steep than many of us fear.
By Gretchen Reynolds
Oct. 3, 2018
Most of us who are older competitive runners are not able to race at anywhere near the same speed as we did when we were 30.
But we can perhaps aim to slow down at the same pace as Bernard Lagat, Ed Whitlock and other greats of masters running, according to a timely new analysis by two professors from Yale University.
The new analysis, which refines famous past research by one of the scientists, finds that, although declines in running performance with age are ineluctable, they may be less steep than many of us fear.
And, perhaps most important, the new research updates a popular formula and calculator that runners past the age of 40 can use to determine how fast we can expect to slow down and provides us with reasonable, age-appropriate finishing-time targets for ourselves.
Scientists do not know precisely why, from a physiological standpoint, we are less able to maintain our old, swifter pace as we reach middle age.
There is evidence from past studies that even in lifelong athletes, hearts become a bit less efficient over time at pumping blood and delivering oxygen and muscles a bit less adept at creating sustained power.
Go beyond the headlines.Subscribe to The Times
Changes deep within our cells, particularly in the energy-producing mitochondria, are thought to contribute to these age-related performance declines, as are simpler explanations such as creeping weight gain and a drop-off in hard training.
But the upshot is that, after a certain point, we cannot keep up with the kids or with our own previous bests.
Professor Ray Fair, an economist at Yale who mainly analyzes and predicts election outcomes, is familiar with this tribulation, since, now in his mid-70s, he is also an experienced masters marathon runner whose times have been slowing year by year.
About a decade ago, he began to wonder whether his rate of performance decline was typical and, being a predictive statistical modeler, decided to find out.
He turned first to information about world records for runners by age group. These times represent what is possible by the best runners in the world as they age.
And cumulatively, he found, the records proved that champion runners slow like the rest of us.
But there was a pattern to the slowing, Dr. Fair realized. As he reported in a 2007 study , the masters world record times rose in a linear fashion, with some hiccups, until about age 70, when they begin to soar at a much higher rate.
Using statistical modeling based on this pattern, Dr. Fair developed a formula that could predict how fast other, less-exceptional runners might expect to run as they grew older. He incorporated this formula into an influential calculator that he made available free on his website. (The calculator also predicts age-related performance declines in swimming and chess, using the same statistical techniques.)
The calculator soon became popular with runners, for whom it provided age-adjusted viable goal times, allowing them to swap despondency about their current plodding for gratification if they had managed to remain at or near their "regression line," as Dr. Fair termed the age-adjusted predicted finishes.
But recently, Dr. Fair began to question whether his statistical model provided the best estimates of people's likely race times and, for the new analysis, which was published in print this month in The Review of Economics and Statistics , he approached a Yale colleague, Edward Kaplan.
Dr. Kaplan is an expert in a complex type of statistical analysis known as extreme value theory, which focuses on exceptional deviations from the norm.
By definition, world records are exceptional deviations from the norm.
Together, Dr. Fair and Dr. Kaplan reanalyzed data about world masters running records through 2016 for the 5K, 10K, half marathon and marathon events, up to age 95.
They used only men's records, since the number of older female participants has been small, Dr. Fair says, making current women's records statistically suspect.
They then ran the numbers, using several different models, and found that, over all, age-adjusted finishing times are slightly slower now than in the 2007 version, rising about 1 percent a year.
But runners seem to be maintaining that rate of decline longer, until they are about age 80, when slowness drastically intensifies.
But even for 90-year-olds, the decline is limited, Dr. Fair points out.
Nonagenarians can expect to be "about twice as slow as they were in their prime," he says, "which I think is encouraging."
Interestingly, the new study's extreme-value analysis also suggests that
Oct 10, 2018 | www.nytimes.com
"Use it or lose it." I'm sure you're familiar with this advice. And I hope you've been following it. I certainly thought I was. I usually do two physical activities a day, alternating among walking, cycling and swimming. I do floor exercises for my back daily, walk up and down many stairs and tackle myriad physical tasks in and around my home.
My young friends at the Y say I'm in great shape, and I suppose I am compared to most 77-year-old women in America today. But I've noticed in recent years that I'm not as strong as I used to be. Loads I once carried rather easily are now difficult, and some are impossible.
Thanks to an admonition from a savvy physical therapist, Marilyn Moffat, a professor at New York University, I now know why. I, like many people past 50, have a condition called sarcopenia -- a decline in skeletal muscle with age. It begins as early as age 40 and, without intervention, gets increasingly worse, with as much as half of muscle mass lost by age 70. (If you're wondering, it's replaced by fat and fibrous tissue, making muscles resemble a well-marbled steak.)
"Sarcopenia can be considered for muscle what osteoporosis is to bone," Dr. John E. Morley, geriatrician at Saint Louis University School of Medicine, wrote in the journal Family Practice . He pointed out that up to 13 percent of people in their 60s and as many as half of those in their 80s have sarcopenia.
As Dr. Jeremy D. Walston, geriatrician at Johns Hopkins University School of Medicine , put it, "Sarcopenia is one of the most important causes of functional decline and loss of independence in older adults."
Yet few practicing physicians alert their older patients to this condition and tell them how to slow or reverse what is otherwise an inevitable decline that can seriously impair their physical and emotional well-being and ability to carry out the tasks of daily life. Sarcopenia is also associated with a number of chronic diseases, increasingly worse insulin resistance, fatigue, falls and, alas, death.
A decline in physical activity, common among older people, is only one reason sarcopenia happens. Other contributing factors include hormonal changes, chronic illness, body-wide inflammation and poor nutrition.
But -- and this is a critically important "but" -- no matter how old or out of shape you are, you can restore much of the strength you already lost. Dr. Moffat noted that research documenting the ability to reverse the losses of sarcopenia -- even among nursing home residents in their 90s -- has been in the medical literature for 30 years, and the time is long overdue to act on it.
In 1988, Walter R. Frontera and colleagues at the Department of Agriculture Human Nutrition Research Center on Aging at Tufts University demonstrated that 12 previously sedentary men aged 60 to 72 significantly increased their leg strength and muscle mass with a 12-week strength-training program three times a week.
Two years later in JAMA, Dr. Maria A. Fiatarone and colleagues at the Tufts research center reported that eight weeks of "high-intensity resistance training" significantly enhanced the physical abilities of nine frail nursing home residents aged 90 and older. Strength gains averaged 174 percent, mid-thigh muscle mass increased 9 percent and walking speed improved 48 percent.
So, what are you waiting for? If you're currently sedentary or have a serious chronic illness, check first with your doctor. But as soon as you get the go-ahead, start a strength-training program using free weights, resistance bands or machines, preferably after taking a few lessons from a physical therapist or certified trainer.
Proper technique is critical to getting the desired results without incurring an injury. It's very important to start at the appropriate level of resistance. Whether using free weights, machines, bands or tubes, Dr. Moffat offers these guidelines:
"Start with two repetitions and, using correct form through the full range of motion, lift slowly and lower slowly. Stop and ask yourself how hard you think you are working: 'fairly light,' 'somewhat hard' or 'hard.' If you respond 'fairly light,' increase the weight slightly, repeat the two reps and ask yourself the same question. If you respond 'hard,' lower the weight slightly and do two reps again, asking the question again.
"If you respond truthfully 'somewhat hard,' you are at the correct weight or machine setting to be exercising at a level that most people can do safely and effectively to strengthen muscles. Continue exercising with that weight or machine setting and you should fatigue after eight to 12 reps."
Of course, as the weight levels you're working at become easier, you should increase them gradually or increase the number of repetitions until you fatigue. Strength-training will not only make you stronger, it may also enhance bone density.
The fact that you may regularly run, walk, play tennis or ride a bike is not adequate to prevent an incremental loss of muscle mass and strength even in the muscles you're using as well as those not adequately stressed by your usual activity. Strengthening all your skeletal muscles , not just the neglected ones, just may keep you from landing in the emergency room or nursing home after a fall.
Dr. Morley, among others, points out that adding and maintaining muscle mass also requires adequate nutrients, especially protein, the main constituent of healthy muscle tissue.
Protein needs are based on a person's ideal body weight, so if you're overweight or underweight, subtract or add pounds to determine how much protein you should eat each day. To enhance muscle mass, Dr. Morley said that older people, who absorb protein less effectively, require at least 0.54 grams of protein per pound of ideal body weight, an amount well above what older people typically consume.
Thus, if you are a sedentary aging adult who should weigh 150 pounds, you may need to eat as much as 81 grams (0.54 x 150) of protein daily. To give you an idea of how this translates into food, 2 tablespoons of peanut butter has 8 grams of protein; 1 cup of nonfat milk, 8.8 grams; 2 medium eggs, 11.4 grams; one chicken drumstick, 12.2 grams; a half-cup of cottage cheese, 15 grams; and 3 ounces of flounder, 25.5 grams. Or if you prefer turkey to fish, 3 ounces has 26.8 grams of protein.
"Protein acts synergistically with exercise to increase muscle mass," Dr. Morley wrote, adding that protein foods naturally rich in the amino acid leucine -- milk, cheese, beef, tuna, chicken, peanuts, soybeans and eggs -- are most effective.Do You Have Sarcopenia?
To help doctors screen patients for serious muscle loss, Dr. John E. Morley and Theodore K. Malmstrom devised a simple questionnaire that anyone can use. It asks how difficult it is for you to lift and carry 10 pounds, walk across a room, transfer from a chair or bed or climb a flight of 10 stairs. It also asks how often you have fallen in the past year. The more challenging these tasks and more often you've fallen, the more likely you have sarcopenia.
This is the first of two columns on countering muscle loss. Read the second here . How to Get Strong
You don't have to lift like a bodybuilder (or look like one) to benefit from resistance training. And the best part is that it's never too late to get started. Read our latest subscriber guide.Sept. 18, 2018
Jane Brody is the Personal Health columnist, a position she has held since 1976. She has written more than a dozen books including the best sellers "Jane Brody's Nutrition Book" and "Jane Brody's Good Food Book."
Martha Grady CO Oct. 5don salmon asheville nc Sept. 26
Jane, How about including the protein available in whole foods / plant based choices? Listing only animal sources of protein perpetuates the myth that you must eat meats to meet protein requirements.DC Rez DC Sept. 24
I don't understand the protests - what about pleasure, stop making us do all this work can't we just relax etc etc
My wife and I (we're in our mid to late 60s) take a 6:15 aerobics class at the YWCA 3 mornings a week. We love it! It's SO much fun. Some of the students have been with the teacher for several decades and the class feels like a family.
After the class (which includes aerobics and light weights) I spend 20 minutes in the gym doing heavier lifting.
Three mornings a week I do a HIIT walk (alternating fast/moderate pace) here in the mountains of Western North Carolina - extraordinarily beautiful views, and I live in a working class neighborhood where everyone is friendly and knows each other. It's a fantastic way to get the day going after morning contemplation.
I do a Qigong routine (8 brocades) several times a day (just takes a minute or two to do a brief version) to stand up and stretch, and if I'm in a mood for something more vigorous, I keep my mini trampoline and light kettlebells in my home office (and k-bells in the work office as well).
And my wife and I go for LOTS of walks in this extraordinarily beautiful region. And we often go for walks with friends as well. We also keep TV (netflix, that is, on the computer) to a 3 night maximum, and stretch throughout.
How in the world is this "work" or lacking in pleasure? We're in the midst of creating videos for others to do the Qigong break. The whole morning routine's about 6 hoursKT IL Oct. 3
The sad fact is that in our sedentary world big majority of people who take up weightlifting based on an article like this will not lift hard enough for the real benefits to take hold. The lower body work everyone now understands is hyper-beneficial to long term health takes a lot out of you. If you dont sleep like a baby the night you lift weights you arent trying hard enough. And be warned, the longer you wait to start the harder it's going to be to get to where you want to be. Meanwhile people who have been lifting for 10-20yrs find that even at say 45yrs old they are stronger than majority of 25yrs olds at their gym. Heavy resistance training is, by far, the single best thing you can do for your physical self.Alesia Stanford San Diego Sept. 23
While weight training is wonderful exercise, the simple act of walking 5-6 miles per day is the single best and most accessible exercise for every human on Planet Earth.bill annandale, VA Sept. 23
I am an Essentrics exercise teacher. This dynamic stretch program helps lengthen, strengthen and tone the body through a series of gentle stretch exercises. It's also wonderful for healing little aches and pains. Most of my clients are 50+ and all have benefited from taking the classes. After a few weeks, they report better balance, being able to lift their arms higher or walk with more confidence. I see the changes as well. You don't have to do anything fancy to get in shape. We use mats for the floor, chairs for "barre" work and sometimes yoga blocks to sit up a little higher. This is an amazing program. I only wish more people knew about it.Mr C Cary NC Sept. 21
I'm 85 and in rather good shape...actually quite strong. When younger, forties and fifties, I was a road racer and lifted weights regularly.
Now I'm very active in the house climbing stairs and walking outdoors as often as I can...but not at all slavish about it.
But my main exercise program now is a comprehensive set of isometric moves. I've been at it for years but have pushed harder in the last year.
Isometrics are - in my view - a lot easier on the joints, and if done in a relatively wide range of motions will add strength and mass.
I don't know why exercise professionals do not mention isometrics as an alternative, especially for seniors with arthritic joints.
When done in connection with ordinary walking, household chores, and stair climbing, the results do indeed stop muscle and strength loss.
Tom NYC Sept. 17
I used to be a couch potato. But I have been going to the gym everyday. My SLIVER sneaker. The benefits are many above and beyond what has been said. First it gives me an opportunity to go out regularly and be in a different environment other than the confines of my apartment (I have downsized from a large house to a modest apartment, like many in my age group). Second, the day goes fast as I go in the morning and by the time I am home, it's lunch time! Third, you get good sleep as your body had been working. Fourth, as you work hard at the gym, huffing and puffing and sweating a bit, you forget other things and your mind gets a rest. So don't wait, get up and join a gym. By the way, don't spend money buy the equipment, it doesn't work.Nino B Amityville, NY Sept. 16
Lots of the usual woulda shoulda coulda in the comments here. Brody's advice has always tended to be prescriptive. Think back to her high-carb diet -- not good for pre-diabetics. But muscle loss is very serious as we age. I see it in myself at late 77. I'm no gym rat but I will try to find my own path.Andy Wohl Bethesda MD Sept. 15
Nine years ago at the age of 54 I purchased a Concept2 rowing machine and have never looked back. It provides a low impact full body cardiovascular workout. I typically row for 30 minutes. Sometimes it's a straight 30 minute session. Other times I will do three sessions of 2000 meters each. From time to time I will do intervals of short bursts at maximum output. I log each workout and am approaching 12 Million meters to date. I also use dumbbells for arm strength and do 120 inclined crunches a day. At 65 years young I am obviously a HUGE fan or my rower. I recommend you give one a try. It's not easy but taken in small increments at first you will see results. I might add that like all excercise it is worth the effort!Apple Jack Oregon Cascades Sept. 14
My answer: racquetball!Tom Hennessy Calgary, Ab, Canada Sept. 14
If you live in the country, chop firewood. Lifting an eight pound maul might seem to be an exhausting task at first. Soon you'll be lifting & bearing down with ease.Reply 5 Recommend
There's a reason top flight boxers chop wood. No pulling punches when follow through on the down swing with an ax or maul is perfected in training..
Many muscle problems with seniors when walking come about because of unnatural mental manipulations of leg musculature resulting in strains & tension. Place attention on foot placement rather than leg movement when moving to remain trouble free. Enjoy.Tom Hennessy Calgary, Ab, Canada Sept. 14
As we age we gain what is called, age related iron accumulation.
"Iron accumulation with age, oxidative stress and functional decline."dsws whocaresaboutlocation Sept. 14
"increased non-heme iron, might contribute to muscle atrophy due to disuse particularly in aged muscle."richard conner Bay Ares, CA Sept. 13
You say that, thanks to your therapist, you know why you have sarcopenia. But then (unless I missed it) you don't tell us why. More importantly, you don't tell us how often protein deficiency is the main cause, how often it's lack of exercise at the right level of resistance or intensity, and how often it's something else.LorneB Vancouver, CA Sept. 13
As we age, strength gradually lessens and we need to use our muscles more to keep strength from fading. Free weights have always been the best for me, nothing heavy, but heavy enough to tire muscles after 10-12 repetitions, 3 times a week.
Then, lots of walking, uphill a bit if you can. Uphill walking gives a better workout in a shorter distance than on the level. Endurance and strength gained from walking 2+ miles a day is just as important as keeping the rest of the body strong using weights. It also helps to get rid of extra weight(77 years young and now the same weight as in college). Take good care of yourself; you deserve it.Reply 21 RecommendRound the Bend Bronx Sept. 13
I am 64 and have always disliked gyms and doing repetitive weight exercises. Truly boring. But 20 years ago, I discovered hatha and ashtanga yoga. We use our own body weight as resistance effectively to build muscles. Downward dogs, and chatarangas, and lunges and warrior positions and planks all use different muscles. Even my gluteus not so maximus has improved. And after all that I have a nice sense of well-being. So for any one who doesn't enjoy repetitive weight exercises, maybe yoga may be for them. Just make sure you go to a class with a VERY qualified instructor.Reply 29 RecommendJudith Spruance Wilmington DE Sept. 13
Many of my friends are afraid to lift weights as I do, fearing they'll injure themselves. I get it. It's a bummer to hurt yourself when you're old. But it doesn't have to be that way. The key is success is to be conservative and think long-term. My motto is "go slow and live to lift another day."
I'm a 66 year-old woman who weights 110 lbs. I do body building and weightlifting three times a week at a cheap, no-frills gym. This includes once-a-week sessions of deadlifts with 80 lbs. on the bar. Post-knee surgery, I asked my DPT (doctor of physical therapy) for strength-training and fitness advice. Based on my issues, which include osteoporosis and osteoarthritis, he designed a program that I took to the gym and now do on my own. About once a month, I see him for a progress report, new exercises and to make sure my form is correct. Many of the exercises I can do at home with little or no equipment, others require a trip to the gym.
The word of the day is "hypertrophy," which is the development of larger muscles. I used to think this was just for vain people who liked to flex their muscles in the mirror. But no. Seniors need to focus on hypertrophy as well as on strength building, so we can compensate for the loss of muscle mass that accompanies old age.
Trust me when I tell you that this kind of workout is not only good for you, but afterwards you feel like a million bucks. Start now. Start yesterday!Reply 22 RecommendA. Stanton Dallas, TX Sept. 13
By all means get a weight program but Honestly! you don't have to do nothing but the gym! Try Vacuuming your house and doing some lunges while you are doing that. Empty the dishwasher and do squats while gathering the knives and forks rather than carrying the carrier over to the drawer to put them away. Haul some hoses around the yard, if you have one, to water your thirsty plants, and spend some time coiling that hose. Fold some king size sheets. There is a lot of '"weight" work in normal living if you look for it. Good luck and think of me, 80 years old, zipping around garden and house working out and getting things done- sort of!Reply 29 RecommendAnalyst SF BAY Sept. 13
Wanting to improve my image of myself, I stopped looking in mirrors about ten years ago.
And it has worked.Reply 17 RecommendJoan In California California Sept. 13
For easy to prepare and digest protein, try whey isolate. One scoop is 30 grams protein. It comes in many flavors. It's broken to small proteins. I usually have digestive problems with milk proteins but not with whey isolate.Reply 4 RecommendMSalmon Bay Area, CA Sept. 15
If 80 grams of protein sounds like a lot, one ounce is approximately 30 grams. 80 grams is not quite three ounces. Of course we must allow some leeway for the elements that aren't strictly protein.Reply 1 RecommendCarol Avri n Caifornia Sept. 12
@Joan In California I just looked up salmon and 4 ozs has about 20 grams of protein, a cup of non-fat milk has 8 grams and egg has 6 grams.Reply 1 RecommendBloUrHausDwn Berkeley, CA Sept. 12
Unfortunately at 86 my equilibrium is severely impaired and a parathyroid tumor robbed my bones of calcium. However, due to fact that I exercised all my life, I have pretty good coordination and when I can't walk, I exercise on my bed using a band and small weights. Don't give up as long as you can still move.Reply 47 Recommendbadman Detroit Sept. 17
Back in the '80s, Jane Brody's "Good Food Book: Living the High-Carbohydrate Way" was my food bible. I made countless meals from that book. Then -- oh dear! -- we found out that high carbs were NOT the answer...and Jane dutifully followed the current thinking and expounded other ideas. Food is like fashion, and "scientific" thinking keeps changing. What will it be next year?Reply 25 RecommendDoug Dudfield Stamford , Ct Sept. 12
I find it amazing how flawed some docs thinking is. Especially their math (probability) understanding. Vitamin D is (was?) a good example. Prescription of statins for cholesterol management. Perhaps Phizer (et al) has "brain-washed" them. The good docs know this - the trick is to find the good thinkers.Reply 1 RecommendRandy Santa Fe Sept. 13
I go to the gym every day. I do a complete workout . All muscels. It is amazing. I keep adding weight. Everybody should go to a gym when you are my age. 76.Reply 22 RecommendLarry Lamar London Sept. 13
@Doug Dudfield At 57, I've been a gym rat for 35 years, through injuries and a hip replacement. I'm mortified by the terrible physical condition of so many men and women my age attributable to poor diet and a sedentary life.
I'm inspired by the folks in your age group I see at my gym, cranking it out, making the most of their workouts. I aspire to be like you in 20 years!Reply 6 RecommendKaren Brooklyn Sept. 12
@Doug Dudfield Instead of doing a complete workout every day, you might want to try focusing on one muscle group each day -- arms one day, back the next, legs the next. That's the way the pros do it. It not only gives that muscle group more of a workout, but crucially, it allows it time to recover and recuperate, which is when muscle growth takes place. I just started doing that instead of circuit training and was amazed at the progress I started making all of a sudden. Very dramatic.Reply 18 Recommendjames.m Dallas Sept. 13
I feel like my 61 year old body is trying to make me weak! I am an avid cyclist, have worked out on weight machines at the gym for many years, but it requires effort just to stay the same. If I miss working out for a week, I loose strength right away and it takes me much longer to build back to where I was.
Weakness is especially profound and alarming in my smaller muscles that don't get much focus at the gym, like my fingers and wrists, toes and ankles. Because of weak ankles and feet my balance sucked. I recently started yoga classes and it helps a lot! I have also started what I call "lap-top calisthenics" where I lift the computer I am typing on using my wrists and fingers. That has really helped also.Reply 12 Recommendbadman Detroit Sept. 17
Try adding standing free weights that require hands, wrist and lower extremety may help. I use kettlebells for this purpose.Reply 3 RecommendRichard Sullivan Keaau, Hawaii Sept. 12
It's called old age. Our strength, O2 intake (lung capacity), speed, all decline. There is basic cellular change - physiology. The trick is to manage all this so you can "keep on keepin' on." I won my 5K age group at age 72 but I was slower than previously. Doesn't matter - normal.Reply 1 RecommendPaolo NYC Sept. 12
Those who justify their lack of desire to put out the effort to strength train to keep themselves mobile and strong by claiming injury, whether valid or not, need to know that proper form is EVERYTHING. Proper form makes all the difference between great results in a shorter period of time and avoiding injury. The article writer rightly recommends hiring a personal trainer, but which many cannot afford. YouTube is a great source for free workout videos although only a minority are made by people who truly know what they're talking about. YouTuber Mike Thurston has a great series: search "Common Gym Mistakes Mike Thurston" for guidance on proper form and injury avoidance.Reply 7 RecommendDILLON North Fork Sept. 12
Perhaps some specifics on which muscles to target might help. What I'm imagining is people overdoing biceps, pectorals, and the six pack part of their abs. Why? That's what they see in the mirror. Too much targeting of these mirror muscles can lead to postural imbalance and pain. It's as much about staying in balance as it is about gaining measurable strength. Re: the nursing home study of 90+ people: how many in the study, what was their baseline (if they were barely able to walk a 48% increase in speed is meaningless.), and how did their function improve? More independent? Easier grooming? Or just a better momentary result of isolated muscles during testing time.Reply 5 Recommend
But thanks Jane, you're an asset to the city.Lorraine Davis Houston Sept. 12
I'm 69 and, on a recent trip to Paris, I fell twice! My kids and wife were shocked but other than a skinned knee I was just fine, my son gave me a hand and I jumped right up. (I was a bit embarrssed.) The reason I was just fine is because I started weight lifting and running in High School and I haven't stopped since. Aside from bragging, I say this because exercise is very important. You don't even need any studies done at universities - everyone knows this is true. Even if you have never exercised, a qualified personnel trainer can help you.Reply 14 RecommendShannon Nevada Sept. 12
I've been weight training since the 1970s and now at 66 I can still run and bike and swim and haul my suitcases around. I walk quickly. My reflexes are still quick. And I still feel like I did at 40. I just look older. I don't feel older though.Reply 20 RecommendTom NYC Sept. 17
Superb information and gives those of us who are over 50, or any age really, a boost to continue doing what we're doing, or start what we need to muscle up. I have a lifestyle that affords frequent, routine, heavy lifting - carrying 40 lb bags of chicken and dog food, hiking daily with 30 lb pack, hunting and packing out harvests. I'm definitely stronger than most all other women my age 57, and boy do I plan to keep it up! My husband says I'm stronger than most men he knows. If you're weaker start gradually and work up to avoid stress and injury, but follow the advice and strengthen your bods!Reply 19 Recommendposlug Cambridge Sept. 12
@Shannon: packing out harvests? No, packing out kills. Legal hunting is nothing to be ashamed of.Reply RecommendAllan Boston Sept. 12
No mention of injury resulting from weight lifting. I am very active but weights tend to lead to ligament and tendon injury that impacts my overall activity not to mention the costs from PT. I love resistance and weights but my body does not. Careful exercise helps only minimally or not at all. Five reps with a three pound weight is enough to have a shoulder or hand be out of service. It would have been helpful if the article addressed this concern.Reply 18 RecommendTish Packman Tallahassee Sept. 12
@poslug I have good news for you. You may be able to minimize the injuries by reducing the weight you lift, making sure your form is correct, and doing enough repetitions to fatigue your muscles. You will see the same benefits as using heavier weights (as long as you fatigue your muscles), but will significantly reduce your risk of injury. Good luck!Reply 10 RecommendNanda Rome Sept. 12
L-glutamine is also an important amino acid that is food for muscles's health.Reply 4 RecommendJane L France Sept. 12
I am close to 70 and have adopted the ASEA cellular REDOX supplement and see quite a difference in my muscle(s) performance in addition to lack of fatigue and extreme focus capability. I recommend that swing at this new tech cellular regenerationReply 2 RecommendEd New York Sept. 12
Why on earth not mention plant-based protein sources?Reply 19 Recommendmhschmidt Escondido, CA Sept. 12
@Jane L, last time I checked, peanut butter came from plants.Reply 4 RecommendRachel California Sept. 11
@Jane LReply Recommend
Soybeans were also mentioned....Larry Lamar London Sept. 13
How can an older person get 80 grams of protein per day on a plant-based diet? Is it possible?Reply 14 Recommend
What enjoyable outdoor exercise can make muscles grow? -- my feet won't permit running and my shoulder can't take bicycling or swimming. I walk a lot but I know that isn't very intense.
I dislike indoor gymnasium intensely.
Would Tai Chi or yoga help build muscle mass?CoolTheSwamp D.C. Metro Sept. 15
@Rachel Soy protein supplements. Or if you're not vegan, whey protein (I know, it's not plant based, but it doesn't have any saturated fat, either.)Reply RecommendSheilah Goodman Mamaroneck NY Sept. 10
@Rachel, Underweight, have fibromyalgia and have done slow, non-combat Tai Chi for 18 months. It's more for flexibility and balance than building muscle because it's mostly upright on two legs. Depending on the type of yoga, you may get more "burn" holding those poses--1hr is harder than it looks. Both are slow-paced, so individual instructor attention and class sociability, however small at first, are important so you don't feel isolated. Good luck!Reply Recommendjoseph usa Sept. 11
Thank you for this essential information. I am a 73 year old health educator and believe that we don't know enough about how to help our bodies to be healthy. I walk a lot and do strength training twice a week at the local Y. I have noticed that when I am gardening, cooking, or doing any kind of stand up work for more than 4 or 5 hours, I need to sit down and rest. I have suspected that this is due to muscle fatigue. I do eat a lot of protein (cottage cheese, chicken, and more). I will ramp up my stretching and strength work. When is part 2 going to be published? Best health to all of us.Reply 13 Recommenditsmildeyes philadelphia Sept. 11
My wake up call was when I started having difficulty carrying a case of wine to my car . I started weight training and all is ok now .Reply 53 RecommendMichael Piscopiello Higganum CT Sept. 10
Not sure why, but I love Joseph's comment.Reply 34 RecommendEric King Washougal Wa Sept. 9
Started using a personal trainer at local YMCA this past January. Weight lifting core strengthening, aerobic workouts. At 67 with heart bypass surgery may be in best shape of my life. Hope to continue for as long as possible.Reply 18 RecommendCindy Williams NYC Sept. 9
I eat watermelon before lifting weights as this is supposed to help with muscle soreness and has electrolytes. The best way to combat muscle loss is full body excersizes not isolated ones, squats and lifts for example.
One issue is back pain but the best solution I have found is the farmer's walk where you carry two weights around at your sides for a minute or as long as you can, this builds core strength and strengthens your back in its best position with the good curves of standing straight-it has eliminated back pain for me which is probably most people's issue with lifting weights-Reply 11 RecommendThe Pooch Wendell, MA Sept. 10
This is one of those articles that leaves me scratching my head, in that it focuses on a problem in which the suggested "cure" causes more problems than the original issue. It presents confounding information that is hard to reconcile with what we now know about the dangers of high protein diets, especially for the aging. For example, heart disease, kidney disease, and osteoporosis, all of which are far more likely to kill an older person than sarcopenia. It could be argued that more muscle mass helps reduce falls, which then reduces the risk for fractures, which are, in fact, often the beginning of the end for the elderly. However, it is the osteoporosis that is the underlying critical issue here, and high protein diets are linked to osteoporosis. Furthermore, in order to consume the amounts of protein recommended in this article, which is extreme, one who have to eat practically an all-protein diet or become obese. Obesity has it's own correlated health risks - a long list, and growing - which, again, are far greater than sarcopenia. Just this week, The New York Times published an article on a well-designed research study that showed an astonishing increase in the muscle-producing cells when aging people engaged in intensive exercise. There are much safer and healthier ways to maintain and increase muscle as we age than eating extremely high protein diets.Reply 24 RecommendEmilia Zurich Sept. 11
@Cindy WilliamsReply 4 Recommend
Higher protein diets _protect_ against all of those things. More protein protects against obesity by satisfying appetite with fewer total calories. Combined with weight-bearing activity, protein _protects_ against osteoporosis by building muscle and bone. Bones are 1/3 protein by weight, and osteoporosis is a loss of both calcium and protein from bones.Rose TN Sept. 9
@Cindy Williams Thank you for your comments. I enjoyed reading this article until I got to the diet/ protein recommendations section. As you mentioned, while a protein dense diet of "milk, cheese, beef, tuna, chicken, peanuts, soybeans" ... might reduce the risk of sacropenia (who knows if this is true), this diet may very well increase the risk of cancer and other very common health problems. Additionally, eating the listed set of foods is also very detrimental for the environment... The author should have instead recommended plant based foods high in protein for example: almonds, broccoli, quinoa, lentils or pumpkin seeds. Thanks for your comments and references.Reply 7 Recommendamskej Northern Europe Sept. 9
Ms. Brody, thanks again for articulating a health need that had been bothering me. 35+ years ago your article on gluten intolerance made my life bearable again. I have been wondering about loss of muscle tone and what to do about it. Again, you have stepped up and made a difference for me. Thanks!Reply 8 Recommendwhatever, NY New York Sept. 11
This active male is turning 61 next week. After doing 10 push-ups 4 days a week off & on for years I decided some weeks ago to increase this by 1 extra push every 2 weeks (currently at 24), 1- minute planks 6 days a week (what back issues?), yoga every day, cross trainer @ home twice a week (max heart rate 165) climb 7 flights of stairs, 3 times /day, 5 days a week @ work, use standing desk @ work, got rid of my bike 10 years ago and walk, have a love affair for oatmeal with blueberries & good nutrition in general. Granted, this is a hobby & I've seen myself as an amateur athlete since high school football. I also currently live in a country where great nutrition / healthcare is affordable for all and that promotes work / life balance. And while I could kil over & die before I click 'submit' to share this comment (Memento Mori) I must say that a lifetime of physical fitness has made me a rich man (in some ways)..Reply 20 RecommendMRH Ohio Sept. 9
if you have your health' you have your wealthReply 11 RecommendCarolyn Jones Seattle Sept. 9
I advise all seniors to do some form of muscle strengthening exercises regularly and to keep their body weight within a normal range. I am a 73 year old RN who specializes in wound care and works in a nursing home. My job is physically active, I only take the stairs in the facility, swim, and belong to a fitness center where I lift weights and do cardio. On my job I have many residents who are younger than I am. While some of our residents have chronic diseases or some catastrophic incident which put them there, the overriding factors I see which landed them in a nursing home is lack of physical exercise to keep themselves in shape and obesity which makes exercise difficult and contributes to all sorts of other physical problems. This results in falls, fractures, wounds, incontinence and a decreased quality of life. Physical exercise is hard work but the refusal to take responsibility for yourself has worse negative consequences. Don't keep yourself fit and live long enough and you'll eventually end up in a nursing home.Reply 43 RecommendRachel California Sept. 11
I am a 68-yr-old female home health RN who also does wound care, which involves lots of squatting to get at heel and leg wounds. My two supply bags each weigh 12 lbs. I go to the gym every Sat morning and do an hour on the treadmill (while listening to Wait Wait Don't Tell Me and laughing) and 30 min of weights. 12-lb for free wts; 50 lbs in the machines, 20 or 30 reps. I've worked up to this over the past few years. I also do yoga, and can finally do a plank-lowered-to-prone for the first time in my life. My cholesterol and fasting glucose are kept in range with the muscle mass. My last DEXA scan moved me from osteoporosis to osteopenia -- a 7% improvement. I feel stronger and am able to balance better than when I was younger. My advice is also use-it-or-lose-it. Plus exercise and good nutrition are great stress reducers. PS. Thanks for such great health articles in the NYT!!!!Reply 31 RecommendExcessive Moderation Little Silver, NJ Sept. 9
@MRH Please remember in your work with the elderly that even a very fit person will eventually become weak, incontinent, etc. My dad hauled water to drink and chopped wood to keep warm (in Canada) until he was 91. He hiked around his 168 acres every day. Fortunately we are able to care for him at home. I agree with your advice--he did make it to 91 on his own--but I don't like your "blame the victim" attitude regarding older people who "landed themselves in a nursing home" or "refuse to take responsibility for themselves." Debility and dependency and dementia will come for all of us if we don't manage to die while still in good general health.Reply 31 RecommendBeverly Kronquest Florida Sept. 11
I'm 75 and I've been a gym rat since I was 40. I row on an ERG, use a stairmaster, work with weights, some heavy, some light. Deadlifts are part of my routine as well as balance exercises. Balance is a MUST for those of us with chronological maturity. When I can outdo a 45-year-old it feeds the ego which is healthy too. BTW I have had both shoulders replaced and delight in replacement parts. Yearly ski weeks also help.Reply 12 RecommendDaveD Wisconsin Sept. 12
@Excessive ModerationReply 1 Recommend
Please tell me about shoulder replacement, doc and recovery time. I'm 81, excercised most of my life with triathlons in 40's and 50's, now at gym 3 days a week w moderate weight machines and tai chi. Humerous severed years ago, now have rod w screws and debilating arthritis and leary of shoulder replacement.DWS Boston Sept. 9
Rowing is tough on the shoulders. I leave oars to the Crew members.Reply RecommendMary Sullivan Roanoke VA Sept. 9
I'm a 60 year old female and didn't really start exercising until 56. I still don't like the exercise part, but I liked losing the 40 lbs, buying new clothes, and feeling much much better.
I don't do anything elaborate or expensive, just a 45 minute routine of treadmill, free weights, and planks at the YMCA. I should add more, but feel it's also important to have a routine that is simple and doable. When I was younger, I didn't really have time to exercise, but it's never too late to start.Reply 35 RecommendAndy Europe Sept. 9
I'm 43 and reading this article is what spurred me to go back to the gym for the first time in years. Thank you! It's encouraging to read comments from others who began exercising regularly later in life. I think, "If they can do it, so can I." So, thank you all! :-)Reply 35 RecommendMike M Ridgefield, Ct. Sept. 9
As my grandfather regularly went hiking and climbing mountains above 12,000 ft until the ripe young age of 84 (when a chronic knee injury stopped him for good), I remember him as an incredibly fit and strong man. Looking at pictures from his days in WW2 I could not discern any significant muscle loss compared to his late 70s, or even his early 80s. He even spent an entire summer volunteering to rebuild a mountaineers' hut (which was actually more like a very large house) when he was 72, working hard at high altitude with men 1/3 of his age!
At the end it was his knee injury that precipitated things: unable to exercise as he was used to, and grieving for the loss of his wife of 55 years, his body rapidly lost all its strength and he died at 90 as a shadow of the "young man" he'd been until 85.
I can only hope to follow in my grandfather's steps when it comes to old-age fitness; there's clearly a genetic component there, but I am realistically aware that it can also all end very abruptly and unexpectedly. Just enjoy your fitness as long as you can, folks!Reply 45 RecommendJay Ryan San Francisco Sept. 9
But, today, we all have knee replacements available to us, which I consider one of the great advancements of medical science for older people. I have met many skiers and other active people with new knees and hips that have no complaints about their new parts. One older fellow was hard to keep up with skiing the trees in Montana last season. No longer are we doomed to a depressing end of life confined to a chair, inactive. And, Medicare pays for it!Reply 16 Recommendcchina39 massachusetts Sept. 11
Sarcopenia is indeed a serious problem in the elderly. Its effects are evident to even casual observers as we watch culturally iconic celebrities shrink with advancing age. This is especially evident in those who have adapted extreme diets in efforts to reduce cardiovascular risk, etc. One likely hormonal/cytokine culprit in sarcopenia may be myostatin, which can increase with age and acts as a "brake" on skeletal muscle mass. Animals with disrupted or mutant myostatin genes (such as the "bully whippet") are impressively muscular but otherwise healthy. Inhibition of Myostatin remains a viable and potent therapeutic strategy for many conditions of aging, including sarcopenia. As a physician I tell my patients to exercise and eat better, but this usually works as well as my "thoughts and prayers" do for gun violence. Most patients would rather have a medicine to make it all better. Perhaps blocking antibodies to myostatin may help here. it almost makes you want to believe in science! Almost, anyway.Reply 10 RecommendJay Ryan San Francisco Sept. 12
@Jay RyanReply 5 Recommend
Is myostatin related to statin drugs, such as atorvastatin and pravastatin used by my wife and me respectively?
I read that many statins (but not pravastatin) have side effects of muscle pain and myopathy. Is myopathy related to sarcopenia?Andrew S Saratoga Springs Sept. 9
No. Myostatin is a naturally occurring protein hormone. It is not a drug but rather a target for blocking drugs. The myositis or myopathy associated with statin drugs is due to rhabdomyolysis or toxic muscle rupture that is a drug side effect. Statin drugs and myostatin are not related but sound similar.g.i. l.a. Sept. 8
I cycle my bike everyday for 10 miles!Reply 4 RecommendTom Lang Chicago Sept. 8
I just turned 74. I belong to L.A.Fitness. Thanks to a nationwide program called Silver Sneakers, my membership is free. Check it out. Forty five minutes, three times a week is all I need. On the other days I walk.Reply 20 RecommendRoswitha Bormann san Rafael,Mendoza, Argentina Sept. 8
As a former YMCA Active Older Adults (55+) personal trainer, I always start with "the 3 rules."
Avoid Injury, Avoid Injury, and ...yes. Avoid Injury!
Ask questions of a pro or fitness staff person, take it slow, and don't "Load Up" with reps or weight... as if that helps you progress.Reply 19 Recommend
Injuries discourage older people, since we take much longer (I'm 72) to heal and return to the activity.Mike M Ridgefield, Ct. Sept. 8
Once again, a good article Ms. Brody. I have 76 years on my back, have been taking calcium since my childhood, I was born lactose intolerant. I have had bone densitometry scans done throughout my life, that have shown that I had the bones of a 20 something person. My new scan was three months ago, it showed that my bone density actually increased to that of an even younger person! And all that without doing weight lifting, eating a redigluless amount of protein, lots of exercise, etc. An anomaly? Why should we have to worry at our age about having lift heavy things, that is what we have help from younger people for. My grandmother's (she died at 94) motto: just live a healthy life and you will age well.Reply 7 RecommendNestor Potkine Paris France Sept. 8
Why I spend so much time in the gym. And, yes, biking and swimming are not enough for muscle strength. I found that out the hard way, thinking 2-3000 miles on the bike a year took care of my legs. Nope. Mix it up. Cycling and swimming and hiking for aerobic, weights for strength. It's hard work, staying in shape when you're old. takes up a lot of time. But, at almost 66, I fell pretty darn good. Better than the alternative, as they say.Reply 14 RecommendJean Holland, Ohio Sept. 8
A useful warning, says this 58 year-old.Reply 7 RecommendJG Tallahassee, FL Sept. 8
I have a Walk Vest. It was developed to help women who have osteoporosis or are at risk. There are little pouches that circle the torso of the vest and hold slender weights. You can start with just 2-5 pounds, and increase as comfortable with it.
The idea is to wear it while taking walks. In hot weather, I go without it ( since weighs interfere with evaporation from sweat) But much of the year I wear it as I walk my dog.
I also wear it sometimes when I walk around the house doing laundry, cooking or vacuuming.Reply 16 RecommendJQGALT Philly Sept. 8
one cup cooked pinto beans = 15.4 grams proteinReply 30 Recommend
1/2 cup cooked spinach = 3 grams protein
one medium baked potato = 5 grams protein
one cup green peas = 8.5 grams protein
one cup cooked edamame = 18 grams protein
1/4 cup almonds = 6 grams protein
one cup cooked lentils = 18 grams protein
You get the idea. Check out these vegan athletes:
https://www.businessinsider.com/elite-athletes-who-are-vegan-and-what-ma...Elizabeth Miranti⚾️ Palatine Sept. 9
I love meat and dairy but trying to wean off.
Trying a 3:2:2 diet.
3 days vegan
2 days vegetarian
2 days meat
Better for me. Better for the environment. Working so far (fingers crossed.)Reply 11 RecommendCynthia Rose NYC Sept. 8
Hmm. Sounds like you want everyone to be on your diet because it works for you.
I have three daughters, one who is vegan, one who is vegetarian, and one who is vegetarian plus poultry. Each one finds their diet perfect for themselves, enjoyable, easy, and healthy. I am a meat eater who tried vegetarian and could never feel full despite constant eating. I eat a tiny bit of meat and am satiated.
Each of us must find our own workable diet and keep tinkering to make health improvements.Reply 9 RecommendRon A NJ Sept. 8
I am 65 year sold and several months ago began using a Power Plate to exercise. It has not only increased my muscle mass but I feel as though my muscles are tighter to the bone, like when I was younger. I use the machine twice a week for about 20 minutes doing planks, squats,triceps dips and an assortment of balance exercises, which are quite challenging. I also do some stretches on it (There are many videos with workouts on YouTube). Other days I go to the gym and do yoga, or a spin class, sometimes a Barre class and I have noticed much better stamina and less soreness after the classes. It's also supposed to be excellent fo rebuilding bone density.
I tried to get my gym to purchase one for the workout floor but couldn't get them to do it so I purchased the home model which slides under the bed. Sometimes I use the back of a chair for stability.Reply 5 Recommendrafael. latorre NY, NY Sept. 8
@Cynthia RoseReply 1 Recommend
You're doing plenty of exercises, for sure, but I'm not sure about Barre class or the Power Plate being helpful for bone density. I'm under the impression that it takes something like box jumps, with its high impact forces, to strengthen leg bones. For the upper body, it would take lifting heavy weights.Joe Riley Seattle, WA Sept. 8
As a 57 yrs old practicing physician and commuter cyclist I can attest to the incredible benefits of excercise very well explained on this article. I would just add the incredible mental and cognitive benefits of exercise in all ages,our natural immunity, hormones, neurotransmitters including our natural endocannabinoids will increase, most free radicals (Cancer causing toxins) will be faster cleared by our kidneys and liver due to the increase in the blood flow of these organs, cholesterol fatty deposits in our vessels including the brain circulation will benefit in dementia prevention.Reply 24 RecommendSarasota Blues Sarasota, FL Sept. 8
Thank you for summarizing many of the additional benefits of exercise. One benefit to mention is that multiple studies show that exercise can help prevent or slow the progression of Alzheimer's.
I would add that there are significant psychological benefits. If you feel vital (and look it), there is less "invisibility."
At 60, I was in horrible shape and knew that I had to change. I'm now 68 and in better shape than most decades younger. What I would like to suggest is that losing weight or looking good isn't the goal. If you live a healthy lifestyle, all the benefits come along for the ride.
And working on your core (and posture) will save you a lot of pain.
If I can do it, anyone can. Do not go gentle....Reply 27 RecommendColenso Cairns Sept. 8
Great article covering 2 key components of The Big Exercise Picture...
1. Strength training
2. Nutrition (specifically protein)
I agree 100% with the article based on personal and client results (I'm a musician AND fitness trainer).
Allow me to toss in an upper range for protein requirements... 1 gram per lb. of body weight. This was documented in a recent (?) NYT fitness article, and I have a 30 year old fitness book by Arnold that states exactly that as well.
Combine a consistent strength training program with sufficient daily protein intake and prepare to be amazed at how your body will transform. You can't change your chronological age, but you can damn sure change your biological age.Reply 10 RecommendMargo Atlanta Sept. 8
As we age, we need to work on our strength and our speed more than our stamina. As I approached sixty, I had plenty of stamina, more than I had in my thirties, but I had lost strength and I had lost shocking amounts of the speed I had in my youth.
In part, this is because the more stamina work we do, our fast twitch muscle fibres will change into slow twitch, but (supposedly) not the other way around. Over the years, as many of us do, I had moved from being a so-so sprinter to an OK middle distance runner to a better long distance runner. But my speed had gone and I missed it.
We can't have speed without strength. Moreover, the product of strength and speed is power, the hallmark of every Olympian and Ancient Greek Hero.
I switched from lifting iron to lifting body mass. But our local council replaced the 28 mm or 32 mm OD overhead bar, in galvanised steel, perfect for pull-up, chins and muscle ups, with a super slippery, fat, electropolished 42 mm bar in marine grade stainless steel that nobody could manage to grip properly, even the two guys pounding out muscle ups.
The solution? Gymnasts' and rock climbers' magnesium carbonate chalk. To cut a long story short, at the age of sixty I've gone from barely being able to do three half pull-ups on the new fat bar to doing three hundred full-drop chins in thirty sets of ten. I'm far better now at chins than I was thirty and forty years ago.
Set yourself high goals. Don't aim for mediocrity. Aim for the stars.Reply 11 RecommendLarry Oswald Coventry CT Sept. 8
As I'm starting back at the gym, the timing of this piece couldn't be better. I'm looking forward to the second partReply 10 RecommendNestor Potkine Paris France Sept. 8
"at least 0.54 grams of protein per pound"
What would Sheldon Cooper think of mixing the British imperial and metric systems like this?
Where is the outrage? Have we no pride?Reply 13 RecommendJames Gramprie Ann Arbor Sept. 8
@Larry Oswald Drop the darn British imperial and go for the logical stuff.Reply 4 RecommendA. Brown Windsor, UK Sept. 9
1. With an increase in protein, more muscle may be made though you may not live as long.Reply 2 Recommend
2. As was pointed out in response to Ms Brody's articleThe Pooch Wendell, MA Sept. 10
@James Gramprie No. It says those over 65 BENEFITED from increased protein.Reply 1 Recommendtmann202 DC Sept. 8
Eating more protein has never been demonstrated to shorten the lifespan of real life protein-eating humans.
Even if it did shorten lifespan, we're looking at a lifespan vs. healthspan trade-off. I would rather have more strength, mobility, and quality of life in the here and now, rather than hypothetical gains in lifespan.Reply 1 RecommendMartha Ohio Sept. 8
"Protein acts synergistically with exercise to increase muscle mass," Dr. Morley wrote, adding that protein foods naturally rich in the amino acid leucine -- milk, cheese, beef, tuna, chicken, peanuts, soybeans and eggs -- are most effective."
Didn't your last column warn against fats such as dairy and beef? Shouldn't we be replacing these with processed vegetable oils??
Yeah probably not.Reply 2 RecommendMary Sullivan Roanoke VA Sept. 9
Is there no end to this nonsense? How long are we supposed to function, function, function? I'm in my 50s and I'm already exhausted by all the bossy health rules inflicted on us all. I like the idea of being active, like walking and swimming, for a long time, but who the heck cares if I can't move furniture when I'm a great grandma?? I'll be happy to putter around my house, knit, watch Netflix, and let other people do the heavy lifting for Pete's sake. Can't we just get a REST from all this insistence we live hyper active lives forever? Are we ever going to be allowed to just die in peace?Reply 63 RecommendForsythia715 Hillsborough, NC Sept. 12
Both of my parents recently died. When you are weak, you tend not to die in peace or pass quickly. You may slowly suffer as you shuffle off. So, perhaps being as fit as you can will keep your quality of life up so that you can enjoy the knitting, etc.Reply 6 RecommendWalter McCarthy Henderson, nv Sept. 8
@Martha I so agree with you, Martha. I'm 71 years old and in reasonably good shape. I do moderate amounts of exercise (which I thoroughly enjoy) and I'm not overweight. I try to eat a reasonable vegetarian diet, but have no intention of giving up ice cream, chocolate, cookies, and all the lovely French pastries/cakes I adore. I'm not going to live forever no matter how much attention I pay to my body. At this time of life, I want my remaining years to be as meaningful and generous-spirited as possible. I want to notice each passing day and revel in it. I want to cultivate kindness, patience, wisdom and gratitude. To me, that's at least as important as as spending large blocks of time trying to outrun the ticking clock imposed by my aging. Life is good. Enjoy it. It won't last forever no matter what you do.Reply 2 RecommendChuck Burton Steilacoom, WA Sept. 8
Sarcopenia also known as couch potato syndrome.Reply 9 RecommendAdolph Lopez New Orleans Sept. 8
My experience suggests that fit and healthy older people (like me) enjoy reading articles like this, because it brings self-validation. On the other hand, those most in need of this advice will skip it or at most scan it quickly. Like most of us, they are more than aware of their shortcomings and hate to be lectured.Reply 22 RecommendLW West Sept. 8
What about joint pain and the way it seems to work against you. I climb as many stairs and lift as many weights as I ever did -- even at age 64 -- but knees, ankles, wrists hurt more often than not. I generally push through the joint pain, but I think it's subconsciousely slowing me down.
How do deal with these together and still get the benefit?Reply 11 RecommendBob Walters Los Angeles, CA Sept. 8
I completely understand. While decades of long-distance running has kept the joints in my lower body arthritis- and pain-free, I have developed the same arthritis in my fingers and wrists that my mother and grandmother did. While I can adapt to some extent by carrying heavy grocery bags or suitcases by shoulder straps rather than gripping them in my hands, "pushing through" most recommended weight workouts, yoga classes and most housework requiring scrubbing or moving furniture end up with me kept awake all night with aching and stabbing pains in my affected joints.Reply 9 Recommendhakan seattle Sept. 8
@Adolph Lopez I'm 62. I've found I needed to add time to my workout routine to isolate small muscles, especially wrist, forearms, neck, lower back (back extensions) and rotator cuff (front and back). I also no longer ignore the romboids and scapula. At the same time, the likelihood of an abdominal hernia rises with age, so either lighten the weight on abdominal and leg press/squats or wear a support belt.Reply RecommendNativetex Houston, TX Sept. 8
12 reps? That's too many for muscle gain. One needs to lift as heavy and be in the 5-8 rep range to build muscle. She doesn't even mention protein supplementation. Nutrition is key in building muscle. I guess this is intended for geriatric types.Reply 2 RecommendBob Walters Los Angeles, CA Sept. 8
?? Ms. Brody gives three paragraphs to protein. You must not have read the whole article.Reply 6 RecommendMarcus NJ Sept. 8
@hakan I beg to disagree. Muscle fatigue will generate repair causing muscle growth.
You're right though, the heavier you lift, the faster you can become stronger. From my 20's to my early 50's I followed your suggestion. However, the rules change for those over 50 or so. IMHO no weight should be lifted unless one can do at least ten reps after age 50. Otherwise, the risk of injury outweighs the potential benefit of the extra gain.Reply 9 Recommendkaren nw arkansas Sept. 8
At 82 and after two back surgeries,I am aware that I can no longer do long hikes with steep climbs,however I still do 5 or 6 miles on relatively flat trails,walk as much as I can and do proper stretching exercises as instructed by a therapist.My philosophy is, keep your mind and body as healthy as you can by doing what you enjoy,avoid excessive stress at all cost and let nature take it's course.Reply 39 RecommendLJIS Los Angeles Sept. 13
I am familiar with the Tufts study. The book is "Strong Women Stay Young" by Miriam E. Nelson, Ph.D. and the first edition came out in 1997. I have been following her program for a little over 12 years; started after 'hormonal changes' aka peri-menopause and menopause started really kicking in.
I bought the equipment at Academy Surplus for under $100, follow the instructions and graphics in the book as closely to the letter as possible, and do this alone, at home, while paying close attention to form and 'muscle memory'. The exercises are truly simple and easy to start from a beginner's level.
Now, I am at about 40 minutes a session about 2x a week, give or take some sessions and/or minutes, and allowing for travel, illness, self-sabotage, etc.
I was astounded at how quickly the physical, mental and emotional benefits appeared. And, they accrue. I am pushing 65, and more often than not, I feel somewhere between pretty good to awesome.
I work from home at a somewhat-stressful, very sedentary job, eat regularly and 'healthily' but don't stress over details or 'forbidden' foods (although I did move away from alcohol, sweets and most highly-processed foods - they just don't taste or feel good anymore).
This is truly something for everyone - not just for those with lots of time and/or money; most especially it is for those of us who, for no good reason, think we can't do it. We can.Reply 33 RecommendTom New Mexico Sept. 8
@karen (and others!) I am exhausted from waking up every hour sweating during my perimenopause. I don't have the energy to exercise and am concerned about muscle loss that I can already see. It's all I can do to drag myself out to walk a couple of miles every day! Thank you for posting. What I'm hearing is that you CAN recover muscles after this time of life. I sure hope so. For now I have a low-starch low-sugar diet with plenty of green vegetables and lean protein and do my best. I wish there was more support around this.Reply Recommendgd Kansas Sept. 8
This article seems to imply that sarcopenia and muscle loss associated with aging are the same thing since the prescription is targeted exercise. If sarcopenia is a pathologic condition how is it different from age-related muscle loss - the article does not address this.Reply 7 RecommendJus' Me, NYT Round Rock, TX Sept. 8
Muscle loss happens to everyone, regardless of what you do. Of course, it can be slowed by vigorous exercise, but let's be honest about it. Despite continuous vigorous exercise, I have seen my strength decline steadily, so that now, at 81, it is difficult to run a distance of several miles, despite having done it regularly for fifty years. I have to content myself with switching to shorter runs along with walking at a brisk pace. We need to manage the decline of aging, not deny it, or call it a fancy name.Reply 33 Recommendtbaker Massachusetts Sept. 8
"Vigorous exercise" is NOT the same as quality resistance training, as you very well note the outcome of your own experience.
Long distance runners get plenty of "vigorous exercise," right? Look at their bodies, then the bodies of sprinters.
Case closed.Reply 1 RecommendJimmyMac Valley of the Moon Sept. 8
The excercise being recommended here is not vigorous aerobic exercise. It is strength building options with weights and/or resistance. Miriam Nelson, who was among the researchers at Tufts who were part of the findings mentioned in this article, reported in her series of books how strength builidng exercises should be prioritized prior aerobic options for their muscle building and maintaining results. Those results will in turn support aerobic acitivty. The claim isn't that there won't be diminished capacity in older years, but that is can be signifcantly countered and preserve independence. Here's a link to research on Miriam Nelson's strenght training program results for women ages 29-89: https://projects.ncsu.edu/ffci/publications/2012/v17-n2-2012-summer-fall...Reply 17 RecommendSusan In Ventura Camarillo Sept. 8
Statins are often the cause of muscle weakness.Reply 11 RecommendSWA Des Moines Sept. 8
@JimmyMacReply 1 Recommend
I would like to read about this.Jus' Me, NYT Round Rock, TX Sept. 8
The key to being active and maintaining muscle mass over a life time is to find something you truly enjoy doing. I disagree with the author that that has to be weight lifting or using bands or tubes. Many people, including myself, find these workouts- typically done in gyms- repetitive and boring. I want to be outdoors and doing things that seem natural and gone be done with a group. For me that is cycling (competitive). Jane writes that cycling alone is not enough even for the muscles used in the activity. That is definitely not my experience. I see many riders in their fifties and sixties ( I am 55) who are extremely active, competitive and have very muscular legs. You just need to ride, or run, or swim strenuously. Also, I think yoga should be suggested as a great group strength building activity. Find something you love, do it routinely and with increasing intensity, vary your workouts and stay active.Reply 14 RecommendLW West Sept. 8
Prevention of sarcopenia DOES require resistance training. There is no alternative.
I too, hate "the gym" and the boring work. But it's that or sarcopenia.Reply 11 Recommendbonmom Arcata, CA Sept. 8
I try to add in those repetitive and boring (I completely agree with your description!) as part of a cool-down stretching routine after an enjoyable vigorous workout (for me it's running, and I'm also mid-fifties). It's a little less monotonous if you can do it outside (grass field, playground equipment) or at home with a TV show on (I rarely watch TV, and tape things I'd otherwise miss as further motivation). When all else fails, I invite the dogs and/or cats to join me and turn the "weight work" into an impromptu wrestling/agility match. My mother, at 88, has never participated in any formal exercise, but still does most of her own housework, gardening, shopping, and so forth. Obviously she has good genes, but I see too many people her age and younger that do nothing but sit still all day, then blame their loss of mobility solely on aging.Reply 8 RecommendHerb Silver, PT, DSc Atlanta, GA Sept. 8
Very good advice, but in the process of compiling an exercise program, there are really 5 important things to consider: strength, anatomy, cardiovascular, flexibilty, and nutrition.
Everyone brings his/her own physical quirks and limits to an exercise program. Not everyone can or should carry a heavy weight, as it increases the load on the knees. Walking stairs can be hard on hips and knees as well. Arthritis is a reality and can be caused to flare with too much of the wrong exercises. Backs can be fragile until strengthened properly.
Be sure to warm up and do not do something that is painful in the wrong way. A groan with an effort is one thing; a sharp wince is another. Listen to your body and push its limits, but do not push into injury territory. You take one step forward and two back if you do.
Also, working and strengthening the muscles increases their tone but can decrease flexibility. Balance and suppleness are very important to avoid falls as well, so mix in some yoga to keep that good posture and reach.
We are more likely to have injuries as we age and/or are deconditioned, so be sure to take care not cause the very thing you are trying to avoid.Reply 13 Recommendshirley seattle Sept. 11
@bonmom 1. If exercising with weights through full range of motion, you add sarcomeres, the contractile units in muscle and you will increase flexibility. There is nothing in the structure of muscles that actually stretches significantly. I have done yoga for almost 50 years. I am pretty close to as flexible as I was as a teenager but I am not a contortionist. My hamstrings actually get longer when I do hamstring curls (but I am not consistent enough). 2. Yes, doing exercise correctly and only doing certain exercises and avoiding others is necessary, but the most obvious observation is that people with knee pain need to exercise more not less. I am not suggesting exercising through pain but research studies are pretty consistent that strengthening tge lehs reduces knee pain.3. It also has been should that physical therapy interventions that include manual therapy interventions is an additional benefit over exercise alone.Reply 7 RecommendBathsheba Robie Lucketts, VA Sept. 8
@bonmom An excellent response!!!!!\Reply Recommendmagicisnotreal earth Sept. 8
I have a condition called pudendal neuralgia. It was caused by medical malpractice. I cannot sit without awful pain and am on pain killers. I have a long list of activities I must avoid, including . House work. I am not allowed to lift anything over ten pounds. Any kinds of exercises which involve sitting are verboten.
Of course, no one can live this way, but I am careful. I still do grocery shopping and most of my chores. I had a cat for 22 years and want to get another. Kitty litter doesn't come in ten pound weights.
I thought I had a high protein consumption but it's nowhere bear what you recommend so protein supplements will be necessary.Reply 6 RecommendJenD NJ Sept. 8
@Bathsheba RobieReply 8 Recommend
If I may suggest, look at some Tai Chi videos on YouTube. It is basically a slow moving dance where you activate your muscles to move your body. It is very well designed to hit all the major and minor muscles.
I am not yet 60 and while aware of muscle deficits, some life long due to injury I was still surprised that muscles I never thought of simply were not activating when I tried to do the movement correctly.joanne South Central PA Sept. 8
@Bathsheba Robie I am familiar with chronic pelvic pain conditions, including pudendal neuralgia. I hope you have been able to get treatment with a physical therapist who specializes in pelvic disorders, as well as a physician who specializes in these problems. Wishing you the best.Reply 1 RecommendLisa Merullo-Boaz San Diego, CA Sept. 8
I am only 68, but started several years ago to try and strengthen my arm and leg muscles. Every day while I am brushing my teeth in the morning I stand on my left leg for 30 seconds, then the right and repeat again. Every night while also brushing my teeth I do at least 15 squats, and after that 20+ push-ups against the edge of the vanity. While not prescribed exercises, I believe they help tremendously to keep my muscles strong. It is easy to remember to do them because it is tied into something (teeth brushing) that needs to be done twice a day.
Some time ago I was listening to a radio program about elder health. The doctor being interviewed was asked what one thing contributes most to aging decline. His answer: "Living in a one floor house". Without that daily climb up and down the stairs as a minimum exercise leg muscles decline quickly as does independence. I think that is a good piece of advice, but one seldom followed even in communities for the elderly. Housing is built for how people are rather than for what they should aspire to be.Reply 20 RecommendNestor Potkine Paris France Sept. 8
@joanneReply 4 Recommend
I love that you said, "only 68." Bravo! I turn 65 next month, and I don't know what's harder to stay healthy: physical exercise or mental, reminding myself that I'm not completely old yet. Thanks!
LMBBoregard NYC Sept. 8
@joanne smart idea, the mixing of exercices with repeated chores !!!!!Reply 2 Recommendbearsvilleboy bearsville, ny Sept. 8
As a retired personal trainer...one of the biggest mistakes the "profession" does with older adult clients is not use heavier weights when applicable. But many trainers immediately shy away from them due to biases about the older client. (some are correct, but the client must be properly assessed physically, not just verbally.)
Loaded carries are a prime example. Carrying a weight (dumbbells or kettlebells, sand bag) in one hand or both, or cradled in the arms, over a distance. It promotes allover strength, and is perhaps one of the most "functionally" driven exercises there is, mimicking a common complaint of the older clients."I cant carry my groceries anymore. My grip strength fails...my shoulders hurt, my legs give out..."
Too many trainers, too often go for basic bodybuilding type exercises - dumbbell curls, presses. Or use machines for exercises (tricep push-downs, lat pull-downs - please stop those completely!) that are more a bodybuilding finishing exercise, then strength builder. An older client will not gain the needed strength from a lat pull-down, no way. Its both too risky (for most clients, of any age) but an uncomfortable movement for those with range of motion (ROM) issues.
Train the non-trained older client by having them do movements, under-load when possible, that mimic everyday movements. Walking, carrying, pushing, getting up from a chair to start, and when possible from the floor.
Creativity for the older client is crucial.Reply 79 RecommendCone Maryland Sept. 8
I am 75 and my first exercise at the gym 3x/week is to balance myself on each side of a Bosu Ball for 60 secs. I believe this builds muscle memory and prevents falls.Reply 14 RecommendBill South Carolina Sept. 8
How inspirational! I have just had a pacemaker implanted and it will be some time before I can fully use my left arm but I can bring back my weights and get started. I have a physical therapist to work with too.
Signed, an 81 year-old.Reply 9 RecommendLisa Merullo-Boaz San Diego, CA Sept. 8
I am a 74 year old man who has been an lifelong exerciser. Before I retired, I ran 15-20 miles per week and lifted weights 2-3 times per week. Running injuries made me a walker who still does 10-15 miles per week in a mountain community.
I noticed at around 70 years of age that I was not able to lift as much as in earlier years. I always try to do better, but have to take care not to injure myself.
I agree with the tone of the article in that exercise is key to a better old age. I see to many of my friends who play golf only(if that) and eat way more than they need. I should post this article in my local wellness center. Unfortunately only those who don't need this advice will see it.Reply 13 RecommendRichard Albany, New York Sept. 8
@BillReply 7 Recommend
Post it anyway. Even if only one person reads it and takes it to heart, you've made a difference!
LMBM. Lyon Seattle and Delray Beach Sept. 8
As a physician with many elderly patients, my sense is that as you get older (70's on) the relative benefit of resistance training (especially in conjunction with balance and flexibility training, which can be integrated) increases. Someone in their 40's can be pretty fit and have good quality of life with just aerobic training. Aerobic training is good as one gets old (brisk walking is great), but without resistance trying, functionality decreases more rapidly. Just 2 days a week can make a huge difference. My biggest problem is figuring out how to motivate people and give them ideas for exercise in a short office visit.Reply 23 RecommendJo Marin California Sept. 8
@Richard As I mentioned in another comment, I highly recommend Canadian physiotherapist Margaret Martin's website, www.melioguide.com . The website offers superb strength-training, balance, and flexibility exercise programs for women over 50, complete with videos of each exercise. The exercises can be done at home and require just a few pieces of equipment. Margaret Martin's programs (beginner to elite) are targeted at those with low bone density, but those with stronger bones will derive great benefits, too. I rarely rave about such things, but this website has changed my 50-something life.Reply 3 RecommendGandhian NJ Sept. 8
Yeah, I'm in my late forties, and do fine with aerobic exercise, but on my to-do list for the next year or so is to start resistance training for the long run.Reply 2 RecommendJus' Me, NYT Round Rock, TX Sept. 8
I am vegetarian from India who rarely consumes eggs. My grandfather was a vegetarian who ate mainly rice twice a day but being a farmer was physically active all his life . He lived up to 90. My father was also a vegetarian who ate mainly rice twice a day but did not do much of exercise as he moved to city to make a living. He lived to 86. My uncles all lived to mid 80s and all were strict vegetarians. On the female side all my ancestors lived to mid 70 to mid 80s. They were all thin just like me. All these health articles and research, I believe are focused on white folks whose genes are perhaps different from Indian genes. It would be best if there were some statistics on diversity.Reply 42 RecommendLW West Sept. 8
And the Indian descended head of the American Vegetarian Society, or something like that, dropped dead in his early 60's.
This article is not about longevity. It is about a quality of life achieved by specific regimens.Reply RecommendGerald Portsmouth, NH Sept. 8
My mother, born in Germany and of German-Swiss, has always eaten a high-fat diet heavy in animal products, as has most of her family. She, her brother, and most of her cousins and friends back in Germany and Switzerland are living active and independent lives in their late 80's and early 90's, and most of their parents and grandparents died in their late 90's and many over 100. Not all are or were thin, but none were ever obese. In their case, I credit both good genetics and lifelong activity (not formal exercise, but walking, living alone and doing their own housework, gardening, shopping, and so forth). I agree there should be more statistics on diversity as well as diet and exercise or lifelong activity, but there is a lot of diversity within racial groups as well.Reply 3 RecommendNagesh Ramamurthy Bangalore, India Sept. 12
My ancient mother in the UK turns 97 in October. She lives on the second floor, with no elevator. Her doctor actually encourages her to use the stairs, which she does 4 or 5 times a day. He also told her to hide the remote control for the TV so she has to get up every time she wants to change the channel or volume. She lives on her own and still insists on cooking for us when we visit. She eats well. She was an avid walker all her life and was never happy if she couldn't exercise. She is my role model for aging and staying active. I'm almost 72 and plan to emulate her.Reply 54 RecommendIvy CA Sept. 7
@Gerald That is amazing! To be 72 and to have a 97 yeaar old, fit mother! Living on the 2nd floor, and taking the stairs 4-5 times a day! Wow! My sincere regards to her!Reply RecommendJames Gramprie Ann Arbor Sept. 7
This is just too much food, even for me 25 years younger.Reply 7 Recommend
And as noted by others, all animal-based sources.
Lift weights yes, eat protein yes, but from a variety of sources.
Also some meds have side effect of sarcopenia--how does this work for elders?Ron A NJ Sept. 8
1. Increased protein intake may be needed for increased muscle mass but this increased protein may occur at the expense of shortened lifespan. "Blue zone" inhabitants do not eat a lot of protein, and most of what they do eat is not from animals.Reply 31 Recommend
2. To my frustration, Ms. Brody mentions no non-meat sources of protein. This is reminiscent of a previous article where she raised concerns about plant-based protein sources. "Complete" protein foods have all 9 essential amino acids. These include soy, the ingredient in the widely available tofu, and quinoa (remarkably tasty - and selected by NASA for long-duration space flights). And, of course, you don't need to get all 9 essential amino acids with only one food source.The Pooch Wendell, MA Sept. 10
Thanks for the links. They were interesting and I ordered a copy of the Blue Zones Solution. Thing is, the US and UK studies do recommend a high protein diet for people over 65. The long-living people of the Blue Zones do not eat a lot of protein but, then, there is no recommendation against it, either.
A quote from the 2014 study funded by the National Institute on Aging:Reply 8 Recommend
"... in participants ages 65 and older, those who consumed high amounts of protein had a 28% lower risk of dying from any cause and a 60% lower risk of dying from cancer. These associations weren't influenced by whether the protein was derived from animal or plant sources."Nina Bay village Ohio Sept. 7
@James GramprieReply 2 Recommend
Humans and human ancestors have thrived by obtaining their protein (and many other nutrients) from meat, fish, and eggs, since forever.Jo Marin California Sept. 8
People age. They need assistance. Instead of pretending aging will not take its toll or it can be prevented, we should provide help and assistance. It is cruel to continually insist that if only old people would do this or that, they can retain what is lost with aging.Reply 19 Recommendvmdicerbo Upstate NY Sept. 8
There is a huge difference between aging badly and aging well. I have watched both. People who were sedentary, and could barely walk at 80, and people who were always active still walking comfortably at ninety. That's ten years of a higher quality of life! That is no small thing.Reply 14 RecommendSteveRQA Main St. USA Sept. 7
@Nina That was not what I took away from the article. No one will deny that aging will eventually take its toll on our bodies. As a lifelong exerciser my primary motivation is my QUALITY of life. I want to get the most out of my limited time here.Reply 7 RecommendJeffrey Dach MD Davie Florida Sept. 7
Weight training or resistance training is, as we know, the best thing we can do to maintain or increase muscle mass in the body.
In my opinion, weight training SLOWS the aging process, forcing the body to constantly repair the micro tears we make in our muscles when we weight train.
So yes, Weight training or resistance training is good, so we should do it. That's easy for folks who like to, (yes, we are out there). But what if you don't like to weight train? Best bet is to get a friend who also wants to weight train and become training partners so you can push each other.
The is still another roadblock. Pain and injury. Nothing can stop you dead in your tracks like pain. Folks who are lucky enough to have enough not to have Pain or injury will of course be able to train.
Lastly and the most important. Get into a routine and DO NOT STOP. This is the most common mistake folks make. Whatever exercise you prefer to do, KEEP DOING IT. Its not easy, but your body and life will be better if you can.Reply 54 Recommendhb mi Sept. 7
One of the best discussions of this topic of sarcopenia comes from Dr. Sgrς from Rome Italy in Feb 2018 Aging Male. Dr Sgro suggests the three pillars to fight sarcopenia are: 1) Physical exercise, 2) nutrition and 3) hormones. I think Dr Sgro is quite correct. A huge consideration concerning nutrition is the age related gastric atrophy with decline in gastric acid production needed for protein absorption. How many of the elderly are suffering needlessly from sarcopenia because of gastric atrophy? For more see: https://jeffreydachmd.com/2013/03/hair-loss-from-low-stomach-acid-lady-i...Reply 5 RecommendMary NYC Sept. 7
I'm over 60, and I still love and crave excersize. There is no better feeling than your heart beating rhythmically on exertion. I just can't comprehend the sedentary, the lazy, the obese. They are not alive but are merely existing. Start slow and never stop.Reply 12 RecommendAnne Arizona Sept. 7
Surely there's a way to do this without a gym?Reply 3 RecommendDiane Newton, MA Sept. 7
@Mary I bought free weights (five- and ten-pound dumbbells), a yoga mat, resistance bands, five-pound ankle weights, and I exercise at home. Plus I try to walk a lot, but it's exercising with the weights and bands that really make a difference. No gym necessary.Reply 25 RecommendMeredith New York Sept. 7
@Mary I have been working out at home, with good TV shows for entertianment, for 20+ years. I see a trainer every few years to get a tune-up. The best exercise program is the one you do so if you hate the gym (I do) start at home.Reply 11 RecommendMargo Atlanta Sept. 8
Oh no! Give us a break, Jane.
"The critically important "but" -- no matter how old or out of shape you are, you can restore much of the strength you already lost."
Well, isn't that great to look forward to? Even people in their 90s, in a nursing home, no matter how out of shape, can work to restore much of their strength? So we'll have this great 'responsibility'?
You mean we won't be able to relax even in our 90s? And in a nursing home yet? Is their no rest? Let's start a movement for R&R for the elderly!
" high-intensity resistance training" significantly enhanced the physical abilities of nine frail nursing home residents aged 90 and older."
"Frail"? Yikes, high intensity? Then feel guilt if we don't "keep in shape" like a 90 year old SHOULD? We owe it to ourselves? I see.
What's the reason it's long overdue to act on this info known for 30 years? Maybe 90 year olds don't want to be bothered with this in their nursing homes. And doctors/nurses don't want to burden them. 90 year olds want to relax, and they deserve it! Give them a break already. Sarcopenia? But muscle loss with aging isn't a disease.
Jane Brody has always written with pride in her great exercise routines, swimming, walking, etc keeping her strong and healthy. Bully for her. I go to exercise class and I appreciate her helpful advice but --- maybe she's a bit too fanatical. I hope if I go to a nursing home, I'm not in the clutches of anyone like that.Reply 24 RecommendJo Marin California Sept. 8
I don't expect any extreme effects from weight training, but I know that stronger back muscles mean my backaches go away and I'm less fatigued after gardening. Given the choice of a lighter weight barbell or a pain reliever, I'd prefer the barbell.Reply 11 RecommendSB Vermont Sept. 7
You need to spend time with more elderly people. The difference in quality of life at higher ages is night and day between those who stay active and those that don't. All 90 year olds do not have identical qualities of life, or eighty year olds, or seventy year olds, and a major factor that makes a difference is exercise.Reply 1 RecommendJus' Me, NYT Round Rock, TX Sept. 8
Yoga and gardening also work. I won't be a slave to the gym -- boring! Do what give you joy.Reply 12 RecommendF. Cox MD Rochester, MN Sept. 7
Yoga and gardening will NOT prevent sarcopenia, any more than walking around the grocery store.
Muscles need to be stressed. Nothing about gym slavery. Buy your own weights or bands.Reply 4 RecommendStephen Spang New Jersey Sept. 7
For those who wish to increase their protein intake, there are some caveats. The September 2018 issue of the Harvard Medical School "Harvard Health Letter" warns of "The hidden dangers of protein powders" and recommends consulting the nonprofit The Clean Label Project's website ( www.cleanlabelproject.org) for information on contamination with toxins.Reply 8 Recommend
You may also be interested in the September 2018 issue of "Nutrition Action Health Letter" which has a several page article on dietary protein consumption. The Letter has been in existence for more than 40 years, has a prestigious science advisory board and is published by non-profit Center For Science In The Public Interest which lobbies Congress on health issues related to food. (Not all lobbyists are evil. This one lobbies in the public interest.)Margareta Braveheart Midwest Sept. 8
Interesting article, but Dr Morely's statement on protein requirements seems higher than the USRDA, Are there references for his statements in peer reviewed journals?Reply 7 RecommendMary Hafer MD Boise Idaho Sept. 7
The USRDA protein numbers are minimal necessary, not optimal. If you do a search on the net, you'll find a number of NIH studies that support Dr. Morely's statement.Reply 4 RecommendF. Cox MD Rochester, MN Sept. 7
If the expert opinion is that older people need AT LEAST 0.54 g protein for each pound ideal body weight, then the following statement should read , not " need as much as " 81 g protein per day, but AT LEAST 81 g protein per day for an individual with ideal body weight of 150 lb. The beneficial effects of protein on preventing and treating Sarcopenia appear to be dose related , meaning even more protein than the 81 g per day example in the article would be advisable. Even in this article highlighting the benefits and importance of dietary protein, the example lowballed the recommendations. Ignorance and ambivalence about the science supporting a diet higher in protein is rampant and helps perpetuate a host of chronic health problems including SarcopeniaReply 3 RecommendIvy CA Sept. 7
@Mary Hafer MD I agree with your comment. And my son who has a Ph.D. in Nutritional Biology from UC Davis and has been the editor for a research volume on sarcopenia says he agrees too. And for the other readers, the article is correct in pointing out that the protein consumed should contain significant quantities of the branched chain amino acids (leucine, isoleucine and valine) because it is the level of these amino acids which turns on protein synthesis needed for muscle hypertrophy. I can also recommend "The Healthy-Aging Diet" report published by Health & Nutrition Letter/Tufts University Friedman School of Nutrition and "The Mayo Clinic Diet" book by Donald Hensrud, M.D., M.P.H.. Dr. Hensrud is Director of the Mayo Clinic Healthy Living Program where a program of classes in health and nutrition (including cooking classes) is taught to the general public and to physicians. DVD recordings of his lectures on The Mayo Clinic Diet are also available from The Great Courses.Reply 10 RecommendErin B.Y. OC, CA Sept. 7
@F. Cox MD What older person can or will eat that many calories? My Mother was active into her mid-80s and even then ate more than me at 30+ younger. I fed her a balanced diet and often we went out for her favorite hamburgers (I couldn't cook, I had salmon burgers)--but is a burger even that much protein? I understand the science but seems off.Reply 1 RecommendOld Lifter California Sept. 7
Ok, these aren't the comments from the anonymous op-ed piece...unless I missed the part about yoga in thereReply 2 RecommendRMH Houston Sept. 6
I think our expectations should be much less modest than the comments and article suggest. I am in my mid/late 60's and between my 50's and now was able to rebuild every bit of muscle mass that I had lost by sitting in an office chair at work every day followed by more sitting at home over decades. I started very modestly with the proverbial 5 pound dumbells and built up slowly over 15 plus years of steady lifting. Exercise and lifting is the highlight of my day, mostly because of the enhanced ability to enjoy day to day life more as a fitter person. With steady progress over a period of years you will be astounded at what you can do. I understand that this seems to not be most peoples cup of tea, and most people seem to get bored with it. In some ways I look at it like brushing your teeth and flossing. I do not skip brushing just because I am not in the mood, and I don't skip lifting either. Don't go overboard, but don't attach undue weight to what your doctor says either. There is insufficient research for any doctor to really know anything about this. As one person noted, each type of doctor sees exercise through their own lens. If I had listened to my doctor I would still be lifting 5 pound dumbells and would not have even one additional ounce of muscle mass. Do whole body exercises. To the extent that your flexibility allows learn and do squats, deadlifts etc. Start with body weight and go up from there. Walk or bike everywhere. But stick with it over the long haul.Reply 45 RecommendLW West Sept. 8
For the aging body I strongly recommend a program of: yoga for flexibility, balance, strength and serenity; weight/resistance training for strength; and aerobics for cardiovascular health. Strength training by itself is not sufficient.Reply 35 RecommendShelley Kath Montreal, Quebec, Canada Sept. 6
@RMH True, except that my aerobic exercise gives me serenity. I do yoga for the other benefits, but find it more annoying than peaceful. Still, I feel better when the class or routine is over!Reply 2 RecommendPhilip Greider Los Angeles Sept. 6
Thank you so much for this important article. Finding out more about what can be done to prevent and even address sarcopenia is something that will be so valuable to so many! More details....please! And of all the factoids in this article, I think it was the visual of marbled meat that most motivated me to look around for my free weights. -- Many thanks, SKReply 8 RecommendSneeral NJ Sept. 6
Of all the studies in the medical literature that I've read over the years that compared exercise to pretty much anything else when treating cardiopulmonary disease, depression, osteoporosis, insulin resistance, etc, etc, almost every single one of them showed exercise to be superior. So it shouldn't be at all surprising that exercise prevents sarcopenia better than anything else. The hard thing will be to get enough people to actually follow that recommendation because, as we have seen, all the ills of a sedentary lifestyle have become more and more common despite the knowledge that exercise prevents them,Reply 14 RecommendRobert Shaffer appalachia Sept. 6
Yes. But the main reason no one should be surprised that exercise is the best way to stave off and reverse sarcopenia is because it's about muscles!Reply 1 RecommendF. Cox MD Rochester, MN Sept. 7
At seventy, I think of the old farmers I grew up around with a nostalgic view of the way they lived. Life was hard. Many of them were as muscled and wiry as old locust posts and still died young. Some sat down in rocking chairs at the age of 60 exhausted after decades of hard, heavy labor, timbering and farming, and never picked up a shovel or tool again, and lived to be old. Many of them did the kind of physical work we don't do today. They tugged and lifted, and walked, and climbed and moved heavy objects,by hand, with their backs and...you get the idea. Then they ate everything put in front of them, vegetables put up in jars, fruit from orchards, bacon, hams, beef, most of it fried, or baked and boiled, baked goods with dough slathered in lard. Were they strong and healthy? Some were as strong as mules and lived to be old men. Some grizzled fellows, tough as old leather but died young from all the things we fear today, heart disease, cancer, diabetes, etc. In other words, there never seemed to be any rhyme or reason to longevity relative to heavy, lifting, muscle work. I agree it can't hurt to exercise, lift weights, and more, but I think a lot of folks just need to relax enjoy a piece of apple pie, put down the extra fries, and take my grandmother's advice, "everything in moderation."Reply 77 RecommendKBD San Diego Sept. 6
@Robert Shaffer Your personal experience is only anecdotal at best. The science of medicine has been working under the auspices of "evidence based medicine" for more than 40 years. The very lowest and rarely used category of evidence in this hierarchy is professional experience but even that is better than what you propose because the observer is highly trained. The overwhelming mass of evidence based medicine/epidemiologic studies have shown a correlation between exercise and a number of positive health benefits (longevity, prevention of heart disease, stroke, diabetes, high blood pressure, etc.). Some noted authorities have even hypothesized that a lifestyle of exercise, a healthy diet, nonsmoking, non-obese body mass index and very modest alcohol consumption would lead to an elimination of close to 80% of all human chronic disease. If you prefer a laissez-faire, only pleasure seeking lifestyle, then you should have to pay much higher health insurance premiums rather than burden your healthy lifestyle peers. You're going to need the health care. e.g.: "Impact of Healthy Lifestyle Factors on Life Expectancies in the U.S. Population", Circulation, vol 138, Issue 4, pp. 345-355, July 24, 2018. (www.ahajournals.org/journal/circ/)Reply 10 RecommendKay White Washington, DC Sept. 6
Having done "heavy" weight lifting all my adult life, at 71 I am still aggressively training to increase my totals. All articles I have read on this critical subject should have advocated a far more demanding weight lifting regime. Of course everybody needs to start at the level they can safely manage, with good form, but they should be encouraged to go beyond that as rapidly as possible. Key to this is certainly increased intake of protein. Another possible key, which the medical profession avoids with statements about "normal" hormonal levels for a given age begs the question of what should be considered normal for a basically enfeebled sample population.Reply 4 RecommendDebbie M Work Sept. 6
Girls should be encouraged to begin lifting weights in school. There has always been this hysteria that if women lift weights, they will bulk up like men. It's not physically possible for women to have men's bodies from weight lifting! (That's accomplished only by taking steroids and extreme dieting.) I started lifting in high school - one of the few girls in weight lifting class. I still lift... Lifted this morning before work, as a matter of fact. I'm 47, strong, and I feel great. And as strong as I am, I don't look like a man! I hope I can lift until the day I die. Women, you will age so much better if you lift. You will feel sexier if you lift! Don't be afraid to start today!Reply 83 RecommendRaindrop US Sept. 8
@Kay White Funny, my little country high school in the South, where you would think women would be encouraged to be extra-feminine, required weight lifting for girls at PE. We never got bulky but we were faster and stronger for it. Back then (class of '79) there was a program called President's Physical Fitness test. It was a good measure of areas we needed to work on to be fit. I'm not sure why that is no longer used at public schools, but I wonder if there would be advantages to resuming it.Reply 13 RecommendSamantha Arey Boston, MA Sept. 6
We had a presidential fitness test when I was in high school. It was replaced in 2012; read more at Presidential Youth Fitness Program, or https://pyfp.org . Do you think the president could pass the old test?Reply 1 RecommendKim North Carolina Sept. 6
"'Use it or lose it'" is a very interesting was to start this article. As someone who has taken psychology in school, I associate that phrase with the loss of neural connections or even the ability to perform certain activities. I did not know that this simple phrase also related to muscle as one ages. It seems that part of sarcopenia is not just a decline in activity, but also a result of the aging process. If hormonal changes, inflammation, chronic illness, and poor nutrition also affect sarcopenia and the accompanying symptoms, this condition seems more complex than the phrase "Use it or lose it". For many people, working out more often or strength-training programs might not be the best fit. It makes sense that it is important to strengthen all muscles in the body and eat well, especially for someone who is older. However, I wonder if the reason few physicians tell patients about sarcopenia is because they have other health priorities to worry about with their patients. As sarcopenia affects the emotional and physical well-being of individuals, it seems crucial that physical therapists and doctors work with patients to reduce fall-risk and increase their independence. As a freshman in college studying physical therapy, I am interested to see further research on this condition. I want to see how exercise and lifestyle can reverse the muscle losses, and how individuals can slow the rate at which muscles are replaced with fat and fibrous tissue.Reply 4 RecommendMon Chicago Sept. 6
I am 60 and began weight training a year ago. I was overweight, my blood pressure was going up, my knees hurt all the time from playing football and doing martial arts in my youth, and I had developed gout and early arthritis. I followed a program called 3x5's which is three separate free weight exercises doing three repetitions five times. In other words you are going to do 15 reps with each exercise. Every other day you add five pounds to the barbell, or if that proved too much add five pounds each week. I tend to do weight training at least three times a week then on the days off from weight training do other excercise such as walking, yoga, bike riding and boxing on the heavy bag. I started just with the barbell (it weighs 45 pounds) now I can do 190 pounds deep squats, bench-press 145 and dead lift 250 pounds. I feel great, my knees no longer hurt and while I have not lost weight (all the muscle I have added weighs more than fat) I have lost three inches off my waist. I feel younger, stronger and now love going to the gym to workout.Reply 26 RecommendVaibhav USA Sept. 6
Very important and informative article. However, the recommendation on increasing protein intake to an ideal of 81 g and listing foods that have high protein but also a high-level of fat is not helpful in figuring out how much protein is needed. One needs to adjust the protein to their level of exercise which needs to be adjusted to the extent of the sarcopenia, gender, exercise tolerance, and many other factors.Reply 4 RecommendRussell Eaton Ecuador Sept. 6
So, ideally usage of ipad to be reduced and restart using the laptops. This will help me use my hand muscles. Why so? Because I tend to skip gym and love to walk. Laptop will work for me as weight training program. :)Reply RecommendTy Thomas Los Angeles, CA Sept. 6
Sarcopenia is not a disease. It is a normal process of aging. To ask the question: do you have Sarcopenia, is meaningless. As we age we gradually lose muscle. But why do we lose muscle? This happens because our body must always maintain a minimum amount of glucose in the blood. When blood glucose drops below the default level, our body strips protein from lean muscle tissue to make emergency supplies of glucose until enough is forthcoming from the diet. This is known as gluconeogenesis. We mostly lose muscle at night when we sleep because that is when glucose levels in the blood drop more than usual. This is perfectly normal, but this is how we lose muscle gradually over time. The best way to minimize gluconeogenesis is to avoid low-carb and intermittent fasting diets, and other lifestyle factors that make your blood glucose plummet in your daily life. Also avoid sugary foods that make glucose zoom up, because insulin will then make your glucose plummet and galvanize gluconeogenesis. Exercise and strength training help, but only very marginally.Reply 8 RecommendGGBound Brunswick, Georgia Sept. 7
@Russell Eaton - I believe your recommendations, while knowledgeable, may not be accompanied by a great deal of personal experience. Or that perhaps your perspective stems from someone with a situation that is not typical of the norm. Your advice about minimizing gluconeogenesis by avoiding low-carb and intermittent fasting diets is reasonable. It's the "other lifestyle factors" that tends to be rather vague because it encompasses such a broad spectrum of possibilities. To say that strength training results in marginal quality of life differences is detrimental and contrary to good sound advice because it is incorrect. In many cases, strength training can make a world of difference for the average individual who knows what they're doing or has someone knowledgeable helping them. As someone who have exercised and participated in strength training for most of their life, I have seen the difference first hand between working out and not working out and working out is better 100% of the time. Maintaining good blood circulation and keeping muscles active daily reduces aches and pains caused by conditions such as degenerative arthritis, a condition that has no cure. Keeping muscles around the affected area strong and active, can help to ease pain and discomfort for many. Of course, everyone is different and I'm sure there are those who would not benefit as much from strength training, but in most typical situations "marginal benefit" is simply not the case at all.Reply 9 RecommendBrian Tilbury London Sept. 6
@Russell Eaton It is difficult to know if sarcopenia is "normal" if the entire population is diseased. That's how 'normal' adult lipid levels were originally established. Then the studies appear that show that every time you lower LDL, even below 'normal', mortality improvesReply Recommendring0 Somewhere ..Over the Rainbow Sept. 6
This and other articles propounding weight training for seniors often ignore the two major obstacles holding back many seniors, which are arthritis and replaced joints. With one bad and one replaced shoulder joint, I have been limited by medical advice from lifting more than two pounds, and with two fake hips, one of which is liable to dislocation, I'm super cautious. Add to that degenerative discs, and I stick with gentle walking and pool exercises. One size doesn't fit all seniors when it comes to exercise.Reply 22 RecommendTy Thomas Los Angeles, CA Sept. 6
@Brian Tilbury I have learned this important point is not grasped until one experiences age-related disabilities.Reply 10 RecommendSergio Stagnaro Italy Sept. 6
@Brian Tilbury - As you say most accurately, one size does not fit all. This is the case for really anything in life and exercise for seniors is no different. Everyone is different and we all have different circumstances. This is why strength training should always be custom fit to each individual. If you can only lift 2 pounds and you can only lift it in one direction, then lift that 2 pounds as much as you can until you can't lift it anymore. Then two more sets lifting that 2 pounds to complete exhaustion. If anything starts to hurt and it's something other than sore muscles, stop. If it goes away after a day or so, resume daily exercises. If not, get it checked. Hopefully the goal here is obvious: Do whatever you can. If you have one good arm, workout with it. Anything you can do to keep your blood circulating and your muscles active, do it if it doesn't hurt. The end result will benefit you more than you know. If you're not sure about technique and proper lifting, work with someone who is sure or hire a trainer. Always get a doctors recommendation before beginning any workout regiment. Anything he clears you for that he deems safe, start doing it. Start light and work up from there. I guarantee you that 2 pounds you're lifting will soon be 4 pounds, then 6 and so on as you gain strength. With strength comes a higher quality of life and a feeling of freedom.Reply 6 RecommendR. Anderson South Carolina Sept. 6
To countering the serious problem of muscle loss, physicians need to know the clinical assessment of tissue oxygenation, Co Q10 deficiency syndrome as well as Carnetine deficiency syndrome, wich can be bedside diagnosed with a stethoscope and removed by replacement therapy, i. e., Reconstructing Mitochondrial Quantum Therapy.Reply RecommendJane NYC Sept. 6
This is helpful because it motivates older people to step up their workouts a bit more.Reply 6 RecommendMarjorie Sheffield MA Sept. 6
My head's spinning. Lotsa protein. Not lotsa protein. Hang out and enjoy getting old. Cardio. Free weights. Bands. Walk. Plank. Elliptical. Resist (it's patriotic!) Could it be that it's personal and we can tailor this to our bodies and individual profiles and psyches? Health and longevity are both genetic and personal. Do you think we're the captains of our rented ships and don't we all want upper cabins? It'd be great, but it's not always gonna be the case. Where we can help ourselves, lets! I appreciate this article and everyone's personal and helpful advice. There are wonderful things, too, about this saggy and often unpleasant stage. I'm the happiest I've ever been and grateful for every day. There's value in waking up to the fact that our bodies are rentals and that we should treat them with love and care and cherish each breath. As Thich Nhat Hanh says, "Peace is Every Step".Reply 16 RecommendCarole San Diego Sept. 6
Commonly prescribed statin drugs cause muscle loss and weakness .
https://academic.oup.com/jcem/article-abstract/103/1/75/4364961?redirect...Reply 9 Recommendwilliam matthews clarksvilletn Sept. 6
I cannot believe what I'm reading. I am 87 and I eat what I like. I also walk my dog twice a day. She's a "herder", so the walks are fairly long ones. I also do light yard work and all my own house work. Only recently, have I discovered I can't lift things I used to and my arms have that "old lady" look. It's depressing, but I don't have the stamina to add daily weight training to my life. Perhaps all you 50 year olds should just learn to enjoy life and not worry about losing your finely honed bodies later on. And, have some ice cream and maybe a croissant now and then.Reply 32 RecommendJus' Me, NYT Round Rock, TX Sept. 8
Get you 100% and agree that you have a point for some people but if people are losing the strength to enjoy life through declining functionality it is very good to know that there are ways to halt decline. Basically it is a personal choice.@CaroleReply 9 RecommendR Hoff Michigan Sept. 6
I'm 72 and refuse to become decrepit in the matters that I can prevent.
I noticed my arms getting flappy last year. A goodly amount of hard resistance training has almost taken care of that.
If you are happy at being not-so-fit, that's your choice. But it WILL impact others and the whole health care system. Which at our age means taxpayer funded Medicare.Reply RecommendBirddog Oregon Sept. 6
Gentle yoga once a week, with advice to daily get on the floor then get up at least 3 x, plus the normal strength training. I'm a youngster at 65 , and hopefully have decades of mobility ahead of me. As an athlete until 55, it's all about balancing expectations and new realities.Reply 7 RecommendNorbert Switzerland Sept. 6
@R Hoff So true! scads of research indicates that regularly participating in a yoga program ,which if performed on a regular basis a few times a week, can also increase the average person's strength, endurance and metabolic functioning, even into our elder years. And I note as a physiotherapist, that in fact many physical therapists and athletic trainers now employ yoga exercises to help strengthen and stabilize their clients back and major muscle groups. So yes please do think about including yoga in your daily exercise routine-But also remember to check with your physician before beginning any type of new exercise or athletic activity if you are elderly or in fragile health.Reply 6 Recommendimpegleg NJ Sept. 6
Gain muscle at any age: Hit training, simply said: Let your muscle know that it is not strong enough by going to your limit. You must leave your comfort zone therefore. It works and does not take much time. Add creatine and magnesium as a food supplement and of course enough protein. You will be surprised.Reply 7 RecommendJune NYC Sept. 6
What constitutes a Rep?Reply 2 RecommendJackie Boston Sept. 6
@impegleg 1 rep is doing one complete exercise one time. Like one squat. 10 squats is 10 reps. 3 rounds of squats is 10 squats done 3 times with a short break inbetween rounds.Reply 1 RecommendKathy Proulx Canada Sept. 5
I am a personal trainer certified with the American College of Sports Medicine who has worked with many clients ages 18-92 and while I absolutely love bringing to light strength training as a tool, I do take issue with some of the language in this article. As defined, sarcopenia is not a "condition," it is honestly just the natural loss of muscle with age. Calling it a "condition" makes it sound like some form of disease, and the reason it isn't talked about may be due to it not being a completely diagnosable illness but something that is perceived as being a part of the aging process. Doctors tend to only "see" patients through the eyes of what is in their scope of practice; meaning that if you see a doctor who is a PCP with a background in internal medicine then they will see you through that lens. If you see a cardiologist then they will only see you through the eyes of your heart, if you see a neurologist they will only see you through the eyes of your brain and nerves. If you are truly concerned about your muscle and bone health then absolutely speak to a sports medicine specialist or orthopedist because those are the folks who will be the most help in that specific field. They are also the clinicians who will have the resources to find physical therapists or personal trainers who will be the best match for you, because if someone who is working so closely with your body doesn't "get" you or doesn't "click" then you may not get as much out of it. We are here for you!Reply 13 RecommendOpen Mouth View Near South Sept. 5
I am 67 with rheumatoid and osteo arthritis including degenerative disk disease. I got on board the use it or lose it wagon when I was diagnosed in 2015. I now regularly do a 6 - 8 minute elbows-toes plank with no body shifts and that has given me a tremendous core strength that I swear is what keeps me active and happy and really fit despite my issues - that plus a great whole foods diet recommended by physiotherapists who are geniuses, by the way.Reply 13 RecommendKatharine Nair Chicago Sept. 5
This is excellent advice. Even those with joint problems can exercise. Ask a trainer for advice and a plan.
I am 66 years old and I suffered from knee (bilateral ACL grafts), shoulder (bilateral rotator cuff tendinitis) and elbow (epicondylitis from golf and tennis) for years. I recently stopped all anti inflammatories after reading that inflammation in moderation is needed for healing. I started with light weights - closed chain to minimize injury risk, and gradually increased. Cardio exercises are on a very low impact elliptical trainer. After each session I spend 15 minutes stretching in a water jet hot tub (my favorite part.)
I started improving my diet slightly without any real deprivation.
I have gradually (9 months) lost weight, become pain free, increased muscle mass and strength, and lowered blood pressure (1 med, down from 3). I will get my lipids and glucose checked soon.
Do whatever you can. Rebuild your health as much as possible. Even small amounts help. We elderly certainly have the resources. What else is better to spend our time and money on than ourselves?Reply 17 RecommendWind Surfer Florida Sept. 6
There is no specific reference to the study of nursing home residents and the success of resistance training. The only article I could find (Cadore EL, Casas-Herrero A, Zambom-Ferraresi F, et al. Multicomponent exercises including muscle power training enhance muscle mass, power output, and functional outcomes in institutionalized frail nonagenarians. Age. 2014;36(2):773-785. doi:10.1007/s11357-013-9586-z) does not give the gender of the subjects. Indeed, there is other research showing that post-menopausal women do NOT gain muscle mass via weight bearing exercise. (Manfredi TG, Monteiro M, Lamont LS, et al. Post-Menopausal Effects of Resistance Training on Muscle Damage and Mitochondria. Journal of strength and conditioning research / National Strength & Conditioning Association. 2013;27(2):556-561. doi:10.1519/JSC.0b013e318277a1e4.) If there is research indicating otherwise, I would like to see it referenced.Reply 14 RecommendRon A NJ Sept. 5
Efficacy of progressive resistance training interventions in older adults in nursing homes: a systematic review.
Can progressive resistance training twice a week improve mobility, muscle strength, and quality of life in very elderly nursing-home residents with impaired mobility? A pilot study
Positive effects of resistance training in frail elderly patients with dementia after long-term physical restraintReply 5 Recommend
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4039260/Edward Blau WI Sept. 5
This is interesting, thanks for the links. A quote from the 2nd study:
"...progressive resistance training does not appear to be beneficial in older adults (based on a lack of significance in leg strength over the 12 month intervention). However, morphological data indicate that the muscle is undergoing favorable metabolic and structural adaptations that are essential in increasing muscle mass, overall physical function, and possibly, oxidative capacity."
So, you're right no increase in muscle size but favorable changes in the muscle tissue. I.e., it's definitely still a good idea to strength train.Reply 23 RecommendBen Toronto Sept. 12
I am close to 80 and try to lift weights and use my old NordicTrac twice week if I cannot walk the golf course. I do this alone in our finished basement. In lifting wights it is not so much how heavy they are but how slow you go so the muscles become fatigued and damaged a bit. Interval training on the NordicTrac avoids the boredom of long stretches on the machine.Reply 67 Recommend
But I like to exercise and it comes easy for me. Other people have a harder time getting started and having a trainer or joining an exercise group might get them started.John Raffaele Saint Petersburg, fl Sept. 5
We have a house big enough to have a little gym room. Exercise equipment is very cheap second-hand from all those folks who fail to keep their New Years resolutions.
I agree about high intensity interval training. I used to take a lot of boring time on the treadmill (and watching PBS News on TV... a crucial piece of gym gear). But I have switched to HIIT using an elliptical trainer. The evidence for one-minute bursts of effort is strong.Reply 1 Recommendwilliam matthews clarksvilletn Sept. 6
Meat and Dairy promote Cancer growth and many chronic diseases. Going Plant Based with no Oils is your best diet for Health. You will get all the protein you need. Started Weightlifting at 14 yrs and still at it at 72, along with running walking and Yoga.Reply 30 RecommendMon Chicago Sept. 6
Most people reading this are already old(Me 74) and may have reached the time to stop worrying about animal v. plant issues(Except for ethical/moral considerations.) Animal sourced protein diets are easier to follow and more reliable than plant sourced. Simple advice: Get healthy skinny, routinely check your blood pressure, eat a variety of foods with plenty of vegs, fruits and whole grains, walk/jog every day, lift free weights(Take them with you when traveling), talk to friends every day, stay in touch with relatives, pray/meditate every day, read the NYT and also Brietbart News, attend public events(Even if it's nothing more than a worship service or a school board meeting), play slot machines/horse races, and KEEP MOVING!Reply 8 RecommendDavid E Hauschild Blaine, MN Sept. 5
But we're helping to decrease carbon consumption and algae blooms and preserve our planet for future generations :)Reply 1 RecommendMALINA Paris Sept. 5
1) NutritionReply 21 Recommend
3) Multiple joint
4) Confuse the muscles
8) "of the flesh poverty"
1) You wouldn't put cheap fuel in a high performance car
2) Body weight or weighted squats target every muscle from the core to the toes
3) Avoid "machines" that target single joints and use free weights to target multiple joints in an exercise routine
4) Vary your exercise routine
5) Incrementally increase weight and/or repetitions to challenge yourself
6) When possible, isolate one arm or leg from the other and do half the weight
7) High Intensity Interval Training (Look it up and do it)
8) That's what sarcopenia means. Age-related sarcopenia can be greatly mitigated
9) Cardiac Exercise Research Group. Look them up and do their "Fitness Calculator" to discover your "fitness age". Do it today and two months after you implemented 1 through 8 and see the difference.derek usa Sept. 6
What about pleasure? I know a bunch of people here in Paris in their nineties. They wouldn't dream of lifting weights. They all have joint problems of some kind wether it's knees, hips or shoulders. But they will walk instead of taking the bus unless they have to cross town, they go to the market, buy good food and prepare home cooked meals every day, they have never read dietary recommendations, they simply eat a bit of everything. They don't miss any exhibits, go see movies and plays, and gather all generations of their family around their table now and then. They keep up to date with new technologies with some help of the younger ones. That's how I want to age. I'm in my early sixties and I do exercise and practice yoga and have no problem walking my 10000 steps since I live in a city where I can walk everywhere but just as I have no intention of having plastic surgery I have no intention of becoming a stakhanoviste of exercise as I age.Reply 121 RecommendWayne Logsdon Portland, Oregon Sept. 6
@MALINAReply 4 Recommend
In Paris you get plenty of mobility exercise stepping over the doggie-poo and the people praying on the sidewalks...I am sure that helps also.DENOTE MORDANT CA Sept. 5
75 and still run (jog) 5k plus light weights 2-3 times a week. This is not for everyone. Each must find one's own regime in order to improve life quality and delay the inevitable as this excellent article and related comments While living in Paris I too walked a great deal since it is a lovely city. Eating healthily throughout one's life is all important as well. The important thing in my view is to find the regime that works for you. A chacun sont gout.Reply 4 RecommendSher Utah Sept. 4
Lift weights. Do weight bearing exercising (walk). Remove sedentary from your life. Do not be lazy about your health. Your life depends on it old timers.Reply 24 Recommendshirley seattle Sept. 5
Building a new house with the living room and kitchen upstairs. People are telling me this is crazy because of how many trips will be taken up and downstairs all day. Yes! Exactly the point. As we age, we have to make the extra effort to stay healthy.Reply 18 RecommendLiz Chevy chase Sept. 5
@Sher. I am healthy, over 80,and would never do that. Although I reject total knee or total shoulder surgery, I definitely have degenerative joint disease in both. And very strong muscles. My knees and I avoid steps and stairs at all cost. Jean from Vancouver has excellent advice. I hope it is not too late for you. Stairs wide enough for a start lift if ever needed, plenty of outlets for power.Reply 10 RecommendWind Surfer Florida Sept. 4
Of course going up and down stairs is good for your heart, but not so great for your knees and hips as you age. I hope your joints hold up, but don't count on it. Lots of folks in their 80s have to move out of their homes because of the stairs.Reply 14 RecommendThe Pooch Wendell, MA Sept. 5
Dr. Valter Longo, a researcher of longevity at Univ. of Southern Calif., proposes that up to age 65 and possibly 75, depending on health status, the 0.7 to 0.8 grams of proteins (plant basis and sea foods)/kg of body weight/day should be recommended. He also recommends 10-20% higher for senior people in order to prevent sarcopenia ( a lot less in comparison with Jane's suggestion)
The key consideration is prevention of early death and age-related diseases. High protein tends to increase growth hormones like IGF-1, though not for seniors.
Furthermore, we need to consider following risks:
Too much protein intake causes metabolic acidosis (low grade), which will become causes of various degenerative diseases, like osteoporosis, cancer, heart attack, lower sex hormones etc.Reply 6 Recommend
1) prevention of osteoporosis
2) Prevention of estrogen deficiency and cancer by vitamin C
Please refer to my comment in "menopause-sex-vagina-vaginal-dryness"
3)Prevention of cancer from red meat
https://www.techtimes.com/articles/23745/20141230/neu5gc-sugar-molecule-...John Raffaele Saint Petersburg, fl Sept. 7
"Too much protein" is not really a thing, and has never been demonstrated to cause acidosis in real life, protein-eating humans.
Too little protein is definitely a thing, and definitely increases risk of osteoporosis, sarcopenia, and frailty in the elderly.
Don't fall for the anti-red meat hysteria.Reply 12 RecommendBewildered Everywhere Sept. 4
@The Pooch Too much protein is a thing especially Animal protein. Many epidemiological studies like the China Study show Cancer and Heart disease incidence increases as Animal protein increases.Reply 1 Recommendforkup PNW Sept. 10
Why doesn't anyone write an article on how so many middle aged women feel totally and completely overwhelmed with all this advice on exercise? What advice can be given to help these women who feel overwhelmed and defeated? These articles with dire warnings are terrifying. Countless middle aged women are depressed. When it comes to exercise they feel defeated before they start. They don't know how to do all this advice. They don't have a hand to hold to get started, and keep going. Many in this age group did not benefit from a past experience of "fun exercise" when they were growing up like young people do today. They don't want to end up in a wheelchair in a retirement home but they don't feel enabled to resist what my mother's neurologist called "the dementia pull down". So many of these women have lived with full blown or latent depression for decades. They get by physically for years and then suddenly they are hit with limitations and these dire warnings about their lack of appropriate exercise send them back to the sofa in total despair.Reply 169 RecommendJames B Portland Oregon Sept. 13
Physical health is important as is mental health. Please do not neglect either.Ken Goddard New Jersey Sept. 4
As the husband of a middle-aged woman I am completely bewildered also. She and her friends are socially interconnected, financially successful, meet frequently, work hard both at work and home, smart as whips... but their Achilles heel is avoiding anything which impacts their psychological dependence on cosmetics (perspiration!). All the time and work invested every morning, frequent check-ins on any reflective surface and subsequent touch-ups; she's not risking those efforts - glistening is the enemy.Doris Brooklyn Sept. 4
"require at least 0.54 grams of protein per pound of ideal body weight, an amount well below what older people typically consume."Reply 4 Recommend
I think you mean "well above", am I correct?
I would also suggest 0.8 as a better target.Camille G Texas Sept. 4
Dr. Michael Greger questions the idea that increasing protein consumption helps seniors to increase muscle mass - but "consuming recommended levels of vegetables was associated with cutting the odds basically in half of low muscle mass. Why? The alkalizing effects of vegetables may neutralize the mild metabolic acidosis that occurs with age. . . And indeed, a more plant-based diet, a more alkaline diet, was found to be positively associated with muscle mass in women aged 18 through 79 years old. . . . So, if we are going to increase our protein consumption after age 65, it would be preferable to be plant-based proteins to protect us from frailty." (August 24th, 2016) https://nutritionfacts.org/video/increasing-protein-intake-age-65/Reply 17 RecommendJus' Me, NYT Round Rock, TX Sept. 8
Don't forget that 1/2 cup of white cream peas contains 8g of protein. Plants - especially legumes - contain quite a bit of protein. Elsewhere, Ms Brody is exhorting the Mediterranean diet, so I find it odd that her list of protein sources is mainly dairy and meat.Reply 20 RecommendStefan Germany Sept. 4
Can you say Incomplete Protein? Lentils are better, but none can compare to meat and animal products.Reply 1 Recommendronbj99 Santa Clara, CA Sept. 4
An excellent article on Sarcopenia! It should be added that with increasing muscle mass also high blood pressure is positively affected, because besides the muscle mass also the small blood vessels will grow. In addition to weights, isokinetic training is also optimal to protect the tendons. With an so called Isokinator e.g., that is not much larger than a mobile phone, you can do this even at home or on travel very successfully.Reply 3 RecommendAmy Jane Alameda Sept. 4
I have been a gym member for the last 25 years, now 89, and do an intensive gym workout 3X/week. I had open heart surgery May 1 and then recuperated, being mostly sedentary but slowly doing home exercises for three months. I hit the gym August 1 after my cardiologist stated that I was healing faster than any other of his patients. I was amazed at how much muscle I had lost! I could manage perhaps 30% lower weight to equal the old rep count. After a month at the gym I am almost back to normal so it is doable if you keep at it.Reply 267 RecommendLuc Kojio Lkojio@yahoo.com Sept. 4
Such a great article, thanks. I enjoyed many comments with links and ideas. Just my 2 cents... I try to do what works for me as an individual. I like the blood type diet because there is more than one way. Healthy vegetarians are probably type A. Type O's need meat.Reply 6 Recommend
In the realm of exercise, I try not to over ride myself and my instincts about what is right for me. The muscles can be perfectly capable but what if my tendons can't handle so much? Here again body type can give a clue. Mesomorphs are naturally bigger in the muscle area, ectomorphs......not so much. I try to know myself and my limitations and keep evolving as my aging body changes. But I need to keep moving and I see from this article that I am not doing enough.Braid NYC Sept. 4
Wondering why my first post was not added. It was about HGH. Is that offensive for some reason? Nothing in my email. Anyway, how about the RBG Workout?Reply 6 RecommendS to the B California Sept. 4
If the splendid Jane L. Brody who goes to the Y (presumably to use exercise equipment as well as the pool) has muscle loss despite all her exercise regimes and trainers, how is it that strength training is supposed to offset muscle loss? Something seems to be missing. In her case is it that she needs to eat more protein? Was she not exercising for strength? I would appreciate a follow-up story with keen editing, because this is a very important topicReply 20 RecommendFred Rickson Tucson, AZ Sept. 4
@Braid I think the article did address this. It sounds as though she is active but didn't strength train. The routine she described sounds like cardio and daily activities. Then she specifically states that cardio doesn't have much effect on sarcopenia.Reply 15 RecommendIvy CA Sept. 8
You folks need to move to southern Arizona. At 80, the only thing to do for the hot middle 12 hours of the day is go to the Fitness Center.Reply 16 RecommendJanet Youngdahl Alberta, Canada Sept. 4
@Fred Rickson,Reply Recommend
Thanks Fred! I visited and it almost killed me walking to Univ. library I would much prefer gym.S North Europe Sept. 4
I would like to send this article to my mother, but at 78 she is offended by the word "elderly." Perhaps she is right. The strength training recommended by Ms. Brody should start in mid-life and continue. If this was reflected in the title, I could forward this to my mother!Reply 11 RecommendLuc Kojio Lkojio@yahoo.com Sept. 4
While weight training, it's best to train smart than to train heavy. I told my personal ttrainer than I was ready to take on bigger free weights and he said : 'your muscles are, but your tendons are not. Let's just change the exercises to make them more challenging.'Reply 62 RecommendJean Holland, Ohio Sept. 4
What about human growth hormone? Isn't anyone doing long term studies? This problem results in a huge cost not just to individuals but to society. You know most people are not going to be lifting weights in their mid-seventies and beyond.Reply RecommendM. Lyon Seattle and Delray Beach Sept. 5
Housework is good strength training exercise.
Reaching and bending to dust, down on floor to wipe dustboards on a rotating basis in various rooms, lugging and pushing the vacuum cleaner under beds and furniture, over carpets, vacuuming the drapes once a month.
Wiping the exterior of cupboards, using a steam cleaner on floors: these all keep us limber.
Why pay someone to usually do it, and then pay for a gym?Reply 30 Recommenddh Guangzhou Sept. 8
@Jean Housework is not strength training. It's really light aerobic exercise, and I say light because it rarely involves breathlessness.
Strength training involves executing specific exercises that entail the use of weights, resistance bands, and one's own body weight to stress many different muscles and build muscle mass. The key to strength training is to keep challenging the muscles by upping the weight, resistance, or number of reps over time. You have to keep your muscles on their toes, so to speak.Reply 16 RecommendGD Huntington Beach, CA Sept. 4
@M. Lyon So how is it that walking isn't "challenging the muscles"? I am unclear on how it is that exercises such as walking, running, swimming, bicycling alone are considered insufficient if they are done at a brisk pace and for necessary duration.Reply RecommendWind Surfer Florida Sept. 6
The conventional wisdom nutrition has contributed to this.
Fat, especially saturated fat, protein, and cholesterol are needed to build new and repair cells and in the creation of hormones like testosterone. this means fatty cuts of red meat and offal should be the backbone of the diet.
Unfortunately conventional wisdom nutrition goes the opposite, saying to avoid these things and make your liver struggle even more by taking statins on top of it.Reply 6 RecommendStephen Rinsler Arden, NC Sept. 4
For the first time, researchers from the University of California, San Diego's School of Medicine were able to link a sugar molecule called Neu5Gc to the consumption of red meat and cancer in a study. Previous evidence has been circumstantial, but now there's solid proof that eating red meat increases risks of developing cancers.
https://www.techtimes.com/articles/23745/20141230/neu5gc-sugar-molecule-...Reply RecommendBarb Hill Malvern PA Sept. 4
A clear view of sarcopenia and its moderation with strength training requires the average absolute percentage lost over time and the average absolute percentage restored with exercise.
After all, even a small average gain in muscle/strength might be statistically significant, but not meaningfully so to many people.Reply 2 RecommendM. Lyon Seattle and Delray Beach Sept. 5
I'm curious to know from people who are 50 years old and older how they define weight training. For example, weight training for me as a 55 year old female, normal weight, I can deadlift 205 lbs on a good day. I work with kettlebells much of the time, some of which are heavy such as 24kg or 32kgs. I'm also a personal trainer. For the record, five pound weights will do absolutely nothing for you! My 94 year old mother can lift more than that!Reply 4 RecommendGreg New Hampshire Sept. 6
@Barb Hill One does not have to be a personal trainer who deadlifts 205 lbs. to prevent sarcopenia.
The key to staving off muscle loss is to incorporate a strength training program into one's routine and to stick with it. Of course, if someone has been sedentary for a long time, he or she might have to start with five-pound weights for bicep curls. And those five-pound weights will make a difference in that person's strength. Before long he or she will move on to eight-pound weights, then ten-pound weights, and so on. But the key if you are over fifty is to increase the weight slowly and to adhere to the program, which means strength training 2 or 3 times per week. You have to be in it for the long haul.
Also, it helps to do a whole range of strengthening exercises, so that you work many different muscles, and these might include bicep curls, tricep extensions, push-ups (step push-ups for beginners), forward lunges, squats, floor M's, and bird dogs.Reply 9 RecommendLuc Kojio Lkojio@yahoo.com Sept. 4
You are to be congratulated, your personal program sounds well-suited to your abilities - good for you for having a vigorous routine at 55 and for your work as a trainer. I'm a bit older, a still-active carpenter and power walker. I'm lucky to have a coach/trainer who got me started with kettles, resistance, foam-rolling (warm up/down) and some sled/agility ladders & HIIT. I don't think I would be doing all that I am without his encouragement, support, demands. I am stronger, leaner, and more confident physically. It takes time and consistency.
But here's the thing: Jane Brody's pieces are often candid and honest looks at how to start changing one's foods and activity levels. The five-pound dumbbells you malign are not the point...a structured beginning, with attention to proper form and posture while training, and some complimentary feedback from diet changes seems to me to be what she's advocating, don't you think? We all can thrive, but those first reps and steps are the key. Folks should get support at the gym or community center or clinic, and the positive feedback loop will help keep them going.Reply 7 RecommendBarb Hill Malvern PA Sept. 4
I'm going to try this again. What about HGH? I suggest this as an alternative because as a practical matter, most seniors are not going to be lifting weights in their 50s, much less 70s and beyond. But I only have the medical facts provided by the internet.Reply 3 Recommendmarty oregon Sept. 6
What is HGH?Reply 1 RecommendPdxtran Minneapolis Sept. 4
@Luc Kojio Maybe most seniors don't lift weights but I work out at the Y in Eugene, OR and there are plenty of us in our 60s-80s doing weight lifting, yoga, circuit training, etc. Physically using our bodies is much better than taking a processed supplement from a bottle.Reply 1 RecommendMidWest Kansas City, MO Sept. 4
The YMCA in Minnesota (I don't know about the rest of the country) has two levels of exercise programs for older adults. One is called Silver Sneakers, and it is geared toward people who have not been physically active recently. The other, more challenging, but still mindful of the needs of older people, is called Forever Well.
I've been taking mostly water aerobics, but unlike water aerobics at other places, these classes always include strength, flexibility, and balance components.
There's also a Forever Well strength training class, which I had to drop temporarily due to an injury (my own fault for trying to do too much), but it's a full-body workout, and you can start with weights as light as one pound. Before I suspended my participation, I noticed that it had become easier to get up off the floor.
An added benefit is that these classes tend to be very social, so I've made new friends as well.Reply 28 RecommendTrish Columbus Sept. 5
@PdxtranReply 7 Recommend
Would like to attend but our ymca charges $50 a month. I don't know if the classes are included. I think they are additional although reduced cost for members. Not easy for many elderly people to afford.Jean Holland, Ohio Sept. 4
@James and MidwestReply 1 Recommend
I have traditional Medicare but my Medigap plan includes Silver Sneakers. It's worth checking into.Linda Friedman Schmidt USA Sept. 4
Another excellent column by Jane Brody. I especially appreciate the information that gives a sample of how much protein is in various foods.Reply 4 RecommendRon A NJ Sept. 5
It makes it difficult for us to determine how much protein we need when the measurements nutritionists and writers like yourself give for necessary daily protein intake is stated in grams. Food store measurements are in pounds and many of us have trouble converting the grams to pounds.Reply 12 RecommendChelsea Hillsborough, NC Sept. 4
@Linda Friedman SchmidtReply 4 Recommend
I'm not sure what you mean. Nutrition labels are always in grams. It's been like this for as long as I can remember. The breakdown of protein, carbs, and fats on labels don't have anything to do with buying meat or produce by the pound.cheryl yorktown Sept. 4
Red Meat sorry i love animals but eating 6 oz. of red meat several days a week for the very aged is the best source of protein and B vitamins, iron . .Why was meat left out of this article. we are omnivores.Reply 12 Recommend
I made my mom start this at age 90 after some arguments and she is so much stronger . she has not had a fall but yesterday ( at her 95th birthday party) she was able to catch herself as she tripped on a log. I have her in P.T. to 2 X a week as you can't trust gyms with the very aged , they'll hurt them. Also 2X massage .NoraKrieger Nj Sept. 4
@ChelseaReply 9 Recommend
A few years ago I was eating almost no red meat - and developed anemia. Using supplements -- and reintroducing a little to my diet - reversed the issue.Kay Sieverding Sept. 4
I am lucky. My trainer is also a physical therapist and closer to my age; therefore, he listens and understands the needs of older people.
I agree that some of the young trainers have no clue and as a result, can unknowingly contribute to injuries.Reply 18 RecommendSusan Victoria Bc Sept. 4
I am a huge fan of water aerobics. I've been participating in water aerobics for 15 months. All my life, I had a bigger size below my waist than above it but now my upper body is a bigger size than my lower body. To my eye I have noticeably more muscles. Until I made an effort to lose weight, I decreased a size but without losing weight, meaning more dense, more muscle. I am not that young but actually look pretty good in a bathing suit. I sleep well and my skin quality is improved. I was able to lose weight while still eating a lot of fattening foods, going to parties, drinking wine etc.
We have a really great group at my health club. There is an 89 year old woman there who is still working. She swims to the side of the pool and quickly hoists herself out without using the ladder. She looks 50 or 60. It is a lot more fun to go to the class and exercise to music while catching up with my friends than to visit a machine.Reply 24 RecommendMidWest Kansas City, MO Sept. 4
My husband and I, in our 70's, have become pescatarian, eating fish, seafood and plant based foods. My husband's doctor (specialist in internal medicine) recommended it, at least 5 times a week. He gave us some reading recommendations, illustrating the many benefits of higher plant consumption. There is evidence that even heart muscles can regenerate after a heart attack on a plant based diet.
We found it restively easy to stop eating meat, but continue to get quality protein from fish, eggs and cheese, and various low fat or skim dairy products.
Weight loss became easy, followed by easy weight control, and much easier longer physical activity.
We make home made soups whibh include high content of various beans, dried peas, and grains, including quinoa. We use vegetarian hamburger (soy), for chili, spaghetti sauce, and burgers. Salmon makes a great burger. .
We use a bread maker to make higher bran content sour dough whole wheat bread, but still but occasionally buy other breads.
My point is, by substituting a high protein diet with fewer animal products, you can improve your vascular health, lose weight without losing muscle, improve your heart function, and be able to enjoy meaningful exercise to retain or gain muscle mass.
And, we still work part time at desk type jobs...this lifestyle does not need to be all consuming. Get a freezer, do your cooking in quantity, and enjoy many quick meals.Reply 52 RecommendCatherine Norway Sept. 3
@SusanReply 4 Recommend
Would love your bread recipe.Cluny Brown NY Sept. 5
Here's a good strengthening program for older adults. It's from Tufts University.
http://growingstronger.nutrition.tufts.edu/Reply 24 RecommendSirius Princeton Sept. 6
Thanks Catherine! This is a great linkReply 1 RecommendCatherine Brooklyn Sept. 3
Love the name! One of my favorite books.Reply Recommendvacciniumovatum Seattle Sept. 4
You should mention that many Medicare Advantage plans cover the Silver Sneakers program, which gives you a free membership in participating gyms. These gyms typically have special exerciae classes for seniors and you can use,all the other facilities too.Reply 129 RecommendLiz C Portland, Oregon Sept. 7
Some Medicare Supplemental plans include Silver and Fit which does just about the same thing.Reply 1 RecommendCarlyle T. New York City Sept. 3
I agree that more mention should be made that many Medicare Advantage plans cover gym membership. As a pre-retiree, I never engaged in exercise beyond daily walks of 3 to 5 miles, but knee pain sent me to a physical therapist who suggested water aerobics. My Medicare Advantage plan pays for it, the pain is gone, and I'm delighted to have discovered the other benefits of this exercise.Reply RecommendCarlyle T. New York City Sept. 3
Gee, I have little family or friends to help me with my wife whoReply 36 Recommend
falls often with Parkinson's ,I pick her up, she is 139 lbs as well
I carry a wheelchair up and down 5 flights of stairs as no one can help me with that chore either, I am 77 years young .
My feeling is if you must do something strenuous ,one can do it in the absence of having help.
My exercise is walking and yes doing those 5 flights of stairs multiple times a day. I have learned how to keep my spine healthy as wee.cheryl yorktown Sept. 4
@Carlyle T.Reply 5 Recommend
Should read I have learned how to keep my spine healthy
as well with back exercises.Diane Michigan Sept. 3
@Carlyle T.Reply 2 Recommend
You are seriously strong for your age: I couldn't lift up my mother at that weight.
But, good lord, I wish you could have some assistance or an apartment with an elevator.Ron A NJ Sept. 3
My elderly Mom eats one cup of beans a day, which works out to about 16 grams of protein. Each cup has about 230 calories, and if made in a slow cooker or pressure cooker, it is an easy, super cheap chunk of her protein requirements. If she opens a can, then it is the easiest, healthiest meal ever, if she adds some veges.Reply 7 RecommendDiana Kincannon Berryville, Virginia Sept. 3
@DianeReply 9 Recommend
I eat beans from the can, too, as well as black eyed peas and lentils, but not everyday. They say that beans are a great source of protein, iron, and minerals. Only, the protein is incomplete so a small amount of rice is needed to complement it.Laura Hertz IL Sept. 7
The article mentions hormonal changes as a contributing factor. Please expand on that and comment on whether hormone therapy is recommended as a means to preserve muscle mass. Thank you.Reply 54 RecommendDawn Oregon Sept. 9
No. Too many other risks come with hormone therapy.Reply RecommendBonnie Pennsylvania Sept. 3
The best advice I could find (without a bias or agenda), from the Mayo Clinic and a UK university, was that hormone replacement therapy is a good idea (benefits far outweigh the risks) for three years or until age 55, whichever comes first. In other words, not a long-term solution. So that got me another three years down the road, but kind of just delays the inevitable.Reply RecommendLucy R Brooklyn Sept. 6
It's tragic that the foods with the most protein are foods that aging Americans have been brainwashed into avoiding for most of their lives and continue to be warned about if they have a so-called cholesterol issue.
I have an aging aunt and uncle who are both whippet thin who are terrified of eating eggs lest my uncle's cholesterol levels skyrocket. No amount of new research can convince them otherwise.Reply 143 RecommendMon Chicago Sept. 6
How about egg whites? And protein supplements might be found acceptable.Reply 1 RecommendKate Baptista Knoxville Sept. 3
They also have to exercise to utilize the additional protein, or else they will just gain fat.Reply 2 Recommendmb Ithaca, NY Sept. 7
I've been doing the weight machines at the Y for several years. I see many older men, but few, if any, other older women. It's so much easier than it sounds.Reply 21 RecommendRon A NJ Sept. 3
At our local senior center the strength training classes are virtually all women--maybe the men are all at the Y?
(My 85-year old husband is in 5 strength, 1 zumba gold and one yoga class a week at the senior center--you should see his biceps!--and all the ladies envy me--sorry, but he's all mine!)Reply 2 RecommendAnn Brooklyn Sept. 4
This article is a little sobering considering all the activity Ms. Brody does and yet she still feels the effects of sarcopenia. It must be a powerful force tearing us down.
For myself, I'm doing the proper exercises, running and lifting, but I don't eat enough protein. Since I gave up meat, I have to keep reminding myself to do that. For instance, today I've just had 3 eggs, oatmeal, and a lot of produce. I don't think I'm going to starve but I'm not building any new muscle, either.Reply 9 RecommendAnn Brooklyn Sept. 4
@Ron A The exercise Jane Brody mentions that she does doesn't build or strengthen muscles or bones. It's all aerobic - geared towards cardio fitness. Swimming is non-weight bearing, as is bike riding. Walking is good for the lower body buy does nothing for upper body.
It's surprising and disappointing that a health writer wasn't aware that to retain/build muscles & bone, resistance and/or weight training is necessary as people age. Even more surprising as she has written in the past about belonging to the YMCA where the necessary equipment, machines and trainers are available for member use, but she probably never took advantage. That should probably change..Reply 6 RecommendCatherine Brooklyn Sept. 3
@Ron The exercise Jane Brody mentions that she does doesn't build or strengthen muscles or bones. It's all aerobic - geared towards cardio fitness. Swimming is non-weight bearing, as is bike riding. Walking is good for the lower body buy does nothing for upper body.
It's surprising and disappointing that a health writer wasn't aware that to retain/build muscles & bone, resistance and/or weight training is necessary as people age. Even more surprising as she has written in the past about belonging to the YMCA where the necessary equipment, machines and trainers are available for member use, but she probably never took advantage. That should probably change..Reply 1 RecommendM. Lyon Seattle and Delray Beach Sept. 5
I have been a jogger for years, and was concerned that my stamina was dropping, starting at about 60. I couldn't run longer than maybe 15 - 20 minutes without stopping to walk. I got my doctor to check out my heart and I was fine. It bugged me no end.
Then I added weight training and protein supplements, and finally I got back to being able to jog for 45 minutes or more without stopping. So happy to be back improving rather than declining!
So I would definitely recommend strength training and eating more protein. I should mention that the protein supplements have also helped me stabilize my weight because I'm not as hungry. It's worked well for me.Reply 122 RecommendJay Brooklyn, NY Sept. 3
@Catherine The exact same thing happened to me, though I'm four years younger. Also, the weight training makes me feel so much stronger!Reply 3 RecommendJ Swampscott, MA Sept. 3
I'm 54 and exercised sporadically for the past 10 years or so. I've been upping the frequency the past few months and have increased my protein to carb ratio and I'm discernibly building muscle. It can be done. Weight train twice weekly, do cardio and core 3-4 days, and cut those carbs. You'll look and feel better.Reply 7 RecommendKate Baptista Knoxville Sept. 3
Yoga is an ideal exercise for all ages. It strengthens and stretches all muscles as well helping with balance. Poses can be modified to adapt to body types and physical limitations, and the practice creates a wonderful sense of wellbeing.Reply 11 RecommendRenee Hoewing Illinois Sept. 3
I love Yoga too, but it does not replace strength training.Reply 18 RecommendMAUREEN SF Sept. 4
These articles seen to be geared toward those who do nothing physical at all. I've been hitting the weights for years and would appreciate having something like a percentile ranking by age/gender based on weights used for a few basic muscle groups and exercises. How many men's pushups can a woman at the 75th percentile be able to do? How much should she be able to squat? And just as importantly, is there any advantage after xxx point in lifting more or is it too risky in terms of joint damage? Personally, I don't need to see another woman curling pink 2 pound weights to know THAT isn't doing her any good at all.Reply 49 Recommendbluegrandma Wasilla, AK Sept. 3
So many of these articles are geared towards those who are overweight and inactive.Reply 2 RecommendPamela L. Burbank, CA Sept. 3
I row, stride, lift weights, and stretch at home for at least an hour four days a week, I have extensive arthritis in my spine and have sought help from physical therapists in the past so I could develop and exercise routine that would counter my ongoing problems. As a result I am reasonably fit and, while not painfree, able to continue most activities requiring physical energy, concentration, and strength. Count me a believer.Reply 147 RecommendEmergence pdx Sept. 3
This is an extremely important article. Thank you for highlighting something most older people need to know and about which they are blithely ignorant.
It's easy to watch as your body slides into decrepitude. It requires nothing of you except acceptance. The trick is to fight the process with everything you've got.
By exercising and eating properly, you give yourself extra strength, mobility and I feel, extra years.
I lift weights and use a treadmill 4-5 times a week. Granted, I have a back injury and I'm trying to keep myself out of a wheelchair, but the benefits of my exercise regime are outstanding. I have more energy and I'm stronger than I ever thought possible. It's worth every bit of the effort.
I can't stop the aging process, but I can stave off the inevitable by, perhaps, decades. And, there's a magnificent bonus involved: The endorphins released after a workout are a libidinal supercharger. Enjoy!Reply 62 RecommendDaveD Wisconsin Sept. 12
As aging individuals try to start or improve their physical activity routines, it is worth remembering the darker side of "use it or lose it" which is "use it AND lose it." The latter is the consequence of overdoing it, given your physical status, resulting in muscle damage. This phenomenon was studied by F. E. Yates and L. A. Benton in 1995.
Everyone has an optimal level of exercise to achieve the best possible fitness given their age and physical limitations. The key is getting the right training advice. Jane's article is a great start.Reply 22 RecommendMaria Hasterlis New Jersey Sept. 3
Exercise all you want. But in the end you will have produced a very healthy corpse.Reply RecommendPenich rural west Sept. 3
This is an excellent article. Thanks.Reply 15 Recommend
But I wonder isn't there a difference between male & female protein requirements? My Dr said 50g protein for me & 70g protein for men. If I increase to the 81g then my total caloric intake will cause me to gain weight as a vegetarian. The so called normal 2000 calories per day is too much for me & trying to get that much protein 81 g & keep cholesterol low & weight normal doesn't sound right. So perhaps there's another criterion? ThanksJay Brooklyn, NY Sept. 3
What about adding egg whites, or low cal fish for your protein? (Not sure what your diet restrictions entail.) Look into whey taken in moderate amounts, though there are some pros and cons to be considered.
The other thing to consider is are you eating too much sugar or heavy carbs in your diet, i.e. grains, rather than greens or colorful veggies? Switching that ratio might let you balance out more protein.
Note: most elderly hospital admits are protein deficient.Reply 7 RecommendJaque Champaign, Illinois Sept. 3
Yo the cardio and supplement protein with plant based protein powder.Reply 4 Recommendwillow Las Vegas/ Sept. 3
You don't need external weights to stress your muscles. Your own weight can help in many ways. Even regular Yoga practice stresses the muscles that you don't even know exists in your body! Get a Yoga video for older and beginner people and start at home.Reply 18 RecommendChris G. Ann Arbor,MI Sept. 4
Exactly. A good vinyasa class will have you doing the equivalent of 10-20 pushups and more, significantly increasing upper body, core and leg strength.Reply 12 Recommendcheryl yorktown Sept. 3
If the use of your own muscles moving your own weight causes stress on them, then you're already in big trouble.
For a typical person, you'll need weight or resistance to achieve results, as properly performing muscles shouldn't need to be stressed to keep one moving throughout the day.Reply 5 Recommendcheryl yorktown Sept. 3
Thanks for this focus.
Bones, Muscles, Balance: a critical three needs for physical health as we age, necessary to maintain independence, but -- much harder to promote with each year. We cannot be or look 25 ( or 40 or 50 ...) but we either work on our own strength or pay for it.
I have a simple practical test of my own. Sit on the floor. Then get up -- I'll bet it's much harder than you remember (if you're over 55 or 65).
I have a small window bedroom conditioner that I put in and take out seasonally: this year, I nearly strained my back and arms lifting the thing. Sign of the time to get working ( and /or find a handy man or move)
Looking forward to Pt II. I hope that the topic of protein and amino acid supplements is discussed.Reply 14 RecommendStephen Ireland Sept. 3
Having looked at the quiz - it is for identifying sarcopenia itself, meaning someone who scored high would already have severe muscle loss. Better not to get to that point as long as we can hold out.
Second thoughts about that reference to nursing home residents in the Tufts study: visit them. If someone has trouble walking, she is encouraged NOT to walk because of fear of falls. ONLY those who are in rehab, courtesy of a recent hospitalization, get PT. Most others get nothing in the way of exercise - unless they can do it alone - but most need encouragement - and "spotting" - to make sure they don't hurt themselves. Nursing homes are barely staffed with enough aides to get people up, toileted and fed. So we need to avoid the injuries that get us there too early.Reply 108 RecommendBill Buffalo Sept. 3
Ms Brody, in terms of the ideal protein intake for older people, should that not be: "[...] older people, who absorb protein less effectively, require at least 0.54 grams of protein per pound of ideal body weight, an amount well ABOVE what older people typically consume" ?Reply 39 Recommendmb Ithaca, NY Sept. 6
Is there a reason we do not read the weights subjects lifted in any of the studies mentioned here? Isn't it crucial to understanding the recommendations here?Reply 6 RecommendPeter Silverman Portland, OR Sept. 3
I'd say the mass of the weights is not mentioned because it differs depending on how strong a person already is when starting to lift weights. I can do biceps curls easily with weights starting at 5 lbs; many others my age can't do more than 2 lbs. to start.
The rule our instructor at our senior center uses is this: the last 2 or 3 reps should be difficult; if they are easy, then you need to use heavier weights. (Be careful and use much lighter weights doing shoulder work: the tendons and ligaments in this area are very vulnerable to injury)
Best to find a book, TV program or video, or a class at a senior center, the Y or a gym that is meant for older people.Reply 3 RecommendJames Igoe New York, NY Sept. 3
As a lazy 75 year old, the idea of knocking myself out at the gym doesn't have much appeal, but I've been doing the same 2 minute routine every couple of days with 10 pound handweights for the last 15 years and I think it makes a difference.Reply 13 RecommendJames Igoe New York, NY Sept. 3
Although I've enjoyed weight-lifting as part of my fitness regimen for decades, I tend to prefer working on activities that develop strength and power endurance, specifically the rowing machine and the cross country ski erg. Both require almost equal amounts of aerobic capacity and strength for success, and a recent study showed that rowers lost the least amount of their physical abilities.
The article was Aging Performance for Masters Records in Athletics, Swimming, Rowing, Cycling, Triathlon, and Weightlifting ( https://www.tandfonline.com/doi/abs/10.1080/0361073X.2010.507433) .
All sports declined with increasing age, with rowing showing the least deterioration. Performances in running, swimming, and walking were reasonably well maintained, followed by greater decline with age for cycling, triathlon, and jumping events. Weightlifting showed the fastest and greatest decline with increasing age.Reply 8 RecommendPenich rural west Sept. 3
@James IgoeCorrected link for anyone interested:
https://www.ncbi.nlm.nih.gov/pubmed/20845122Reply RecommendFritz Ziegler New Orleans Sept. 3
Thanks for this study!
I wonder how an elliptical machine would compare with rowing and cross-country machines?
The weight lifting results are dismaying. Perhaps people simply stop working themselves as hard with weights as they age, or . . . ?Reply 6 Recommendevaretiree Millbrook, NY Sept. 3
Is this what the author wanted to say? "To enhance muscle mass, Dr. Morley said that older people, who absorb protein less effectively, require at least 0.54 grams of protein per pound of ideal body weight, an amount well below what older people typically consume." Didn't she mean, "... an amount well ABOVE what older people typically consume"? Or is it just me? Ms. Brody, thank you for your work, and for focusing on this muscle-maintenance issue!Reply 18 Recommendrobert manhattan Sept. 3
@Fritz Ziegler I caught that also. Hopefully a clarification is forthcoming. Thanks for posting.Reply 5 RecommendLuc Kojio Lkojio@yahoo.com Sept. 4
Thank you, Jane, for this most important article. As a Personal Trainer with 30 years of experience, specializing in the 70's-90's age group, I've seen first hand the incredible physical and emotional benefits of weight training. Ive also worked with clients with conditions as physically challenging as Parkinsons, Marfan's Syndrome, Neuropathy, etc, and in every one of these cases, strength training has improved activities of daily living. The confidence and peace of mind it brings is immeasurable. It doesn't have to be time consuming and you don't need to join a gym, although you may want to as you see and feel the improvements! Getting proper instruction is crucial, so if you are in this population and are open and excited to learn activities of daily living strength training, ask at a senior center if there is a physical therapist or a qualified personal trainer available that has experience working in this age group and go for it! Your body will thank you for it!Reply 175 Recommendheretoday Northern California Sept. 6
@robert I'm not in my 70s, but have seen my older relatives grow frail. I wish there were decent training options in assisted living, or even before that. Residents don't seem to receive any emphasis on improvement. Frailty seems to be regarded as inevitable. If there is an association of trainers who specialize in geriatric training, I'd love to know about it.Reply 7 Recommend
@Luc Kojio There is a TV show on PBS that has been on for years called "Sit And Be Fit". It features movements done while sitting in a chair. It would help a little.Reply Recommend
Oct 25, 2018 | www.nakedcapitalism.com
"Is Medicare for All the Answer to Sky-High Administrative Costs?" [New York Times].
The answer will surprise you! "Medicare's direct administrative costs are not only low, but they also have been falling over the years, as a percent of total program spending.
Yet the program's total administrative costs -- including those of the private plans -- have been rising. 'This reflects a shift toward more enrollment in private plans," Mr. [Kip] Sullivan said.
"The growth of those plans has raised, not lowered, overall Medicare administrative costs.'" • It is very gratifying to see a single payer stalwart like Kip Sullivan quoted as the authority he indeed is.
And, contrary to the headline, it does look like Medicare has a bad neoliberal infestation that needs to be dealth with. "Free at the point of delivery" is a good starting point, because that strikes a deathblow at the complex eligibility determination process so beloved by markets-first liberals.
Oct 22, 2018 | www.moonofalabama.org
somebody , Oct 21, 2018 3:53:21 PM | link
Number of people with preexisting conditionsAbout half of nonelderly Americans have one or more pre-existing health conditions, according to a recent brief by the U.S. Department of Health and Human Services, or HHS, that examined the prevalence of conditions that would have resulted in higher rates, condition exclusions, or coverage denials before the ACA. Approximately 130 million nonelderly people have pre-existing conditions nationwide, and, as shown in the table available below, there is an average of more than 300,000 per congressional district. Nationally, the most common pre-existing conditions were high blood pressure (44 million people), behavioral health disorders (45 million people), high cholesterol (44 million people), asthma and chronic lung disease (34 million people), and osteoarthritis and other joint disorders (34 million people).
While people with Medicaid or employer-based plans would remain covered regardless of medical history, the repeal of pre-ex protections means that the millions with pre-existing conditions would face higher rates if they ever needed individual market coverage. The return of pre-ex discrimination would hurt older Americans the most. As noted earlier, while about 51 percent of the nonelderly population had at least one pre-existing condition in 2014, according to the HHS brief, the rate was 75 percent of those ages 45 to 54 and 84 percent among those ages 55 to 64. But even millions of younger people, including 1 in 4 children, would be affected by eliminating this protection.
US has no concept of solidarity.
Sep 30, 2018 | www.rt.com
Scientists had assembled separate bacteria, viral or fungi databases, but to fully decode our environmental exposures, we built a pan-domain database to cover more than 40,000 species," says one of the team, Chao Jiang . The researchers soon began to realize that even those participants who occupied the same areas had their own unique 'invisible friends' in their exposomes.
"The bottom line is that we all have our own microbiome cloud that we're schlepping around and spewing out," Snyder said, admitting that although the current study is limited in scope (only three individuals wore the devices for an extended period of time), it could mark the beginning of a new area of medical research.
READ MORE: Pro-ISIS outlets vow unleashing biological warfare on West
For instance, Snyder's allergies, which he believed were caused by pine pollen, were actually shown to have a higher correlation to eucalyptus through analysis of his exposome data. Snyder suggests combining immune response data (through blood or urine sampling via traditional medical practice) with that collected through his exposome device in order to create a more complete picture of human health.
Sep 21, 2018 | www.webmd.com
The doctor may also prescribe an oral rinse to restore mouth moisture. If that doesn't help, he or she may prescribe a medication that boosts saliva production called Salagen .
You can also try these other steps, which may help improve saliva flow:
- Suck on sugar-free candy or chew sugar-free gum.
- Drink plenty of water to help keep your mouth moist.
- Brush with a fluoride toothpaste , use a fluoride rinse, and visit your dentist regularly.
- Breathe through your nose, not your mouth, as much as possible.
- Use a room vaporizer to add moisture to the bedroom air.
- Use an over-the-counter artificial saliva substitute.
Sep 12, 2018 | apple.slashdot.org
sootman ( 158191 ) , Wednesday September 12, 2018 @02:19PM ( #57299382 ) Homepage Journalnew Apple Watch features ( Score: 4 , Informative)
from https://twitter.com/sixcolorse... [twitter.com]
: If you fall and are unresponsive for a minute the apple watch series 4 will call the emergency number for you. Also sends your info to your emergency contact. AW also can now detect and alert on low heart rate and screen your heart rhythm and alert if it detects a-fib
How much does Apple care about this heart-analysis feature? Here's the president of the American Heart Association to call it "game changing."
You can have my Apple Watch when you pry it off my cold, dead wrist. Literally.
Sep 12, 2018 | www.zerohedge.com
ThunderStruck ,alfbell ,
I don't give a fuck about the next new iPhones that will not deliver any improvements in technology. Bigger is just bigger, not better. How about Apple fix the problems that really irritate people; 1) Siri sucks, fix the fucking thing, 2) Speech to text sucks, fix the fucking thing, 3) Apple has never been able to maintain a reliable Bluetooth connection to a headset, fix the fucking thing. That's just a the beginning. Stop blowing it out about your wonderful amazing new OLED screens, it's already old technology, Samsung phones have had OLED screens for years. How about Apple do what Jobs did and come up with products that change the way people do things. The iPhone changed the way people communicate. The iPod changed the way people listened to and purchased music. Invent something we haven't seen before and don't even know we need it until it's introduced. Or...., just shut the fuck up...TalkToLind ,
The new iPhone allows the CIA and NSA to keep better track of you and your activities. Don't worry though, this is for your safety and protection.Dr. Winston O'boogie ,
I only buy inexpensive, unlocked phones with removable batteries and I pay cash for them.AnonymousCitizen ,
I prefer to keep my Galaxy S8. It is more than enough for my liking. I also have managed to be perfectly satisfied with my 10 year old pc (with a few minor upgrades). The only Apple product I use is my trusty, old Ipod.
This continued obsession with the masses to get their hands on the latest Apple product is ridiculous.
Faster, thinner, more pixels, better camera. Okay, got it.
Sep 07, 2018 | science.slashdot.org
(theguardian.com) 71 Six to eight hours of sleep a night is most beneficial for the heart, while more or less than that could increase the risk of coronary artery disease or a stroke, researchers have suggested. The study, presented at the European Society of Cardiology Congress in Munich, indicates sleep deprivation and excessive hours in bed should be avoided for optimum heart health . The study's author, Dr Epameinondas Fountas of the Onassis cardiac surgery centre in Athens, said: "Our findings suggest that too much or too little sleep may be bad for the heart. More research is needed to clarify exactly why, but we do know that sleep influences biological processes like glucose metabolism, blood pressure, and inflammations -- all of which have an impact on cardiovascular disease." Data from more than a million adults from 11 studies was analysed as part of the research. Compared with adults who got six to eight hours of sleep a night, "short sleepers" had an 11% greater risk, while "long sleepers" had 33% increased risk over the next nine years.
Aug 23, 2018 | www.unz.com
You may remember my dictum: If you are fatter than you want to be, eat less.
That post led to an outpouring of deeply lived personal experience, of almost French complexity, extolling the virtues of eating particular food types in particular combinations at particular times, and not paying too much attention to calories. Fine. If you wish to be befuddled, that is your perfect right.
So, with some trepidation, here is a summary of the current state of knowledge regarding intelligence and health. Indeed, it is my summary of a summary paper. A pointless redundancy, you may say, but I know you are busy, and I would not like to interrupt your lunch break.
Intelligent people lead healthier lives, and that is not just because they intelligently make healthy decisions, but also, it would appear, because they are inherently healthier. Spooky.
What genome-wide association studies reveal about the association between intelligence and physical health, illness, and mortality
Ian JDeary 1 Sarah EHarris 12 W DavidHill 1
1 Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, 7 George Square, Edinburgh EH8 9JZ, United Kingdom
2Medical Genetics Section, Centre for Genomic & Experimental Medicine, MRC Institute of Genetics & Molecular Medicine, University of Edinburgh, Western General Hospital, Edinburgh EH4 2XU, United Kingdom
The associations between higher intelligence test scores from early life and later good health, fewer illnesses, and longer life are recent discoveries. Researchers are mapping the extent of these associations and trying to understanding them. Part of the intelligence-health association has genetic origins. Recent advances in molecular genetic technology and statistical analyses have revealed that: intelligence and many health outcomes are highly polygenic; and that modest but widespread genetic correlations exist between intelligence and health, illness and mortality. Causal accounts of intelligence-health associations are still poorly understood. The contribution of education and socio-economic status -- both of which are partly genetic in origin -- to the intelligence-health associations are being explored.
Until recently, an article on DNA-variant commonalities between intelligence and health would have been science fiction. Thirty years ago, we did not know that intelligence test scores were a predictor of mortality. Fifteen years ago, there were no genome-wide association studies. It was less than five years ago that the first molecular genetic correlations were performed between intelligence and health outcomes. These former blanks have been filled in; however, the fast progress and accumulation of findings in the field of genetic cognitive epidemiology have raised more questions. Individual differences in intelligence, as tested by psychometric tests, are quite stable from later childhood through adulthood to older age. The diverse cognitive test scores that are used to test mental capabilities form a multi-level hierarchy; about 40% or more of the overall variance is captured by a general cognitive factor with which all tests are correlated, and smaller amounts of variance are found in more specific cognitive domains (reasoning, memory, speed, verbal, and so forth). Twin, family and adoption studies indicated that there was moderate to high heritability of general cognitive ability in adulthood (from about 5070%), with a lower heritability in childhood. It has long been known that intelligence is a predictor of educational attainments and occupational position and success
In addition to mortality, intelligence test scores are associated with lower risk of many morbidities, such as cardiovascular disease, cerebrovascular disease, hypertension, cancers such as lung cancer, stroke, and many others, as obtained by self-report and objective assessment. Higher intelligence in youth is associated at age 24 with fewer hospital admissions, lower general medical practitioner costs, lower hospital costs, and less use of medical services, and intelligence appeared to account for the associations between education and such health outcomes. Higher intelligence is related to a higher likelihood of engaging in healthier behaviours, such as not smoking, quitting smoking, not binge drinking, having a more normal body mass index and avoiding obesity, taking more exercise, and eating a healthier diet.
All this work launched a new field: cognitive epidemiology. When studying health, factor in intelligence. If you read any research about a health problem, like for example obesity, always ask yourself the question: how much of this problem is associated with intelligence? Do they have early childhood data on ability and health? Without that, there is probable confounding.
The associations which are found between health and intelligence could be due to a direct genetic pathway shared by intelligence and health, and/or by better, more educated and wealthy intelligence choices.
Genome-wide association studies transformed the field. Box 1 summarises all the different statistical methods. This is a very good guide to the field. The main one is GWAS, which finds regions of the genome which are correlated with the trait in question and statistically significant at a P-value of <5 Χ 10−8 to control for the multiple comparison being made.
Here are all the correlations between the genetic code and health.
Table 1 here
Another part of understanding the genetic contribution to intelligence health correlations concerns other predictors of health inequalities, and intelligence's correlations with them. Intelligence is related to education and socio-economic status (SES), and those were known to be related to health inequalities before intelligence was known to have health associations. Although education and SES are principally thought of as social-environmental variables, both have been found to be partly heritable, by oth twin based and molecular genetic studies, both have high genetic correlations with intelligence, Mendelian Randomisation results show bidirectional genetic effects between intelligence and education, and both have genetic correlations with health outcomes
What does all this mean? It may mean that the underlying causes of health, happiness, morbidity and mortality are unequally distributed, and favour some people more than others. Evolution does not have to conform to our imaginings or our notions of fairness. If genetics is a significant contributor within a genetic group, it is plausible that it contributes to between group variance. Perhaps the Japanese live longer because they are Japanese. This remains to be proved, but is worth testing. If we ever achieve the noble ambition of creating healthy environments all over the inhabited world we may yet have a residuum of health differences due to purely genetic causes.
Meanwhile, you may be wondering what is the intelligent thing to do about your health. Don't smoke, don't get fat, and don't read too many health warnings.
Aug 23, 2018 | www.unz.com
anon ,  Disclaimer says: August 21, 2018 at 4:00 pm GMTAnonymous ,  Disclaimer says: August 21, 2018 at 5:06 pm GMT
What a condescending attitude toward the science of the relationship between food, appetite and health – sneering at any criticism of your simplistic view of the subject.dearieme , says: August 21, 2018 at 5:26 pm GMT
@ comment #1:
It's a wonder you didn't label him racist too.
United States, Overweight and Obesity:
• White 64%
• Hispanic 70%
• Black 72%James Thompson , says: Website August 21, 2018 at 5:31 pm GMT
"Don't smoke": certainly don't smoke cigarettes. Whether occasionally puffing contemplatively on a pipe does any measurable harm I don't know. Just in case it does I gave up decades ago. If it does no harm then those puritanical swine in the medical trades have denied me a good deal of pleasure.
"Don't get fat": but be careful to understand what's too fat, what too thin. If correlation is worth anything – never certain – then if you want a long life be "overweight". Don't, please don't, flirt with being "underweight". Some evidence is displayed in fig4:
That was for a control group. For a bunch of invalids, specifically people who have had a stroke, look at fig 5. As the good Dr Grimes remarks "The death rate at 10 years for normal weight individuals is standardised as 1.0. We see a survival advantage in those with low overweight, high overweight, and low obesity – that is with people with BMI between 25 and 32.5. With "low obesity" there is a death risk reduction of almost 40%.
Repeat, stroke-people with "low obesity" outlive those who are "normal" by a whopping margin. You might almost think that the sawbones and quacks ought to redefine "normal", "overweight" and "obese" in light of such figures. Sorry, the surgeons and physicians.
"and don't read too many health warnings": I never disagree with tautologies.@anonBruce , says: August 21, 2018 at 5:44 pm GMT
If you have data showing that calorie reduction is not the main factor in weight loss, then of course that would be relevant.Bruce , says: August 21, 2018 at 5:47 pm GMT
I assume increased health is a result of lower mutational load which also correlates with higher IQ.FKA Max , says: Website August 21, 2018 at 7:15 pm GMT
Not to start that debate again but my experience agrees with Dr. Thompson wrt calories. Whether my goal is to lose weight or stabilize my weight I can eat a LITTLE BIT more (calorie wise) each day if I eat more protein and less carbs but it really doesn't make much difference.
I have meticulously counted my calories while trying various "macros" and it's basically how many you eat. It may be easier to stay within a particular calorie limit depending on what you I eat but that's beside the point.@RaceRealist88James Speaks , says: August 21, 2018 at 7:29 pm GMT
You also have to think of the body weight set point and how metabolism drops while on an extended kcal deficit.
That is why intermittent fasting is the way to go:
Intermittent Fasting May Preserve Muscle Mass That Is Usually Lost When Dieting
Most weight loss diets cause you to lose fat and muscle, which is a big problem.
Maintaining muscle is fundamental to ensure your metabolic rate doesn't drop and just to support a healthy weight loss (5, 6) https://www.ncbi.nlm.nih.gov/pubmed/20935667/ , https://www.ncbi.nlm.nih.gov/pubmed/22327054/ .
Failing to do so means any fat loss will come back fast, such as what happens with every Biggest Loser contestant.
According to the authors of the review study mentioned above, fasting may be more useful than regular calorie restriction for many overweight patients because of greater loss of body fat, and better preservation of muscle (4) https://www.ncbi.nlm.nih.gov/pubmed/27708846 .
Another study found that 25% of weight lost was muscle mass in normal calorie restriction diets, compared to just 10% lost in intermittent calorie restriction diets (8) https://www.ncbi.nlm.nih.gov/pubmed/21410865 .
– https://www.dietvsdisease.org/intermittent-fasting-is-powerful-for-weight-loss/RaceRealist88 , says: Website August 21, 2018 at 8:23 pm GMT
The basic equations implicit in your assumptions are
(caloric intake – caloric demand) = caloric excess
(caloric excess) / (3,500 kcal/lb) = daily gain or loss.
You fail to consider that the type of food eaten affects caloric demand, both short term (fiber reduces blood sugar) and long term (gut microbes, metabolism).@James SpeaksSantoculto , says: August 21, 2018 at 10:02 pm GMT
"You fail to consider that the type of food eaten affects caloric demand, both short term (fiber reduces blood sugar) and long term (gut microbes, metabolism)."
He's under the delusion that a calorie is a calorie. It's clearly false:
The second law of thermodynamics says that variation of efficiency for different metabolic pathways is to be expected. Thus, ironically the dictum that a "calorie is a calorie" violates the second law of thermodynamics, as a matter of principle.
Stating that a "a calorie is a calorie" is fallacious. Humans are not bomb calirometers. A whole slew of variables affects weight gain/loss, reducing it to calories only doesn't make sense.Santoculto , says: August 21, 2018 at 10:06 pm GMT
Intelligent people lead healthier lives, and that is not just because they intelligently make healthy decisions, but also, it would appear, because they are inherently healthier. Spooky.
Long-lived sardinians "have" higher IQ **Kratoklastes , says: August 21, 2018 at 10:44 pm GMT
Urban-industrialized-cognitive adaptation, aka, higher IQ, is correlated with mental stability which is correlated with organism stability.@RaceRealist88James Speaks , says: August 21, 2018 at 11:36 pm GMT
As you point out, we're sneaking up (slowly) on genuine root causes of Western lifestyle disease and 'metabolic' syndrome (better referred to as insulin resistance syndrome) – the root cause seems to be the damage done by rapid intraday insulin cycling, driven by excess consumption of carbohydrate. Give it a generation, and that will be the dominant paradigm.
There are two big red flags in this piece that make it pretty clear that the pudding is over-egged.
The first red flag is the implicit acceptance of CICO – which is GIGO on a par with other dead tropes like dietary-cholesterol-causes-serum-cholesterol, dietary-fat-causes-CVD, and 'healthy whole grains'.
CICO is true (almost) by construction, so long as all excess calories are stored as tissue of the same density, which is a stretch. But the 'CO' side of things is not meaningfully within the scope of things that individuals can control, because most of the 'CO' happens as a result of basal metabolism and the composition of the 'CI' affects that.
Why didn't the writer go full-retard, and declare that the key paradigm is WIWO ( weight -in/ weight -out)? That must be true irrespective of metabolism. (Answer: it would be meaningless, even though it would be more useful than CICO but WO is also not under anybody's conscious control).
Besides: body weight is relatively unimportant. Body composition is much more important, but it's also not a very good measure of cardiovascular fitness.
In my 20s I weighed upwards of 250lb, but was lean as a motherfucker (6-pack with vascularity lean). Nowadays I weigh ~225-230 depending on whether I've had a shit, but my abs have a good 2″ of fat covering them.
And yet I'm also objectively fitter: my VO2Max is 15% higher at 54 than it was in my 20s.
Long story even longer: nutrition, metabolism, body comp and fitness/longevity are thinks that require bespoke attention; measures of general tendency are worse than meaningless, and most 'research' in the field is worse than muscle-mag bro science.
Anyway enough about that. Back to red flags.
The second red flag is that the author presents obviously-poor data-munging as if it's science.
Take a look at the list of variables for which correlations were obtained: the entire study is one of those lamentable exercises in promotion-disguised-as-research: the reduced-form, grant-seeking paradigm that was eliminated from Economics in the 1970s after the Lucas Critique –
test everything against everything else, and pick some interesting things that correlate with IQ with our preferred sign, and pretend that we did science
Most of those correlations – even the 'highly significant' ones – are absolutely meaningless when expressed as contributions to variance ; they are certainly not of any predictive use (because most people's lives are mostly noise).
Worse still, correlation coefficients are meaningless if the Gauss-Markov conditions do not hold (because ρ – Pearson's correlation – is explicitly the correlation derived from an OLS estimation; OLS is not efficient or unbiased if the model is not linear).
What is the basis for assuming that the true relationship between any of those factors and IQ is linear? (Hint: if it's not, the G-M conditions do not hold).
So, absolutely no surprise that this piece of 'research' was performed in a Department of Psychology – the natural stamping ground of the innumerate charlatan. (It's fun to watch the psycho-charlatans starting to re-brand themselves as 'neuroscientists' grifters always need to know which way the wind is blowing and reposition themselves to extend the grift).
It's exceedingly tedious when badly-performed 'research' of this kind gets any publicity: it reflects poorly on the numeracy of those doing the publicising, for a start.
But it's doubly -tedious when the conclusions are things that I broadly agree with: it tars my anecdotally-supported personal hypotheses when they are associated with the sort of pseudo-scientific bunk that this article presents as 'research'.
My own view is based on a few hundred anecdotes (smart people I know) contrasted against the sea of Betas-and-below readily observable in any shopping mall.
Put broadly, it seems that in general, higher intelligence endows the bearer with a greater capacity for introspection, which in turn will help drive a general tendency to moderation. (Oddly, although being objectively the smartest of my social group, I am not introspective in the least – and moderation can go fuck itself).
Smarter people do tend to be less fat than the Deltas and Epsilons, but that's not saying much. They smoke much less (although that's a recent thing – a behavioural change that started in the mid-80s) – and that single difference is enough to be the driver for almost all non-obesity related health outcomes.@RaceRealist88Bruce , says: August 22, 2018 at 11:35 am GMT
Stating that a "a calorie is a calorie" is fallacious. Humans are not bomb calorimeters. A whole slew of variables affects weight gain/loss, reducing it to calories only doesn't make sense.
There is also the factor that the body reacts to stimuli in complex ways. Merely eating less signals times of famine, and ensures a stored fat gain after normal eating resumes. Paradoxically, eating slightly more while exercising (like walking) where the total mass of the body must be carried signals reduction in total mass while maintaining muscle and bone tissue. That adequate food is available (slightly increased caloric intake) enable weight loss.EliteCommInc. , says: August 22, 2018 at 11:24 pm GMT
I feel bad for distracting discussion of the article but to respond to RaceRealist88
I can only go by my experience tracking my weight, approximate body composition and food/macro/calorie intake. If it makes a difference I do some basic weight training (not a 250 lb ripped bodybuilder like 0.1% of the population).
With high carbs, my weight and body composition stabilize at about 2250 KCAL per day (which is about what the Cunningham formula predicts for my age and LBM). If I eat low carb, it's a bit higher. Maybe 2400-2500 KCAL per day (it's hard to track macros and calories with extreme precision). So there's not a big difference. Is a calorie a calorie? Not exactly but close enough.
If I had to guess what's going on, based on what I've read a protein calorie counts for 3/gram when your body burns it (not 4/gram like in a lab) and foods with a higher insulin load encourage growth (potentially muscle and fat). Ok, there's some nuance.
But fat people eat too much food.@BruceAnonymous ,  Disclaimer says: August 23, 2018 at 4:27 am GMT
"But fat people eat too much food." They eat too much of the wrong kinds of foods.
I think the evidence that our sugar intake is just too high and that processed foods have had a long term negative impact on masses of people, , not most perhaps not even all, but the case to curb eating sugars/carbs of a certain type in large doses and processed foods is clear, in my view.
As for intelligence and health, unfortunately our society is so caste laden with upper castes regardless of intelligence having access to better incomes and therefore better care I would be hard pressed to buy that healthy eating is hardwired in people with higher IQ's. Maybe.
But the analysis here is pretty darn near a circular ring around the rosey. The uncontrolled biases effecting results are pretty open wound.
What constitutes a healthy body and lifestyle might not reflect what is noted in the BMI, even we could agree on the standard for healthy, fat, skinny etc.@KratoklastesIlyana_Rozumova , says: August 23, 2018 at 4:35 am GMT
So you were on the gear. And now you're not.
The Abs Of Natural Bodybuilders vs. The Abs of Steroid Users
Eat Clen, Tren Hard!Triumph104 , says: August 23, 2018 at 6:50 am GMT
Hogwash. Testosterone and its production by body is the key. Physical activity at young age result in increasing testosterone production through lifetime.anonymous ,  Disclaimer says: August 23, 2018 at 6:56 am GMT
The associations between higher intelligence test scores from early life and later good health, fewer illnesses, and longer life are recent discoveries.
While the above statement isn't wrong, it is misleading and irrelevant. Regardless of intellect, cultural values and norms determine behavior and behavior determines health outcomes and mortality rates.
I don't deal with IQ, but instead look at academic performance and income. In the US, Hispanics perform significantly worse than whites and slightly better, but nearly the same as blacks. Throughout the US, Hispanics often live in the same neighborhoods as blacks and attend the same schools. Yet Hispanics do not experience the same health disparities that blacks do. Instead we have the "Hispanic paradox" where Hispanics often have the same or sometimes better health outcomes than whites. When looking at Hispanic subgroups, Puerto Ricans have outcomes significantly worse than whites, although better than blacks.
Hispanics have a much higher incidence of HIV/AIDS than whites, but if you look at an HIV/AIDS map of the US, you will see that Hispanics in the western half of the US (mostly Mexican-Americans) have the same incidence of the disease as whites. It is only along the East Coast of the US that significant disparities in HIV/AIDS rates are seen between the two ethnic groups. Puerto Ricans and Dominicans tend to live on the East Coast and not only do they have varying degrees of African ancestry but they also behave more like black Americans.
Diabetes is rampant among Native American Indians in the US, Pacific Islanders on Polynesian islands, and Australian Aborigines. Their ancestors from 150 years ago didn't have higher IQs, but avoided diabetes by eating differently.
This remains to be proved, but is worth testing.
The Research Industrial Complex doesn't want to prove or cure anything because funding will dry up.@BruceVojkan , says: August 23, 2018 at 8:10 am GMT
Is a calorie a calorie? Not exactly but close enough.
If I had to guess what's going on, based on what I've read a protein calorie counts for 3/gram when your body burns it (not 4/gram like in a lab) and foods with a higher insulin load encourage growth (potentially muscle and fat). Ok, there's some nuance.
But fat people eat too much food.
Yep, but you aren't gonna sell any potions, powders, courses, or books with thinking like that.Vojkan , says: August 23, 2018 at 8:24 am GMT
"Higher intelligence [....] lower general medical practitioner costs, lower hospital costs, and less use of medical services"
Or it might be that intelligent folks don't go to the doctor for a mere cold. And it might also be that intelligent have healthier eating habits because they can afford to buy healthier food. Calory for calory, some foods happen to be healthier, and also more expensive than others. a calory is just a quantity of energy.@Vojkantalents , says: August 23, 2018 at 8:48 am GMT
I wanted to rephrase my second sentence but my attention was diverted and my time to correct expired.
It might be that people who score higher on "intelligence" tests have healthier eating habits because they usually can afford to buy healthier foods. Calory for calory, some foods happen to be healthier, and also more expensive than others. A calory is just a unit of energy.
We are not created equal : tall , small , fat , thin , ugly , handsome , clever ,dumb , healthy , ill . white ,black
Maybe God is not a democrat ?
Aug 02, 2018 | www.rt.comPeople who don't drink alcohol are at as much of a risk of developing dementia as people who drink excessively, according to a new study by researchers who recommend wine as a way to ward off the degenerative brain disease. Middle-aged moderate wine drinkers, in particular, are at a reduced risk of developing dementia in comparison to teetotalers, the study, published in the British Medical Journal, says.
In fact, researchers found those who abstain from alcohol are 45 percent more likely to develop dementia than those who drink about half a bottle of wine per week.
Read more Alcohol may lower Alzheimer's risk, stress increases it in older people - studies
However, the study says people who drink above the recommended alcohol limit of 14 units per week are also at an increased risk of developing dementia.
" We show that both long term alcohol abstinence and excessive alcohol consumption may increase the risk of dementia. Given the number of people living with dementia is expected to triple by 2050 and the absence of a cure, prevention is key, " the study's authors said.
Researchers say it's nearly impossible to definitively determine the effect of alcohol consumption - as it would require a trial in which participants would have to stop drinking or start drinking heavily.
However, previous research has shown non-drinkers are at an increased risk of diabetes and cardiovascular disease, both of which could contribute to dementia.
Moderate alcohol drinkers, meanwhile, have been known to have reduced cholesterol and blood pressure levels, which may protect them from dementia.
The findings are based on a 1985 study involving 9,087 British civil servants aged between 35 and 55. The study assessed participants over an eight-year period in which they analysed the social, behavioral and biological implications alcohol has on long term health.
READ MORE: Jungle juice! Wild chimpanzees regularly drink alcohol, scientists find
The authors say while the study is important to fill gaps in knowledge, " we should remain cautious and not change current recommendations on alcohol use based solely on epidemiological studies ".
The researchers are also careful to say these findings " should not motivate people who do not drink to start drinking " given the detrimental effects alcohol consumption can have on other parts of your health, such as liver disease and cancer.
Jul 31, 2018 | www.zerohedge.com
Ignatius -> FEDbuster Mon, 07/30/2018 - 21:38 Permalinkdirty fingernails -> Ignatius Mon, 07/30/2018 - 21:42 Permalink
Can't waste resources here at home assuring sound drinking water for all, no, we need to attack Iran because as the rumor has it that the "undemocratic" Ayatollah is denying his people the benefits of premium drinking water. Or something like that. I get confused.
I'm certain, however, that the banks will step forward in their community spirit and lend the money at interest necessary to see Kalamazoo through their current crisis (bonds maturing sometime in the 22nd century).107cicero -> Ignatius Mon, 07/30/2018 - 21:56 Permalink
"Don't ask no questions, just give the money"snblitz -> Ignatius Mon, 07/30/2018 - 22:01 Permalink
Well said.dirty fingernails -> snblitz Mon, 07/30/2018 - 22:11 Permalink
Reverse Osmosis for the home is pretty cheap. So is nano-filtration. Both are effective against PFAS and PFOS.
I have been RO for decades. Been converting everyone I know.
You can get a under sink RO unit for about $140 and replace the membrane every 2 years for about $50.
Same here. Living on a 100+ year old farm in the corn belt, no freaking way was I going to risk the well not being contaminated with agricultural chemicals and who-knows-what
Jul 09, 2018 | www.huffingtonpost.com
Hat tip to The Empire's Suez Crisis
As a follow up to previous blog posts about America's dysfunctional for-profit health care system, read:Badly Injured Woman Begs Passersby Not To Call An Ambulance, Due To Cost
Most ambulance rides in the USA are over $1000, some are twice that amount, and bills of over $8000 are not uncommon. At one time, some cities provided ambulance rides as a free public service, or hospitals provided them for free to boost business. I suspect more than 90% of Americans would agree that their state or federal government should limit ambulance bills to perhaps $500. If this makes companies unprofitable, the government would need a subsidy scheme. The biggest problem for ambulance companies are poor people without insurance, which is why they boost fees for paying customers. The government could pay their $500 if they submit a financial form claiming poverty.
Once the government must pay some of the cost, it will end waste, like when highly paid fire department paramedics show up at the scene to provide care, but don't transport to a hospital because an ambulance is called too. So the patient is double billed, which pleases the ambulance company and the paramedics who prefer to return to their fire station quickly to resume their movie. In many cases, people with minor problems in rural areas could be transported to a local urgent care facility, but are driven to a hospital ER over an hour away because of a wasteful policy that ambulances only transport to hospital ERs.
You don't get a bill when the fire department shows up for a fire, so why when they show up to save a life? In many cases, an ambulance is called because someone is mugged or hit by a car. Why should a victim get billed? In other cases, an ambulance is called for someone who has a minor injury or dizzy spell, but the ambulance employees insist that hospital care is required so they get paid for showing up. Governments can easily control the ambulance racket because they control 911 dispatches, so can negotiate prices and rules for ambulances they dispatch.
May 26, 2018 | www.forbes.com
Nothing beats hard work and perseverance when you're trying to lose weight and keep it off, but there are also a few sustainable ways that you can use to drop those first few pounds and keep them off. These 5 steps will have you 5 pounds slimmer by next week.
1. Work out first thing in the morning. What do 90% of people who exercise consistently have in common? They exercise in the morning. Working out in the morning more or less guarantees that you'll work out every day, and the benefits carry over throughout your day. For one, exercise in the morning increases your energy levels, which makes you more productive throughout the day and more focused on your work. Also, getting in an early morning workout helps you burn more calories throughout the day. Working out helps to increase your metabolic rate, burning calories for long after you've stopped exercising.
A study done at Appalachian State University found that people who had completed a 45-minute exercise routine burned 17% more calories in the 14 hours following exercise than those that didn't work out. Also, when you exercise, you tend to be more mindful of your food choices throughout the day. You want to carry your new good habits over into the rest of the day, and remember that exercising is NOT a free pass to eat what you like throughout the day. If you're looking to reduce, you need to watch your food as well. And speaking of food...
2. Get Bitter about Food. Bitter greens like kale, arugula, mustard greens, collards and escarole are summer diet staples that aid in digestion and de-bloating. Bitter foods are also known to stimulate and support better digestion, as recently outlined in a study by the European Herbal and traditional Medicine Practitioners Association. These dark greens are low calorie (about 36 calories in a cup for greens), and are packed with vitamins and fiber that your body needs to stay lean. For instance, kale is high in iron (per calorie, it has more than beef!), vitamins A, C and K, is great for your liver and for lowering your cholesterol levels. Most bitter greens are also great anti-inflammatories, which can help fight bloating and get you down to your fighting weight.
3. Spice Up, Salt Down. High-salt diets lead to water retention. Cut the salt, and you cut the bloat. But it takes more than just leaving the salt shaker on the table. A study reported on by the
American Heart Associationfound that 75% of American's salt intake comes from the food itself! While you need a little salt in your diet, for most people, everything they need will already come from the food that they eat, and most people will get too much. Cut out processed foods as much as possible and you will drastically reduce your excess sodium. Food items like salad dressings and sauces are some of the worst culprits. For example, per tablespoon, ketchup has 20 calories and a whopping 6% of your daily salt intake. A few squirts of ketchup and you're already at 20% of your daily value, and that's not even including what the ketchup is on! Instead of "secret sauces" that will cause bloating and completely mask the flavor of what you're eating, try spices, especially hot ones. Conversely, spices enhance the flavor of what you're heating, and hot spices that contain capsaicin increase thermogenesis in your body. The latter can help burn more calories after your meal. Sprinkle some cayenne pepper, bell pepper or jalapeno into two of your daily meals and increase your metabolism.
4. Eat the Whole Thing. Whole foods, that is! You want to give your body the cleanest fuel possible so it can run at maximum efficiency. When you want to shed all you can, you want to avoid anything processed (for salt-related reasons above.) Raw vegetables, fruits, whole grains and proteins like cold water fish, beans, and eggs should be your staple diet if you're working on trimming down. You'll also want to limit your fat intake to "healthy fats" only. This includes fats from olive oil, nuts and avocados. These "good", monounsaturated and polyunsaturated fats can actually be beneficial to your heart and help lower bad cholesterol (LDL) levels. In fact, research done at Harvard found that while bad fats like saturated and trans fats increased risk factors for certain diseases, total amount of "good" fats did not. In fact, eating "good" fat can help you burn fat. In another Harvard study, researchers found that participants who ate 20% of their calories from "good" fats dropped 5 pounds more after 18 months than the participants who went on low fat diets.
5. Deep breaths. It may sound trite, but breathing deeply not only helps you calm down, but it can help your weight loss efforts as well. Deep, calming breaths can actually "trick" your body into de-stressing. While most people take breaths with their chest, you should be taking long, deep breaths with your abdomen. Taking a moment to focus and breathe deep into your abdomen can do wonders for your stress level.
So what does stress have to do with weight loss? Stress increases your levels of cortisol, a hormone in your body that can increase your appetite and lead you to eat more. This response used to make sense in "fight or flight" situations, where we need that energy to defend ourselves. Now, a more common situation is to come home after a long day at work and chow down. Elevated cortisol levels also lower your cognitive functions such as learning and memory, decrease your immune function and bone density, and increase your blood pressure, cholesterol and risk of heart disease. Need a reminder to breathe? Set an alarm for every hour on your mobile phone, and take a few long, deep breaths every time it pings. It'll help your weight and your sanity.
Mar 27, 2018 | science.slashdot.org
(theguardian.com) BeauHD on Wednesday February 14, 2018 @11:30PM from the not-what-you-want-to-hear dept. An anonymous reader quotes a report from The Guardian: Ultra-processed" foods, made in factories with ingredients unknown to the domestic kitchen, may be linked to cancer , according to a large and groundbreaking study. Ultra-processed foods include pot noodles, shelf-stable ready meals, cakes and confectionery which contain long lists of additives, preservatives, flavorings and colorings -- as well as often high levels of sugar, fat and salt. They now account for half of all the food bought by families eating at home in the UK, as the Guardian recently revealed . A team, led by researchers based at the Sorbonne in Paris, looked at the medical records and eating habits of nearly 105,000 adults who are part of the French NutriNet-Sante cohort study, registering their usual intake of 3,300 different food items. They found that a 10% increase in the amount of ultra-processed foods in the diet was linked to a 12% increase in cancers of some kind. The researchers also looked to see whether there were increases in specific types of cancer and found a rise of 11% in breast cancer, although no significant upturn in colorectal or prostate cancer. "If confirmed in other populations and settings, these results suggest that the rapidly increasing consumption of ultra-processed foods may drive an increasing burden of cancer in the next decades," says the paper in the British Medical Journal .
Mar 23, 2018 | www.newsmax.com
If you're still using the BMI -- body mass index -- to determine if you're dangerously overweight, you might as well be listening to music on an 8-track tape player or watching movies on an old VHS recorder.
That's because the latest research shows that once-vaunted BMI is as outmoded as those old audio-video technologies and that other methods are far better at obesity-related risks for heart attack or other health problems.
A new study, published last month in the Journal of the American Heart Association, found that one newer type of obesity measurement -- called a waist-to-hip ratio test -- is a far better way to calculate excessive body fat than the BMI.
To reach their conclusions, British researchers tracked 265,988 women and 213,622 men and found individuals -- particularly women -- with a bigger waist-to-hip ratio face greater risks of experiencing a heart attack than those who don't.
Lead researcher Sanne Peters, of the George Institute for Global Health and the University of Oxford in the U.K., explained that waist-to-hip ratio tests are a better measure of how and where fat tissue is distributed in the body than BMI.
"Waist‐to‐hip ratio was more strongly associated with the risk of [heart attack] than body mass index in both sexes, especially in women," reported Peters and his colleagues.
The British study is only the latest research to question the value of BMI tests. University of California-Santa Barbara scientists also recently found that an elevated BMI isn't the best way to determine if you're overweight, obese, or unhealthy.
UCSB psychologist Jeffrey Hunger and colleagues said their work shows that you can be fit and still be considered overweight by BMI guidelines.
In fact, the UCSB research, published in the International Journal of Obesity, indicates nearly 35 million Americans labeled overweight or obese based on their BMI are, in fact, "perfectly healthy" -- as are 19.8 million others considered obese.
"In the overweight BMI category, 47 percent are perfectly healthy," said Hunger, a doctoral student in UCSB's Department of Psychological & Brain Sciences, arguing that BMI is a deeply flawed measure of health and should be abandoned.
"So to be using BMI as a health proxy -- particularly for everyone within that category -- is simply incorrect," he said. "Our study should be the final nail in the coffin for BMI."
The BMI -- calculated by dividing a person's weight in kilograms by the square of the person's height in meters -- was developed by Adolphe Quetelet, an 18th century Belgian mathematician. But the tool was originally designed to measure and compare societies, not individuals.
A growing number of researchers, including Hunger, have suggested measuring weight and height only isn't a good way to gauge obesity or a person's overall health.
For one thing, the index doesn't accurately measure body fat content or distribution on the body, or the proportion of muscle to fat -- all critical factors in determining obesity-related health risks. Nor does the BMI take into account gender and racial differences in body composition.
The BMI treats body weight the same, no matter what it's comprised of -- fat, muscle, bone, or other tissues. As a result, many people who are very muscular can be falsely labeled overweight or obese by the BMI, while those who fall within BMI's weight parameters may have high levels of body fat content.
Declaring a person obese based only on BMI, "is old-fashioned and not terribly useful," said Dr. Scott Kahan, director of the National Center for Weight and Wellness in Washington, D.C. He sees patients who are deemed overweight by the BMI, but are healthy and well.
"They're heavy," he noted. "BMI puts them in the obesity range. And yet on every level
their health is actually good. Cholesterol and blood pressure are excellent. Blood sugar is excellent. They don't seem to have any health effects associated with excess weight."
So what alternatives can be used in place of BMI to more accurately measure health and obesity? Here's are a few tests experts recommend that provide a broader picture of a person's health than BMI:
Waist-to-hip ratio. This test calculates how much excess weight you are carrying, which can indicate your susceptibility to high blood pressure, heart disease, and diabetes. To calculate your waist-to-hip ratio, use a tape measure to measure the size of your waist line and the widest part of your hips. Then divide the circumference of your waist by your hip measurement. Men with a waist–to-hip ratio above 0.90 and women over 0.85 are considered obese, according to the World Health Organization.
Waist measurements. Simply taking a tape measure to check your waist size can also provide a clue to whether you need to lose weight. Generally, a waist size over 35 inches in women and 40 inches in men indicates that weight loss is warranted, with the exception of only the most muscular individuals.
Body-fat content tests. Instruments such as DEXA (dual-energy X-ray absorptiometry) scanners -- becoming more widely available at health clubs and clinics -- provide a highly accurate measurement of body fat and lean mass distribution. They can also reveal important information about bone health.
In addition to these tests, health experts say measurements of other vital signs and health numbers are more reliable ways to gauge your overall health than the BMI. Among them:
- Blood tests to check for cholesterol levels, blood glucose, and hypertension.
- Measures of your heart rate and pulse.
- Screenings for hormone levels, heart function, and cardiovascular fitness.
UCSB Hunger argued that the idea of using a single measurement, such as the BMI, as a gauge overall health is outmoded and should be abandoned.
"We need to move away from trying to find a single metric on which to penalize or incentivize people and instead focus on finding effective ways to improve behaviors known to have positive outcomes over time," he said.
Mar 21, 2018 | www.nakedcapitalism.com
Note that this is Kaiser Health News monthly feature provided jointly with NPR to analyze medical bills. If you have a bill you'd like to see if they will puzzle out, can submit yours here . Be sure to give the background.
By Shefali Luthra, who covers consumer issues in health care. Her work has appeared in news outlets such as The Washington Post, CNN Health and NPR.org. Originally published at Kaiser Health News
During Anne Soloviev's semiannual visit to Braun Dermatology & Skin Cancer Center in Washington, D.C., in January, the physician assistant diagnosed fungus in two of her toenails. Soloviev is vigilant about getting skin checks, since she is at heightened risk for skin cancer, but she hadn't complained about her toenails or even noticed a problem.
The assistant noted some unusual discoloration where the nail meets the skin. "They took a toenail clipping and said, yeah, you have a fungus," Soloviev recalled.
So the PA called a prescription into a specialty pharmacy with mail-order services, which would send medication to Soloviev's Capitol Hill home.
It seemed like an easy fix to an inconsequential health issue. "I did not ask how much it cost -- it never crossed my mind, ever," said Soloviev, a former French teacher, who still works part time.
Then the bill came.
Patient: Anne Soloviev, 77 on March 18, of Washington, D.C.
The Bill: $1,496.09 for Kerydin, a topical medication that treats toenail fungus. Originally produced by Anacor Pharmaceuticals Inc., it is now a product of Sandoz, a Novartis division.
When Anne Soloviev, a retiree who lives in Washington, D.C., received a prescription to treat toenail fungus, she never thought to ask how much it cost. As it turned out, she was prescribed a topical medication costing almost $1,500.
Service Provider: My Express Care Pharmacy, plus Braun Dermatology & Skin Cancer Center
The Medical Treatment : Shortly after the physician assistant phoned in the prescription to My Express Care Pharmacy, in Maryland, the pharmacy contacted Soloviev for her health insurance information.
Soloviev is covered by Medicare, Parts A and B, and has supplemental insurance through her late husband's government health benefits that covers prescription drugs. She also has a health reimbursement account (HRA), which contains almost $1,500 pretax dollars each year to pay for uncovered medical expenses. She typically uses that pot of money to cover copays for the other medicines she takes regularly.
Kerydin, the toenail medication, arrived by overnight mail, and an automatic refill came a few weeks later. She began swabbing it on the two toenails, as directed, having been told it would take about 11 months to treat the fungus.
She thought little of it.
But when Soloviev went to her local CVS to pick up another medication -- a statin that is usually paid for by her HRA -- she discovered her reserve was empty.
Unbeknownst to her, Kerydin, which it turned out costs nearly $1,500 per monthly refill, had wiped out her entire reimbursement account.
Anne Soloviev's prescription for Kerydin, at $1,496.09 per monthly refill, wiped out her entire health reimbursement account for the year. (Courtesy of Anne Soloviev)
What Gives: We're talking about mild toenail fungus. The price tag is difficult to rationalize, experts said.
"Reality check -- this is $1,500 for a medicine to treat [it]," said Wendy Epstein, an associate law professor at DePaul University, who researches health care law. "That's quite a chunk of change."
Leslie Pott, Sandoz's vice president of communications, explained that Kerydin is patent-protected and priced "at parity" with its one market competitor, Jublia. She also pointed out that to secure a place on an insurer's list of approved drugs -- its formulary -- the drugmaker often had to offer substantial discounts to insurers and various middlemen. "We have no visibility into the extent to which these discounts are passed onto patients or payers," she wrote in an email.
There are many prescription treatment options for toenail fungus -- both older medicines in pill form and newer topical treatments such as Kerydin, said Dr. Shari Lipner, an assistant professor at Weill Cornell Medicine and director of its nail unit. The patient in this case would have been a candidate for "quite a few" of them.
Patients are likely to pay less for the pills, for which a course of treatment lasts three months, compared with the newer topical treatments, she said, adding that the pills also seem to have greater efficacy.
In its application for Food and Drug Administration approval granted in 2014, Anacor Pharmaceuticals highlighted that a yearlong treatment of Kerydin completely cured toe fungus in 6.5 percent of patients for one trial, and 9.1 percent of patients in another.
Over-the-counter treatments are also available, but there's not much data on them, Lipner said.
Xavier Davis, Braun Dermatology & Skin Cancer Center's practice manager, said a drug's price tag simply isn't a factor when prescribers recommend a course of treatment.
"When our providers are treating patients, we're not treating them based on what the cost's going to be. We look for what's the best care for the patient," Davis said. "If the patient calls and says that's too expensive, then we'll look for alternatives."
Kavita Patel, a nonresident fellow at the Brookings Institution and a practicing physician, said this process contributes to the problem. "My sister's a dermatologist, and she'll do the same thing -- she'll prescribe and she doesn't know. You're getting at many layers of how [messed] up the system is, starting with the doctor doesn't know."
And patients often don't see the actual price. Or they see it too late, when they're at the pharmacy counter picking up medicines they have been told they need or in a roundabout way discover unexpected payouts.
In January, Soloviev's insurance plan was billed the full price of Kerydin. Of that, $1,439.57 came from her HRA. The difference, $56.52, was covered by a patient-assistance program from the drug manufacturer, explained Jonathan Lee, a pharmacist for My Express Care.
In February, when Soloviev's prescription was refilled, her plan was again billed the full drug price. But she didn't know about that either. A manufacturer coupon was applied to cover what remained of her insurer's $2,000 annual deductible and the $60 copay. Her insurance then kicked in to pay the difference.
Such patient-assistance programs and coupons are meant to insulate patients from cost sharing, so that they don't feel a pinch from a drug's price. But in this case, the drugmaker's patient-assistance program apparently took effect only once Soloviev's HRA has been wiped out, allowing the manufacturer to maximize revenue from both patient and insurer.
DePaul University's Epstein said it took her "15 minutes to figure out what was going on" here. And, unlike the average patient, she studies this issue for a living.
Lee, the pharmacist, said even he didn't realize that money could be withdrawn directly from a patient's HRA without her knowledge, and he's been in the business for the better part of a decade.
None of that is consolation for Soloviev, who said: "I just find it is outrageous for a fungal medicine to cost $1,400, to be prescribed for 11 months, and for neither the PA nor the pharmacy to warn you," Soloviev said.
Resolution: Though she has told My Express Care not to renew the prescription, Soloviev's HRA is depleted. For the rest of the year, she'll have to pay out-of-pocket costs for any other medications, an expense she hadn't planned on.
The Takeaway: For even the most informed of patients, getting a new prescription can mean walking through a financial minefield. And Soloviev hit a number of booby traps.
Bottom line, experts say, medical professionals should make the patient aware if they prescribe a high-priced medicine and explain why it's beneficial.
Patients should play defense and ask their physicians about the cost of every new prescription. They should ask again at the pharmacy -- even if that means calling a mail-order pharmacy. Because costs can vary depending on each patient's coverage, they may need to contact their insurance carrier or the PBM that handles their medicine claims.
And if the cost is extremely high, they should ask their doctor about generic or over-the-counter alternatives.
"This is an important component of the decision a patient's going to make," Epstein said. "If it's toenail fungus and not life-or-death, it strikes me an individual might want to have relevant data."
Mar 21, 2018 | www.nakedcapitalism.com
Enquiring Mind , March 20, 2018 at 9:17 amRabidGandhi , March 20, 2018 at 6:16 am
Shame is a 20th century concept ill-suited to this modern post-tobacco settlement world. Where some saw a consumer victory after decades of warnings on packs by getting big tobacco to acknowledge risks, others saw methodology victory for the neo-liberal machine, and an instruction manual .
Like the Big C, cancer, that machine keeps rolling along. Now it is mainstream, to be emulated instead of castigated. At least that is what appears to have happened among those shame-free star pupils of Big Pharma and their fellow travelers in FIRE, aided and abetted on the Big Screen where deviancy got defined down so far it got erased. Political and economic trends ebb and flow, with some elements of populism appearing on the horizon. Greater awareness of the plight of one's fellow humans may help focus the mind.notabanker , March 20, 2018 at 6:36 am
Bottom line, experts say, medical professionals should make the patient aware if they prescribe a high-priced medicine and explain why it's beneficial. Patients should play defense and ask their physicians about the cost of every new prescription.
Bottom line, it's doctors and patients fault for not defending themselves against the ludicrously corrupt health insurance industry. Bottom line, medical professionals and patients have to spend their time and effort (increasingly dwindling, because markets) to try to avoid being charged a month's pay for a tube of ointment. Because, bottom line, changing the system is not an option, so keep banging your head against that wall!oh , March 20, 2018 at 2:30 pm
Yeah, try getting a straight answer on what this stuff will cost BEFORE you take possession, er , are treated. "$200" has turned into $1000 bills from a third party device company that magically turns to $0 after 3 months of emails and phone calls. I've walked out of hospitals after getting full disclosure of costs minutes before a procedure that was scheduled weeks in advance.
The neolib corruption numbness has to seep through the cartilage into the bones to call these practices anything but criminal.Amfortas the Hippie , March 20, 2018 at 4:15 pm
There is really no excuse for the crooks in the medical (health care? nah!) industrial complex not to provide costs of any procedure or service ahead of time. I admire you for walking out minutes before the procedure and more people should do the same. I would do the same and have.Bukko Boomeranger , March 20, 2018 at 7:06 am
If there's no "Price Discovery", is it really a "Marketplace"?
towards the end of my six and a half year slog through the disability process(sic), I learned about Cuba. I got a price for a new hip pretty easily from them (around 10 grand, including a "bungalo on the beach with a private nurse for recovery")
so I called the nearest hospital, and asked what a new hip would cost me, cash money, walking in the door.
The person obviously didn't understand the question, and after some time of me waving my arms and trying to word the question in a form she would understand she said" oh insurance takes care of that and it depends on many factors"
"such as?" sez I
Her:" like what kind of replacement they use which is up to the surgeon and many things"
This went on and on, and I finally got her not nailed down at around 300 grand.
Then I asked her what medicare would pay for the same thing and she hung up on me. It ain't a "Market", it's a Racket.
(and, about the toenail fungus my grandmother would tell her to just pee on it .)HistoricalPerspective , March 20, 2018 at 11:32 am
By the "logic" of the guest post, bottom line is it's that baby's fault for not being strong enough to defend itself against the big kid who took its candy. It's the woman's fault for dressing that way before she was raped.
The victims should be blamed because they didn't play defence well enough against the criminals who write the rules of the system. I presume your comment is to flesh out the BS justification from the article, Gandhi, not to endorse it. Excuses like the one capping the guest post, instead of rabid outrage, are part of what allows the crimes to continue. I can see why so many Merkins want to burn the (family blog)er down, even though they wind up voting for Trump as a means of expressing that feeling.jackiebass , March 20, 2018 at 6:31 am
" experts say "
Seriously, who are these 'experts'!?!? Between the 'experts' , who blame the victims, kick cans down the road and pass the bucks to the lay-people (no one is an expert in everything, i.e. everyone is ignorant about something at some point in their lives) they're suppose to be advising whenever 'expertise' is required, and the 'journalists' who give them a venue to spew their apocryphal twaddle in an attempt to portray themselves as 'experts' when their true intentions are to gaslight, obfuscate and divide common sense and decency. Throw in the politicians, crony capitalists and all the other puppet masters and you have the perfect storm so many Americans, like myself, finds themselves drowning in. Once upon a time expertise inferred wisdom. Those days are history.divadab , March 20, 2018 at 8:00 am
I don't know if it works but I've been told that petroleum jelly will cure toenail fungus. it seems salves or topical medicines are usually expensive. I use a salve that I apply to the rash from my. Eczema. I have used it for years and the price is constantly increasing. When I started using it the cost was $50 per tube. The last tube I got cost $480. I was prescribed an inhaler for Bronchitis. It cost almost $500 and didn't seem to do much to relieve the symptoms. Fortunately my insurance payed for the medicine. It still makes me mad when I think about what was charged for these prescriptions.Arthur J , March 20, 2018 at 10:13 am
There are much cheaper alternatives to inhalers for asthma or bronchitis. Buy a "Nebulizer" (we just bought a portable one for $50), which is a vaporiser, and get your doctor to prescribe "nebules" of albuterol sulphate and/or sodium chromalyn to load into the nebulizer. We get a prescription refill of nebules for $3.49 v. over $50 for a ventolin inhaler . And there is no propellant in the nebulizer which there is on an inhaler.
The greed and parasitism of the pharmaceutical cartel is criminal.Eudora Welty , March 20, 2018 at 12:32 pm
My gp told me to use Vick's VapoRub for my toenail fungus. I asked the pharmacist and she said it has about a 10% success rate, same as the petroleum jelly from which Vick's is made. There was some branded treatment, $40 for a 2ml bottle that she said worked maybe 15% of the time. Only been a few weeks, but so far I haven't seen much of a change.home for wayward trout , March 20, 2018 at 1:00 pm
Yes, I used Vick's Vaporub on a toe fungus and it worked. I was told it wouldn't work.RalphR , March 20, 2018 at 8:22 pm
The People's Pharmacy has a lot of information on toenail fungus and also has an article recommending treatment with mentholatum.
I now go to their website before filling any prescription I'm given by a doctor.donw , March 20, 2018 at 12:42 pm
I did (after trying other topical but non-prescription products) and it didn't initially.
But then I used it in conjunction with a lotion with a lot of hyaluronic acid in it. Hyaluronic acid is widely used in cosmetic products to increase penetration of the active ingredients into the skin.
Just by sure to apply any treatment to the cuticle, particularly at the root of the nail. That is where the fungus lives.Marie Parham , March 20, 2018 at 6:42 am
It is a fungus, so being outside in the sun wearing flip flops might kill it.Normal , March 20, 2018 at 6:42 am
Last summer I had toenail fungus and researched how to treat it. Soaked my feet is diluted vinegar a few days and scrubbed the area. Then I used https://www.cvs.com/drug/miconazole . It worked. Next time I have an annual checkup I will talk to my nurse practitioner. Web MD was a big help. https://www.webmd.com/skin-problems-and-treatments/guide/fungal-nail-infections-topic-overview#1
So was Mayo clinic
I am not recommending websites replace physicians, but apparently it is necessary to always second guess the physicians.
My treatment cost less than $10.XXYY , March 20, 2018 at 10:22 am
How about requiring every provider to give a firm quotation on every product and service? Every other industry has to live with this constraint.sharonsj , March 20, 2018 at 12:58 pm
I'm amazed this simple idea never gets traction. Car mechanics, e.g., are required by law to provide a written estimate before work begins; if something is found that will change the estimate, they have to get your OK. Car repairs are usually much cheaper than medical bills and are often equally or more opaque to diagnose.
Having doctors and medical offices provide you with an estimate after diagnosis but before treatment does not seem like it would be terribly hard. They (uniquely) have visibility into your insurance arrangements, their reimbursement rates, their costs, overhead, profit rates, and so on. Software for this purpose would make pretty short work of boiling this down to the out-of-pocket for the patient. The patient could then either OK it, negotiate other options, or decide to shop around. If the provider later tries to charge more, the patient would have something on paper to justify refusing it.
There's no reason patients should be treated like a bottomless bank account by the medical industry.oh , March 20, 2018 at 3:02 pm
Many doctors have no clue what things cost. I received a single shot of cortisone for an arthritic shoulder and was charged $200. When I complained to the health care system, I was told that, had I been insured, the cost to me would be $100 less. When I complained to my doctor, he had no idea about any of this.
P.S. I knew the owner of an herb farm who had foot fungus. She visited a podiatrist and was prescribed some expensive salve which didn't work. The woman then went out on her farm, gathered some herbs according to an old remedy, made her own salve and was cured.JTMcPhee , March 20, 2018 at 10:25 am
I was told to get the shot for shoulder pain (was a bad idea from this quacK). The "doctor" had no idea what it would cost!! At any rate it cost me over a $100 even with Kaiser coverage and it did NOT help. It hurt a lot for a few days (in more ways than one). What a fraud this industry is.
I dread the day I'd have to go to the hospital where I it was such an emergency that I'd be at the mercy of this robber baron systemFluffytheObeseCat , March 20, 2018 at 11:19 am
Had any car or truck repair work done lately? Or speaking of things automotive, have any of us had experiences with the sales machinery of car and truck dealers, new or used? Speaking of transparency in pricing, firm quotes and all that? As just one example of how The Machine actually works? Catch-22: "They can do anything to us they want that we can't keep them from doing." http://www.slate.com/articles/life/the_spectator/2011/08/seeing_catch22_twice.htmlnycTerrierist , March 20, 2018 at 3:07 pm
Big ones twice in the past four years on the RAV4. 2 different shops, in different states. They both gave me firm, up front price quotes. One was wrong on the low side, and the owner called me with the real price and an apology before doing the work. Just like the law requires.
This kind of fair dealing and respect for the customer never happens in medical practices. The doctors rarely soil their highly educated minds with matters of cost; everyone else in the office has little authority, and the chubby young women who sit up front in scrubs do as little as possible for the captives they call patients.Paul P , March 20, 2018 at 7:19 pm
"This kind of fair dealing and respect for the customer never happens in medical practices. "
This! And stress over billing affects health!
it is stressful and aggravating that doctors can't/won't address cost at the point of service. This destroys patient's trust in the physician as well.
Therapeutic relationship is wrecked as well as health and personal finances.anonymous , March 20, 2018 at 6:57 am
This NYS law applies to services, not drugs. It's a start:
Emergency Medical Services and Surprise Bills Law – New York State
https://www.health.ny.gov/regulations/ bill /ems_and_surprise_bills_law_faq.htm
If they do not participate in a patient's health care plan, they must upon request from a patient inform the patient of the estimated amount they will bill absent unforeseen medical circumstances that may arise. Under subdivisions (3) and (4), physicians in private practice also must provide information regarding any other ..Eureka Springs , March 20, 2018 at 7:03 am
"We're talking about mild toenail fungus. The price tag is difficult to rationalize, experts ( and every breathing human ) said."Enquiring Mind , March 20, 2018 at 9:07 am
We're talking about mild toenail fungus. The price tag is difficult to rationalize, experts said.
What kind of "expert" tries to rationalize cost of prescription on severity, rather than, say, cost of making the product?
16,500 for the course of an eleven month treatment with 6 percent chance of working. Seems like a medical RX vacation almost anywhere else in the world would be prudent.Jon S , March 20, 2018 at 12:34 pm
What kind of expert, you ask?
Today's fast-paced, stimulating world in pharmaceutical revenue management and marketing needs H1-B visa assistance to hire the kind of expert that is not available in sufficient quantity or quality to allow efficient pursuit of medical excellence. In past years, such personnel were to be found only in select industries such as tobacco and other personal care products. Building the right team, with applicable key performance indicators and mission-critical elements, is too important to be left to chance so every avenue must be explored, every base touched. Consumer options are opened up in the free market of healthy competition for products rather than stifled under excess regulatory and legal layers.
That kind of expert. /ssgt_doom , March 20, 2018 at 1:54 pm
I really enjoyed that!Lambert Strether , March 20, 2018 at 7:07 am
Man oh man!!!!
Had a deja vu moment there -- thought I was back as an employee during a leveraged buyout by the typically sleazy PE firm of Baird Private Equity!!!!!Miamijac , March 20, 2018 at 7:28 am
Sounds like Soloviev wasn't a "smart shopper"!Croatoan , March 20, 2018 at 8:17 am
Teatree oil, anti fungal. >$3.00. They only have a license to practice.Kevin , March 20, 2018 at 9:06 am
Just be careful with the natural stuff
"The results of our laboratory studies confirm that pure lavender and tea tree oils can mimic the actions of estrogens and inhibit the effects of androgens ," said Korach. "This combinatorial activity makes them somewhat unique as endocrine disruptors."
https://www.nih.gov/news-events/news-releases/lavender-tea-tree-oils-may-cause-breast-growth-boysoh , March 20, 2018 at 3:14 pm
My wife is a massage therapist and dispenses oils occasionally. NEVER use straight oils – ALWAYS use a carrier oil in conjunction.
BTW – anyone else notice the toe fungus ad placed above the comments we're being watched!cnchal , March 20, 2018 at 8:29 am
Another myth propagated by the hand maidens to the Pharma industry.sgt_doom , March 20, 2018 at 1:55 pm
The title of the post is a bit misleading.
It should have been "Bill Of The Month: For Toenail Fungus, A $16,500 Prescription and less than 10% effective".
. . . She began swabbing it on the two toenails, as directed, having been told it would take about 11 months to treat the fungus .
– – – –
Unbeknownst to her, Kerydin, which it turned out costs nearly $1,500 per monthly refill . . .
– – – –
In its application for Food and Drug Administration approval granted in 2014, Anacor Pharmaceuticals highlighted that a yearlong treatment of Kerydin completely cured toe fungus in 6.5 percent of patients for one trial, and 9.1 percent of patients in another.
The post's title diminishes the scale of the scam by a factor of at least 100.lyman alpha blob , March 20, 2018 at 3:52 pm
Very well articulated and thought out!
Props and kudos!!!Joel , March 20, 2018 at 8:35 am
That last bit blew my mind. Why in the hell is the FDA approving anything as a treatment that can only be shown to cure what it's supposed to less than 10% of the time!?!? And we know how the approval process scam works – the companies only submit the best results in the first place and leave out the data the shows treatments to be less successful.
That being said, who would like to try out my new wonder drug? It cures absolutely everything that ails you at least 5% ot the time. I call it Plaisibeaux – the ingredients are French and they're a trade secret. Any FDA employess around who can fast track this one for me?Stillfeelinthebern , March 20, 2018 at 2:43 pm
My simple stupid solution just avoid them entirely, the docs the tests the meds the hospitals. Advil is cheap and works for most of the pain. A couple of other basic meds for occasional random stuff that I buy when I travel outside the US. Try to work out a bit and eat more or less right. Except for easy obvious stuff I never met anyone that actually got better by going to a doctor. When its time to die I guess I will die.oh , March 20, 2018 at 3:16 pm
Couldn't agree more.sierra7 , March 20, 2018 at 10:00 pm
+1mark , March 20, 2018 at 8:35 am
In our healthcare system (and I guess totally), when you're healthy you're wealthy!Thomas Briggs , March 20, 2018 at 9:14 am
It's really worse than the article suggests. Kerydin (tavaborole) isn't even all that effective. In one trial, "cure" was achieved in about 7% of cases and in other trials "completely or almost clear nail rates" were achieved in 15 – 30% of cases:
In clinical trials, tavaborole was more effective than the vehicle (ethyl acetate and propylene glycol) alone in curing onychomycosis. In two studies, fungal infection was eliminated using tavaborole in 6.5% of the cases vs. 0.5% using the vehicle alone, and 27.5% vs. 14.6% using the vehicle alone.
For those interested, this is the original paper that the Wikipedia entry is based on:
https://www.sciencedirect.com/science/article/pii/S0190962215015121oh , March 20, 2018 at 3:18 pm
Last visit was a snake bite. Antivenom was about 60k. Pretty sure same can be had in Mexico for less than $1,000, maybe much less. That was 5 years ago. I refuse to participate any longer, & I have good insurance. I hope eating better, exercise, & homeopathic treatments can work for me. Have not seen a doctor since & won't unless taken unconscious.Pat , March 20, 2018 at 9:19 am
Agree with you. Eat healthy foods, exercise, homeopathic or ayurvedic treatment when absolutely necessary. No need to go for their "free" physicals. Listen to your body.XXYY , March 20, 2018 at 10:32 am
So a physicians assistant diagnosed a fungus strictly on observation, calls in a prescription for an ineffective and more difficult to use but massively expensive prescription and it is the patient's fault.
Don't know about the rest of you, but I see at least three problems in that that have nothing to do with the patient OR even the obscene greed of the pharmaceutical industry but a whole lot with the Braun Dermotological Center.Kevin , March 20, 2018 at 11:02 am
I have no proof, but my guess is that these medical centers have sweetheart deals with mail-order pharmacies for various overpriced drugs. We took my son to a dermatology place several times for acne treatment; they would commonly propose something I had never heard of and urge us to order from a particular mail-order pharmacy, often providing coupons. I saw no reason not to get it from our local pharmacy but they were strangely insistent on us doing it by mail.
One obvious problem with mail-order pharmacies is made clear in this piece: by the time you find out how much things cost, it's already a done deal. At a retail pharmacy, you can walk away without paying. This is obviously a feature of mail-order pharmacies, not a bug.Katniss Everdeen , March 20, 2018 at 11:33 am
The proliferation of specialty medical centers around the western Chicago suburbs has been amazing to witness – similar to the proliferation in the number of bank outlets prior to the crashJoel , March 20, 2018 at 4:45 pm
No kidding. How is prescribing a drug, even a cheap one, that's "effective" only 7% of the time even considered medical "treatment?"
And what in the world is that "statement" pictured above? It's flat out false. Is it somehow supposed to be official? Where did it come from?
"Total Rx cost" in January: $56.52???? No, it was $1,496.09–same as in February.
"You paid" (Patient paid?) in January: $56.52? No, the patient paid $1,439.57, "funded" through her HRA and shown with an asterisk at the bottom. $56.52 was apparently a drug company rebate / coupon.
About the only true thing in January was that the insurance paid $0.
The "You paid" in February was not, in fact paid by the patient, but by another drug company rebate / coupon. She was not even asked to write a check for the copay, an expense she would have expected.
The "Your Cost" of $620.43 at the top appears to be the sum of the two drug company coupons for January and February, although no time frame is specified. At this point, the patient had written NO checks, even for the copays.
As an aside, where is the $60 "Copay/Co-insurance for January?
The patient's actual "cost" over the two months would most accurately be represented as the sum of the two months' Rxs–about $3000–plus two $60 copays. "You Paid" should be what she actually paid, either out of pocket or through the HRA, and any fees or copays that were covered by drug company rebates should be clearly noted as CHARGED but ABROGATED.
I'd suggest that deliberately confusing and understating seemingly obvious terms such as "cost" and "paid"
deliberately obfuscates the situation in order to sell expensive drugs that people would balk at purchasing if they knew the true "cost."
And all of this is before figuring out, for a Medicare recipient, how all these worthless, expensive drugs, coupons and rebates propel the patient toward the "donut hole," an entirely different kettle of fish in which nobody pays for nuthin' except the patient.anonymous , March 20, 2018 at 9:48 am
+1 These "statements" web pages or whatever are designed by either morons or sadistic fiends. Probably the same ones that design cell phone billsvidimi , March 20, 2018 at 10:05 am
This reminds me of the time I was billed $300 for a foot splint by a podiatrist that my insurance refused to pay for. I could have bought a foot splint off Amazon for $30.
Always ask for prices for any treatments or medicines. I trust my dentist way more than any doctor I've been too.Bugs Bunny , March 20, 2018 at 10:46 am
this stuff is free in france for anyone with a social security numberJon S , March 20, 2018 at 12:40 pm
Kerydin has not been approved by the European Medicines Agency. You shouldn't state things as fact unless you can back them up.crittermom , March 20, 2018 at 10:15 am
I'm sure he meant "medicine that fixes toe fungi" is free in France, not Kerydin. And of course Kerydin isn't approved in Europe, with a 7% efficacy rate, it's doesn't really have medicinal value. It would only be prescribed in the US.Lord Koos , March 20, 2018 at 1:08 pm
Stories such as this are infuriating.
I went to a Podiatrist a couple years ago for a different problem but mentioned I thought I had a toenail fungus, too.
The Dr confirmed that but instead of prescribing something he recommended coconut oil. He said it worked much better & faster than any pills he could prescribe & he was right.
I had a large jar of solid coconut oil (around $6) & applied it with a Q tip.
In very short time the fungus was gone.
A girlfriend had gone to her Dr who prescribed pills.
Her fungus returned within a few months.
Mine hasn't.JamesG , March 20, 2018 at 10:41 am
This is not surprising – before I read your post I was thinking, there is probably a simple home remedy for that condition. There are a lot of useful drugs out there, but there are probably just as many that are useless, ineffective, or that have dangerous side effects and unintended consequences. I took over-the-counter anti-allergy meds for my hay fever for years, only recently reading that they (Claritin, etc) are now implicated in the onset of Alzheimer's. Thanks a lotSteve Roberts , March 20, 2018 at 10:42 am
I caught a similar prescription with a high co-pay and refused to pick up the merch from the pharmacist.
I then treated my fungus with Lamisil an OTC product which works for me.otis , March 20, 2018 at 11:22 am
I was written a script for a tube of cream that supposedly cost nearly $3k. It's hard to know what the pharmacy benefit manager actually paid because they are pretty secretive about that sort of thing. Per a friend she estimated it at probably $50 which is still idiotic. It was an anti-itch cream and wasn't any better than a $2.50 tube of cortisone cream.perpetualWAR , March 20, 2018 at 11:32 am
For the love of Pete. Isopropyl alcohol costs $1.79. Cut your toenails then apply with q tip. No more nail fungus. One bottle = many years supply.
I'm amazed people will take pills to cure nail fungus. So Dumb.
$14.000 annual toe cream. Dumb dumb dumber.
Thanks for posting these absurd bills. It lays bare the financialized health care holocaust underway in the USA.Synoia , March 20, 2018 at 11:49 am
Toenail fungus? Get apple cider vinegar.
Why do people not first look at home remedies?
Apple cider vinegar clears that up in a snap.Fred , March 20, 2018 at 1:00 pm
Fungus can be treated by soaking in a 25% solution of vinegar, twice a day for two weeks.
Change the pH, kill the fungus.
That was my prescription for a fungus on my foot, by my doctor. And it worked.Pogonip , March 20, 2018 at 1:16 pm
I pay less for my medicines when I pay cash as the pharmacy gives me a discount. But, because Part D has a penalty for not enrolling, I use it for 5 of medicines and then pay cash for one of them and pay about $5 more per month. Not to mention my doctor offered to do my stints for half price if I paid for cash. The whole healthcare system is a mess.Anonymous , March 20, 2018 at 1:54 pm
I don't know about other countries, but here in the U.S. you should always, always, always assume that in any transaction you engage in, the seller has been financialized and will actively try to squeeze more money out of you, the ideal being to take all your available money and give you nothing in return. Be wary.
There are plenty of honorable exceptions, like the honest doctors and the mechanics described above. Cherish those sellers, patronize them, spread the word of mouth, especially if you think capitalism is the best of all possible economic worlds. The rent-seekers, if they continue unchecked, will destroy capitalism, because it requires some minimum level of trust to work. The odds that the seller will provide a good product or service have to be at least better than even.jrs , March 20, 2018 at 3:51 pm
Philia is a necessary casualty of identity politics. Society depends on the collective will of people to take actions that are not in their direct benefit because they know others will make them. The "Tragedy of the Commons" does not occur when philia is strong because people know they can trust others not to abuse common resources. Once people do not trust others to act for the greater good it is a race to the bottom. The problem with identity politics is that it creates distrust of others outside ones own identity group as 'others' who cannot be trusted.CrosslakeJohn , March 20, 2018 at 3:12 pm
oh yes identity politics created that, as if there wasn't far stronger prejudice by dominant groups long before identity politics was even a glimmer in it's dad's eye.rps , March 20, 2018 at 4:48 pm
Ten years ago or so in Corte Madera California, I was very lucky to find a podiatrist who was doing research on toenail fungus. I had nine of ten toe nails involved, some since high school (so for decades). His protocol for this was
1) pulse dose of two Lamasil tablets at the start of treatment
2) OTC bottle of fungoid tincture (with little brush built into the cap) from drug store with half a Lamasil tablet dissolved in it
3) every morning in the shower, scrub the nail ends with a toothbrush and a chlorine powder cleaner like Comet
4) brush a small amount fungoid tincture onto nail ends after morning shower and at night before bed.
5) keep nails short with clean cut ends
As I recall, the Lamasil pulse dose kills the fungus in the nail bed right away, and the fungoid tincture wicks into the nail every time and carries the anti-fungal drug to the fungus residing within the nail. The chlorine cleaner acts as a dessicant and pH modifier.
Ultimately, he gave me the few necessary Lamasil tablets as free samples, and back then the fungoid tincture was maybe $4/bottle at walgreens.
The new nails grew in from the nail beds perfectly, and after many months I had perfect toe nails and ceased treating them. They have remained so ever since.
I have always wondered if this approach was ever published in a medical journal. No significant money to be made from it by the manufacturer of Lamasil, so it's hard to see who had an incentive to promote it.
Disclaimer: I am not a doctor and am not giving medical advice. Pursue at your own risk.
Thanks!!P Fitzsimon , March 20, 2018 at 4:57 pm
Why your pharmacist can't tell you .
WASHINGTON -- As consumers face rapidly rising drug costs, states across the country are moving to block "gag clauses" that prohibit pharmacists from telling customers that they could save money by paying cash for prescription drugs rather than using their health insurance The pharmacist cannot volunteer the fact that a medicine is less expensive if you pay the cash price and we don't run it through your health plan ."
The White House Council of Economic Advisers said in a report this month that large pharmacy benefit managers "exercise undue market power" and generate "outsized profits for themselves."Bill Carson , March 20, 2018 at 6:09 pm
I'm going to get in trouble for saying this but toenail fungus isn't exactly leprosy. I've had a case continuously for 40 years after damaging my toenails in an accident. About 20 years ago I went to a doctor to see what could be done to get rid of it. He said I can give you a prescription that may cure it . But would you rather risk your liver or take the fungus with you to the grave after a full and healthy life with the fungus. I dont know what it would have cost because I chose the fungus. If it had cost $1500 and he hadn't told me the cost I would have been most unhappy.Bill Carson , March 20, 2018 at 6:28 pm
This is shameful and absurd. However, the article mentions that there are "pills" that can be prescribed to treat the toe fungus, but some people taking those pills (terbinafine aka lamisil) have developed severe liver damage leading to liver transplant or death.
How much does it cost to just remove the toenail?Bill Carson , March 20, 2018 at 6:46 pm
Why does this prescription cost $1,650 per month and not $16,500? Or $165,000? Or $1,650,000? Who decided that $1,650 was reasonable and $1,650,000 wasn't?Bill Carson , March 20, 2018 at 6:39 pm
Oops, I meant $1,500 per month. But it probably costs more now anyway.
And how do they make an ointment last only a month? I've got some ointments under my sink that are 30 years old.mtnwoman , March 20, 2018 at 7:40 pm
I'm a lawyer. I took Contracts 25 years ago in law school, but I seem to remember that there are certain elements to a contract that have to be present before the parties can be bound. Let's see
Now, it seems to me that Consideration can't just be left blank. It is a very rare (non-medical) contract indeed where the buyer says, "I want X, no matter what it costs."
If I stay at a hotel and they have a mini-fridge with various refreshments and snacks, and I take a Diet Coke and a Milky Way, they can't legally charge me $10,000 for that.
I don't know why this isn't considered defrauding the consumer. We should be able to sue the crap out of these companies.Tim , March 20, 2018 at 9:09 pm
Give the medical practitioners a break! So now they need to puruse the Wall St Journal daily to see what pirate has acquired what formerly cheap generic drup to monopolize it and raise the price 500%?
Yes, the price was outrageous. How is the practitioner supposed to know every patients health care coverage and what one particular insurance carrier will cover for what drug? What's $50 for one person is $1500 for another, depending on their insurance.
Our entire health care system sucks. The only people who like it are the Insurance and Pharma execs.
I won't give a doctor a break that prescribes a non-essential medicine with a 6% success rate.
Mar 17, 2018 | www.zerohedge.com
... ... ...
Approximately 63% of Americans have no emergency savings for things such as a $1,000 emergency room visit or a $500 car repair, according to a survey released Wednesday of 1,000 adults by personal finance website Bankrate.com, up slightly from 62% last year. Faced with an emergency, they say they would raise the money by reducing spending elsewhere (23%), borrowing from family and/or friends (15%) or using credit cards to bridge the gap (15%).
... ... ...
You are going to need five things, which I am going to give to you, today, free of charge!
- Some absolutely critical industry vocabulary
- A clear understanding of how healthcare is priced in the USA
- Insight into to actual pricing
- A proven negotiation strategy, including:
- a. The point of contact
- b. Foreknowledge of what prices medical providers will usually agree to
- c. A sample offer and agreement
- The confidence to successfully negotiate
Unfortunately, I couldn't come up with a better way to impart to you an understanding of the industry lingo, other than these simple handouts. However, this information is so important for you to be able to understand any negotiation strategy that I simply must slog through each term with you now. Please, I ask that you hold your questions and comments until I get through the vocabulary. Many of the terms are cross-referenced, and will become more clear after we here them all.
- Premium: The monthly amount enrollees pay the insurance company to be covered.
- Deductible: The amount paid by the member before insurance will begin to reimburse services. It is reset annually, and based on the level of benefits or amount of premium paid. For example, with a $1,000 deductible the patient must pay medical providers for the first $1,000 of allowable expenses incurred by the patient each year, after which costs may be split according to a coinsurance arrangement, and/or may be limited to the patient's out of pocket expenses.
- Coinsurance: A cost-sharing requirement of some insurance plans where the patient assumes a percentage of the costs for covered services after the amount of the deductible has been met. Coinsurance is described as a ratio, for example 30/70, meaning the patient is responsible for paying 30% and the insurance will pay 70% of the allowable.
- Copayment (co-pay): The amount to be paid to a physician by or on behalf of the patient in connection with the services rendered by the physician. It is due at the time of service, is a fixed dollar amount determined by the insurance company based on the level of benefit, and is usually found printed on the patient's insurance card.
- Out of Pocket Expense: The total of covered health care expenses that are paid for by the member or patient, not including any premium. This is typically the total of the deductible and any coinsurance paid during a year. It may be a maximum amount where after 100% of allowable expenses are paid by the insurance company.
- Explanation of Benefits (EOB or ERA: Electronic Remittance Advice): The insurance company's explanation of the benefits they have, or have not, paid to a medical provider, along with any remaining amounts for which the patient is responsible, if any.
- CPT code: Current Procedural Terminology codes maintained by the American Medical Association. These five digit codes describe most medical, surgical, and diagnostic services and are used for administrative, financial, and analytical purposes such as on fee schedules and bills. These CPT codes are also known as Level 1 HCPCS codes, with Level 2 HCPCS codes being for non-provider medical services like ambulances and prosthetic devices. The CPT code is equivalent to a part number, SKU Stock Keeping Unit, or UPC Universal Product Code.
- Inpatient Prospective Payment System (IPPS): A system of payment for the operating costs of acute care hospital inpatient stays under Medicare Part A (Hospital Insurance). Under IPPS, each case is categorized into a diagnosis-related group (DRG). Each DRG has a payment weight assigned to it, based on the average resources used to treat Medicare patients in that DRG.
- Diagnosis-Related Group (DRG): a system to classify hospital visits into similar groups. Its intent is to identify the products that a hospital provides, such as an appendectomy. DRGs are assigned by group based on diagnosis (ICD code). DRGs may be further grouped into Major Diagnostic Categories (MDCs). DRGs are used to determine how much Medicare and some insurance plans pay hospitals and other services like home health.
- ICD code: The International Statistical Classification of Diseases and Related Health Problems provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. Supposedly, every health condition can be assigned to a unique category and given a code.
- Billed charges (usual and customary fees): The undiscounted fees a healthcare provider lists on the bill (list price, or retail). These fees are usually set well above the highest allowable of all the provider's contracts, sometime as much as 800% or even 1,000%. The purpose of this overpricing is to force the insurance companies to the negotiating table.
- Allowable: The discounted fee for service a healthcare provider has contractually agreed to accept from an insurance company. It is listed by CPT code on the EOB or in a fee schedule available from your insurance company, Medicare, or Medicaid. UNDERSTANDING THIS TERM IS THE KEY TO UNDERSTANDING HEALTH INSURANCE AND TO NEGOTIATING DIRECTLY WITH MEDICAL PROVIDERS.
- Global Period: The number of days after a medical procedure when the fee for office visits is included, contractually, in the allowable for the procedure. It is typically 30, 60, or 90 days.
- Elective: For our purposes, care for any medical condition that is not an emergency.
- Emergency: A medical condition manifesting itself by acute symptoms of sufficient severity, which may include severe pain, such that the absence of immediate medical attention could reasonably be expected to result in serious jeopardy to patient health, and/or serious impairment to bodily functions, and/or serious dysfunction of any bodily organ or part.
- EMTALA: The Emergency Medical Treatment and Labor Act (EMTALA) is a federal law that requires anyone coming to an emergency department of a hospital with an emergency condition to be stabilized and treated, regardless of their insurance status or ability to pay.
- Insurance Verification: the process where a healthcare provider contacts the financially responsible party (usually an insurance company, Medicare, or an employer) and verifies that coverage is in effect and the information current. This generally includes the amount of the deductible met by the patient, copayment amounts, and coinsurance terms.
- Precertification: The process of obtaining approval from insurance, in advance, for a proposed treatment or diagnostic test, and is NEVER required for emergency care.
- Medicaid: The United States health program for eligible individuals and families with low incomes. It is a means-tested program that is jointly funded by the states and federal government, and is managed by the states. Generally is the lowest allowable fee for medical care.
- Medicare: a social insurance program funded by taxes and administered by vendors hired by the United States government. Medicare provides health insurance coverage to people who are aged 65 and over, or who meet other special criteria such as a disability. Generally it reimburses close to the average allowable fee for medical care. It is the easiest fee schedule to access at: www.CMS.gov
- Tricare: Health insurance for military personnel and their dependents.
- Workers Compensation: Insurance that provides medical care for employees who are injured in the course of employment. It is usually has the highest allowable fees for medical care.
... ... ..
To begin to understand how healthcare is priced, we are going to look at
- the doctor's bill given to a patient,
- the claim forms the doctor and hospital send to the insurance carrier, and
- ERAs that the insurance carrier then send back to the patient and the providers.
As we have already learned, all healthcare services have been assigned a code by the AMA, a five digit CPT code. So, if you trip and fall off your patio, you might get a doctor's bill like the following table located in your handouts:
On the hospital's bill you might see something like this:
It is important to understand that the amounts shown on both of these bills are un-discounted Billed Charges (Usual and Customary Fees). They are the highest price the provider might ever hope to receive for the service, also known as full retail, or MSRP. Don't panic when you get these bills, because as everyone knows, "Never pay retail."
You may receive other bills from several doctors such as anesthesiologists and radiologists, as well as laboratory services, therapists, and the ambulance company. The bills all look similar, and the strategy and tactics I am presenting, today, should work for each of them as well.
If you have insurance, the providers will send your carrier a claim with essentially the same data as is on the bill they will provide to you if you are not insured, or if you simply request a copy.
An important fact is that Federal Law, as a requirement for the medical provider's participation in Medicare, requires that a medical provider charge every patient the same amount for a given CPT item. What it does not require, however, is that a medical provider accept the same payment amount from every patient for a given CPT item. This allows insurance companies, government payers, and you to negotiate a discounted fee, known as a contracted allowable, and not be in violation of the law.
The purpose of this overpricing by the medical providers is to force the insurance companies to the negotiating table. The insurance company is bringing a large volume of patients to the medical providers, the members in their network, so they are able to negotiate a lower discounted allowable fee from the medical providers. However, if the insurance carrier is not able to negotiate a contractual allowable fee schedule, then they will end up paying the higher billed charges of the out-of-network provider for the members that still end up being treated by that medical provider in emergencies when precertification is not required.
This creates a tiered-pricing structure for medical services that looks very much like this table in your handouts:
At this point, if you are paying close attention, then it should start to dawn on you where I am leading you with this talk, which, after all, is titled: How to negotiate directly with physicians and hospitals.
Spoiler Alert: You are learning how to negotiate for Medicare rates, at worst, and Medicaid rates, at best. In our example, a bilateral elbow fracture patient in Texas received surgeon and hospital bills totaling $179,219. Medicare allows $30,542 and Medicaid $22,600, which means the government negotiated an 83% or 87.4% discount, respectively. You can too!
Before we move on to providing you with access to these fee schedules, and then a negotiation strategy, do you have any questions about how healthcare is priced in the USA?
Now, on to where you can find these prices. Well, if you have insurance, then after you receive medical care and the healthcare providers send their claims to the insurance carrier, you should receive from the payer an Explanation of Benefits (EOB), or you probably can go online and view an Electronic Remittance Advice (ERA). For every CPT code that the providers billed , you will see both a billed charge and allowable.
Quick show of hands: how many of you have received a medical bill, or an EOB, and threw it away because you could not understand it? That is intentional! They want you to be confused. However, after today, I doubt that you will ever do that again.
What if we do not have insurance, or we want to know the allowable, because we think this is important information to know so that we can negotiate before receiving healthcare? Think having a baby or elective surgery. Do not worry! The federal government provides us with the Medicare rates online, and I believe that each state provides its Medicaid fee schedules online.
- Medicare Physician Fee Schedule Look-up Tool: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PFSlookup
- Medicare Acute inpatient hospital stays: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpa
- Texas Medicaid Fee Schedule: http://public.tmhp.com/FeeSchedules/Default.aspx
You would soon discover, however, that it is much easier to determine the allowable for a physician service than a hospital service, for which you will likely need to look up the DRGs for the ICD codes and then try to cross-reference them with the IPPS Fee Schedule, at a minimum, or you may even need to look up and calculate conversion factors. It is not easy, again, intentionally so!
Regardless, we would first need the CPT codes for the services you are seeking from the physician, and probably the ICD codes, too, in order to price hospital services. You could try to guess at the diagnosis and the services you think the doctor is going to provide to you, and then try to use a search engine to determine the ICD codes and CPT codes, or buy a coding book.
"I know I need a hip replacement. My trainer at the gym told me so. I'll just Google, hip replacement ICD and CPT code."
Good luck with that! The odds of you guessing the correct diagnosis and appropriate procedures (without going to medical school) are incredibly slim, especially with the new ICD-10 diagnosis codes. Also, chances are good that your athletic trainer doesn't know what the hell she is talking about when it come to medicine, and in reality, you probably just need a new athletic trainer, and not a new hip.
Is your head spinning, yet? Good! Now, stop it, because you will see that we don't need to do any of that! It's all just a red herring designed to keep us confused and the health insurers in business and profitable. Sounds a lot like our banking system, no?
Fortunately, as you will now learn, there is a much more simple and better way to be 100% certain of your diagnosis, diagnosis code, procedure, procedure code, and even the medications the physician will offer you, at least for elective conditions. Here it is. If it isn't an emergency, then make a doctor's appointment!
You may be thinking, "Isn't that putting the cart before the horse? Don't we want to know the costs in order to negotiate the fees before the services are provided?" The surprising answer is, no! Why? Well, because we only need to negotiate the fee schedule, specifically, Medicare or Medicaid, and not the exact fee. This is very important. Think back to the tiered-pricing structure.
Eventually, we may want to know the actual (or sometimes estimated) allowable amounts in order to budget for elective procedures, but this occurs after, or at the time of the physician's office visit, when they can provide us with the ICD codes, CPT codes, and usually the allowable amount, too! Later, we may choose to audit the allowable amount they give us, to make sure it is correct, and we were not over charged, but this is seldom done, as most people still trust their doctor, and the discounts you will be receiving are so HUGE you may feel a little guilty. Also, I will tell you, the auditing process is very tedious, not to mention the appeal process.
Therefore, we are now going to start talking about a negotiating strategy before we even attempt to access any pricing data. Again, we first need to know the diagnoses and proposed treatments. So, the solution is to start with a simple negotiation with the physician's office, probably just for the cost for the initial office visit, at the very least, and maybe some expected diagnostic tests. This is best done over the telephone, is easier and more successful than you might think, and is analogous to finding a mechanic to, "just take a look," at your car and tell you what is wrong with it, and then getting an estimate to repair it. Just like we expect to pay a little bit for the mechanic to diagnose our car, we should expect to pay a little bit for the doctor to diagnose us. The funny thing is that my mechanic and Medicare both charge or allow about $100 for a diagnosis. This is not so funny if you are the surgeon that spent 13 more years in school than the auto mechanic with a high school diploma.
Here we go, step by step:
1) I usually prefer to skip the added expense of going to a GP or family practice intermediary just to get a referral to a specialist that can actually help, especially when I can determine what medical specialty is likely to be most helpful for by medical condition by visiting the website of the American Board of Medical Specialties. (Is your ignition system acting up, your suspension riding a little rough, need new tires, brakes squeaking, transmission grinding?)
2) Use the links on abms.org to visit the appropriate specialty board's website, and then use their "find a physician" with the sub-specialty likely to be most helpful for the condition
3) Start calling the sub-specialty physician offices listed, tell them you are a prospective new patient, and ask to speak to the Business Office Manager. Ask him or her the following questions:
a) "Do you accept Medicare and/or Medicaid insurance?" If yes, then...
b) "Super! Do you accept cash payment at the time of service?" If yes, then...
c) "Great! Then, of course, you will accept as payment in full, the Medicaid allowable, but paid in cash by me to you, directly, at the time of service? Correct?" If yes, then (e). If no then (d).
d) "I guess I understand. Well, then surely you will at least accept as payment the Medicare allowable, paid in cash by me to you, directly, at the time of service? If yes, then (e). If no then conclude the call, because you cannot fix stupid.
e) "Thank you! Can you please tell me what the estimated amount is for an office visit, using this fee schedule, so I can know how much money to bring, and please make a note on my account that we have negotiated a Single Case Agreement for me to pay these rates to you, in cash, at the time of service?
f) Tell him or her your specific reason for the visit (I am leaking red fluid on the floor of my garage) and that you want to be fully prepared for the visit. Ask what diagnostic tests, if any, are usually required for this type of problem, lab, X-ray, CT, MRI, ultrasound, etc., and which ones would probably need to be done outside the physician's clinic?
g) Make sure to get the BOM's name and contact information, and the appointment time and date.
After your office visit, if it turns out that you need a procedure such as day surgery at an Ambulatory Surgery Center (ASC), an inpatient admission at a hospital, a diagnostic test like an MRI or CT, or a series of treatments such as physical therapy, then you simply repeat the above negotiation, starting with the facility your physician recommends, and in the case of a hospital or ASC, always where he or she has privileges. ASC's allowable rates are always much lower than a hospital, so act accordingly. When telling the BOM that you are a prospective new patient, make sure to give the name of your physician. Instead of just making a note of any negotiated agreement in your account, the BOM and you should execute a written Single Case Agreement. It is usually a one-page agreement that looks something like this sample found in your handouts:
It should be obvious to you why, when possible, these negotiations should occur before treatment, which is more often than you might imagine. In general, elective conditions are negotiated in advance in this manner. Next, we are going to look at emergency conditions, which are more than likely negotiated after examination and treatment.
Before we do, are there any questions?
Ok, so I experience some kind of true medical emergency, where my life or limb is in jeopardy, like a heart attack. mrs_horseman puts me in an ambulance that rushes me to the Emergency Room at the hospital, and they run all kinds of tests, and give me some very expensive medications. Fortunately for me, a long enough timeline has not yet passed, my survival rate has not dropped to zero, and I don't even get to go to the cath lab or have emergency heart surgery. However, we do get several large medical bills from the hospital, ER doctor, ambulance, laboratory, and cardiologist. I either have no insurance, am self-insured, or I have a catastrophic insurance plan with a very high deductible that I am not likely to meet with this event, or this year. What do I do?
When I receive each bill, I immediately call each provider and get the name and address of the BOM. I then draft a Single Case Agreement Offer and Acceptance, and I offer to pay the estimated Medicaid allowable clearly labeled as such (by using the tiered-pricing structure I covered earlier) and expiring 10 days after it is received. I may also include some horseshit narrative about how I just received a small windfall, and was advised by my attorney to settle my hospital bill before I piss it away on fast women and slow horses, or worse, squander it. I send this to the BOM, Certified Mail-Return Receipt Requested , with my attorney copied on the bottom of the offer. The BOM may argue the accuracy of my Medicaid estimate, and make a counter offer with a more accurate Medicaid allowable, but the odds are very, very, high that he or she either agrees to the Medicaid allowable, or counters with something like a Medicare allowable. Either way, at this point I have successfully negotiated somewhere around an 83% - 87% discount on average, less for doctors, more for hospitals.
It is important to lock this agreement in, quickly, before my account is sold to a third-party collection agency, which is nowhere near as likely to accept such a deep discount, and far better than a healthcare provider at actually getting blood from a turnip. Medical providers are now turning their accounts over to collections as soon as 90 days from the date of service, which can mean that you are still being treated for this condition when this happens! Do not let this happen to you! Open the bills! Mail the offer! Maybe they say no, but that is not likely. On the other hand, the collections agencies are working very hard to get you on a payment plan for Billed Charges, with interest, for the rest of your life!
Does this sound unlikely? Too good to be true? Then consider this: Medical providers are highly incentivized to give the patients they treated huge discounts. Why? Because they know that collecting money from patients foments malpractice litigation. They would rather have you pay them pennies, than have you sue them for millions.
There it is. I said it. Think about that for a moment.
Now, considering the minimal risk of negotiating, and the large potential reward, do you now have the confidence to successfully negotiate directly with physicians and hospitals?
Before I spend just a few more minutes talking about pharmacies, and then finally some self-insurance goals, are there any questions or comments?
I recently had breakfast with a pharmacist friend of mine that has worked as a manager for Walgreens for more than a decade. mrs_horseman is probably smiling when she hears that I have a pharmacist friend, because she knows how I feel about most of the people in that industry. Nonetheless, I told him about this presentation I am making, and asked if he had any advice for negotiating directly with the pharmacies for medications. It turns out, he does, and I would have never guessed the tactic he described.
Are you ready? Coupons and free discount cards. He explained that if one simply goes online and searches for Walgreens coupons, it is usually possible to save between 5% and 60%. He specifically recommends Good Neighbor Pharmacy Prescription Savings Club.
He says that when you purchase medications, then you have 5 days to return to the same location Walgreens and bring a coupon for reimbursement of any savings. He says that if you are paying cash, then you must be sure to request a generic, if available. For long term meds, he explains that the drug manufacturer's web sites will often offer a free co-pay assistance card. If you have insurance, then you can present the free card from the manufacturer to the Walgreens pharmacy, and it will cover your co-pays. In closing, I want to talk just a bit about insurance and one of the situations where we would want to be able to negotiate directly with physicians, hospitals, and pharmacies.
As we have discussed, today, one of the primary benefits of having health insurance is to take advantage of the discounts negotiated by the insurance company or government. However, we just learned that providers are usually willing to accept similar discounted rates from cash pay patients.
The other big benefit of health insurance is to share with other people the risk of having to pay large bills that are the result of serious and unexpected injuries or illnesses. This is the traditional role of insurance. However, the costs and benefits of sharing risk are directly related to the health and healthcare consumption habits of all the members of the risk pool. As the post-vasectomy head of a healthy household, do I really want to be swimming in the Obamacare risk pool with millions of morbidly obese, perpetually pregnant, HIV infected drug abusers? No. It is too expensive!
What to do? Well, what do many smart employers in Texas do to save money with Worker's Compensation Insurance? They self-insure! They have money put away in case of an emergency. If they have an employee that is injured, then they negotiate directly with the healthcare providers, and pay deep discounts well below the statutory Worker's Compensation allowable, which we learned earlier is usually the highest allowable. They pay themselves a premium each month, which is effectively a forced savings plan. Sometimes, these companies may also purchase a relatively inexpensive health insurance plan called catastrophic, just in case a really big and expensive event occurs, like the whole oil refinery blows up and puts a few hundred employees in the hospital. However, if nothing happens, and the employees don't have any accidents, the company gets to keep most of the money, instead of giving it all to the insurance companies!
Hmmm. I wonder. Could I do that for my health insurance? Yes, and in fact mrs_horseman and I do exactly this. We have a high-deductible catastrophic health insurance plan and a $600 savings line item in our budget that we pay ourselves every month. We bet on ourselves to be healthy, unlike an HSA, where you bet on yourself to be unhealthy. This is true, and why we simply refuse to take the pre-tax bait of an HSA.
... ... ...
Mar 04, 2018 | en.farsnews.com
That's the conclusion of new research, and it could revolutionise the way we detect and treat diabetes in the future.
Analysing past studies covering a total of 14,775 type 1 and type 2 adult-onset diabetes patients across Sweden and Finland, scientists have found five different and distinct disease profiles, including three severe and two mild forms of the condition.
The more precise we can be about different categories of diabetes, the better we can understand and treat it, according to the team of researchers from Scandinavia
It might even give doctors an earlier window of opportunity for preventing the onset of diabetes.
"Evidence suggests that early treatment for diabetes is crucial to prevent life-shortening complications," says senior researcher Leif Groop, from the Lund University Diabetes Centre (LUDC) in Sweden.
"More accurately diagnosing diabetes could give us valuable insights into how it will develop over time, allowing us to predict and treat complications before they develop."
Six different measurements were used across four separate studies: age at diagnosis, body mass index (BMI), long-term glycaemic (blood sugar) control, the function of insulin-producing cells in the pancreas, insulin resistance, and the presence of specific autoantibodies linked to autoimmune diabetes.
Instead of splitting diabetes simply into type 1 and type 2, the researchers came up with five different disease profiles - one autoimmune type of diabetes and four other distinct subtypes. All five types were found to be genetically distinct, with no shared mutations.
This is enough to suggest we're looking at five distinct diseases that all affect the same body system, rather than the same disease at different stages of progression, say the researchers.
So how did they differ? One of the three more serious forms was a group of people with severe insulin resistance and a significantly higher risk of kidney disease. Another more mild type was seen mostly in elderly people.
You can see how those distinctions could improve the way we tackle diabetes – by identifying the types of patients involved and the complications they're at risk from, doctors could work out more personalised courses of treatment.
Indeed, the researchers found that many in the study weren't being given the right treatment for the particular characteristics of the diabetes they had.
With diabetes now the fastest-growing disease on the planet, more options for dealing with it can't come soon enough. More than 420 million people are now thought to have diabetes worldwide.
Between 75-85 percent of people with diabetes have the more common type 2, where the body can't produce enough insulin to cope with levels of insulin resistance.
The researchers do note some limitations though: there's no evidence yet that these five types of diabetes have different causes, and the sample only included Scandinavian patients, so a wider study is going to be required to investigate this further.
"Existing treatment guidelines are limited by the fact they respond to poor metabolic control when it has developed, but do not have the means to predict which patients will need intensified treatment," says Groop.
"This study moves us towards a more clinically useful diagnosis, and represents an important step towards precision medicine in diabetes."
Feb 07, 2018 | consortiumnews.comCold N. Holefield , February 5, 2018 at 4:09 pm
Yes, but increasingly there is no "working class" in America due to outsourcing and automation.
I hear that Trump wants to reverse all of that and put children to work in forward-to-the-past factories (versus back-to-the-future) and mines working 12 hours a day 7 days a week as part of his Make America Great Again initiative.
With all the deregulation, I can't wait to start smoking on airplanes again. Those were great times. Flying bombs with fifty or more lit fuses in the form of a cigarette you can smoke. The good old days.
backwardsevolution , February 5, 2018 at 5:50 pmDiana Lee , February 6, 2018 at 3:16 pm
Cold N. Holefield -- it's like Ross Perot said re NAFTA and globalization: "When the rest of the world's wages go up to $6.00/hour and our's come down to $6.00/hour, globalization will end." That's what's happening, isn't it? Our wages are being held down, due in large part to low-skilled labor and H-1B's flooding into the country, and wages in Asia are rising. I remember Ross Perot standing right beside Bill Clinton when he said this, and I also remember the sly smile on Bill Clinton's face. He knew.
Our technology was handed to China on a silver platter by the greedy U.S. multinationals, technology that was developed by Western universities and taxpayer dollars, technology that would have taken decades for China to develop on their own.
Trump is trying desperately to bring some of these jobs back. That's why he handed them huge corporate tax breaks and cut some regulations.
Things "should" be made locally. There's no reason, especially with declining energy resources, that a toaster should be shipped from thousands of miles away by boat, plane, truck, rail. That's simply ridiculous, never mind causing a ton of extra pollution. We end up working at McDonald's or Target, but, yay, we just saved $5.00 on our toaster.
Trump is trying to cut back on immigration so that wages can increase, but the Left want to save the whole world, doing themselves in in the process. He wants to bring people in with skills the country can benefit from, but for that he's tarred and feathered.
P.S. I remember sitting behind a drunk on a long flight, and I saw him drop his cigarette. It rolled past me like it knew where it was going, and I couldn't find it. I called the stewardess, and she and I searched for a few anxious seconds until we found it. Yes, the good old days.backwardsevolution , February 6, 2018 at 4:48 pm
I don't know how you know about the so-called safety net. I know because I had to use it while undergoing treatment for 2 types of stage 4 breast cancer the past 4 years. It is NOT what people think. It beats the already vulnerable into the ground -- -- this is not placating -- -- it is psychological breaking of human minds until they submit. The paperwork is like undergoing a tax audit -- - every 6 months. "Technicians" decide one's "benefits" which vary between "technicians".
Food stamps can be $195 during one period and then $35 the next. The technicians/system takes no responsibility for the chaos and stress they bring into their victims' lives. It is literally crazy making. BTW: I am white, a member of Phi Beta Kappa, have a masters' degree, formerly owned my own business and while married lived within the top 10%.
In addition, most of those on so-called social programs are children, the elderly, chronically ill, veterans. You are correct that the middle class is falling into poverty but you are not understanding what poverty actually looks like when the gov holds out its beneficial hand. It is nothing short of cruelty.
Diana Lee -- I hope you are well now. It breaks my heart what you went through. No, I cannot imagine.
I didn't mean the lower class were living "well" on food stamps and welfare. All I meant was that it helped, and without it all hell would break loose. If you lived in the top 10% at one point, then you would surely notice a difference, but for many who have been raised in this environment, they don't notice at all. It becomes a way of life. And, yes, you are right, it is cruelty. A loss of life.
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Stress is often described as a feeling of being overwhelmed, worried or run-down. Stress can affect people of all ages, genders and circumstances and can lead to both physical and psychological health issues. By definition, stress is any uncomfortable "emotional experience accompanied by predictable biochemical, physiological and behavioral changes." 1 Some stress can be beneficial at times, producing a boost that provides the drive and energy to help people get through situations like exams or work deadlines. However, an extreme amount of stress can have health consequences and adversely affect the immune, cardiovascular, neuroendocrine and central nervous systems. 2
How stress harms your health
In addition, an extreme amount of stress can take a severe emotional toll. While people can overcome minor episodes of stress by tapping into their body's natural defenses to adapt to changing situations, excessive chronic stress, which is constant and persists over an extended period of time, can be psychologically and physically debilitating. Unlike everyday stressors, which can be managed with healthy stress management behaviors, untreated chronic stress can result in serious health conditions including anxiety, insomnia, muscle pain, high blood pressure and a weakened immune system. 3 Research shows that stress can contribute to the development of major illnesses, such as heart disease, depression and obesity. 4
Some studies have even suggested t hat unhealthy chronic stess management, such as overating "comfort" foods, has contributed to the growing obesity epidemic. 5
Yet, despite its connection to illness, APA's Stress in America survey revealed that 33 percent of Americans never discuss ways to manage stress with their healthcare provider.
Chronic stress can occur in response to everday stressors that are ignored or poorly managed, as well as to exposure to traumatic events. The consequences of chronic stress are serious, particularly as it contributes to anxiety and depression. People who suffer from depression and anxiety are at twice the risk for heart disease than people without these conditions. 6 Additionally, research has shown that there is an association between both acute and chronic stress and a person's abuse of addictive substances. 7
Managing your stress
Studies have also illustrated the strong link between insomnia and chronic stress. 8
According to APA's Stress in America survey, more than 40 percent of all adults say they lie awake at night because of stress. Experts recommend going to bed at a regular time each night, striving for at least seven to eight hours of sleep and eliminating distractions such as television and computers from the bedroom. Many Americans who experience prolonged stress are not making the lifestyle changes necessary to reduce stress and ultimately prevent health problems.
Improving lifestyle and behavioral choices are essential steps toward increasing overall health and avoiding chronic stress. The key to managing stress is recognizing and changing the behaviors that cause it, but changing your behavior can be challenging. Taking one small step to reduce your stress and improve your emotional health, such as going on a daily walk, can have a beneficial effect. Being active is a small but powerful change you can make to manage stress.
Physical activity increases your body's production of feel-good endorphins, a type of neurotransmitter in the brain, and helps in treating mild forms of depression and anxiety. 9 In addition, eating a healthy diet and enhancing both the amount and quality of your sleep may be beneficial. But remember, if a high stress level continues for a long period of time, or if potential problems from stress continue to interfere with activities of daily living, it is important to reach out to a licensed mental health professional, such as a psychologist. Research has shown that chronic stress can be treated with appropriate interventions such as lifestyle and behavior change, therapy, and in some situations, medication. 10
A psychologist can help you ovecome the barriers that are stopping you from living a healthy life, manage stress effectively and help identify behaviors and situations that are contributing to your consistently high stress level.
Special thanks to Mary K. Alvord, PhD, Karina W. Davidson, PhD, Jennifer F. Kelly, PhD, ABPP, Kevin M. McGuiness, PhD, MS, ABPP-CH, and Steven Tovian, PhD, ABPP, who assisted with this article.References
The full text of articles from APA Help Center may be reproduced and distributed for noncommercial purposes with credit given to the American Psychological Association. Any electronic reproductions must link to the original article on the APA Help Center. Any exceptions to this, including excerpting, paraphrasing or reproduction in a commercial work, must be presented in writing to the APA. Images from the APA Help Center may not be reproduced.
- Baum, A. (1990). "Stress, Intrusive Imagery, and Chronic Distress," Health Psychology , Vol. 6, pp. 653-675.
- Anderson, N.B. (1998). "Levels of Analysis in Health Science: A Framework for Integrating Sociobehavioral and Biomedical Research," Annals of the New York Academy of Sciences , Vol. 840, pp. 563-576.
- Baum, A. & Polsusnzy, D. (1999). "Health Psychology: Mapping Biobehavioral Contributions to Health and Illness." Annual Review of Psychology , Vol. 50, pp. 137-163.
- Dallman, M. et al. (2003). "Chronic stress and obesity: A new view of 'comfort food.'" PNAS, Vol. 100, pp. 11696-11701.
- Anderson, N.B. & Anderson, P.E. (2003). Emotional Longevity: what really determines how long you live. New York: Viking.
- Sinha, R. (2008). "Chronic Stress, Drug Use, and Vulnerability to Addiction." Annals of the New York Academy of Sciences , Vol. 1141, pp. 105-130.
- Vgontzas, A.N. et al. (1997). "Chronic insomnia and activity of the stress system: a preliminary study." Journal of Psychosomatic Research , Vol. 45, pp. 21-31.
- Fox, K.R. (1999). "The influence of physical activity on mental well-being." Public Health Nutrition , Vol. 2, pp. 411-418.
- McEwen, B.S. (2004). "Protection and Damage from Acute and Chronic Stress: Allostasis and Allostatic Overload and Relevance to the Pathophysiology of Psychiatric Disorders." Annals of the New York Academy of Sciences , Vol. 1032, pp. 1-7.
Dec 12, 2017 | www.nakedcapitalism.com
...Neoliberal epidemics are particular pathways of embodiment. From Ted Schrecker and Clare Bambra in The Conversation :
In our new book , we draw on an extensive body of scientific literature to assess the health effects of three decades of neoliberal policies. Focusing on the social determinants of health -- the conditions of life and work that make it relatively easy for some people to lead long and healthy lives, while it is all but impossible for others -- we show that there are four interconnected neoliberal epidemics: austerity, obesity, stress, and inequality. They are neoliberal because they are associated with or worsened by neoliberal policies. They are epidemics because they are observable on such an international scale and have been transmitted so quickly across time and space that if they were biological contagions they would be seen as of epidemic proportions.
(The Case-Deaton study provides an obvious fifth: Deaths of despair. There are doubtless others.) Case in point for one of the unluckier members of the 90%:
On the morning of 25 August 2014 a young New Jersey woman, Maria Fernandes, died from inhaling gasoline fumes as she slept in her 13-year-old car. She often slept in the car while shuttling between her three, low-wage jobs in food service; she kept a can of gasoline in the car because she often slept with the engine running, and was worried about running out of gasoline. Apparently, the can accidentally tipped over and the vapours from spilled gasoline cost her life. Ms Fernandes was one of the more obvious casualties of the zero-hours culture of stress and insecurity that pervades the contemporary labour market under neoliberalism.
And Schrecker and Bambra conclude:
Neoliberalism operates through labor markets to undermine health not only by way of the financial consequences of unemployment, inadequate employment, or low wages, as important as these are, but also through chronic exposure to stress that 'gets under your skin' by way of multiple mechanisms. Quite simply, the effects of chronic insecurity wear people out over the life course in .
... ... ...
Oh, and "beyond class" because for social beings embodiment involves "social production; social consumption; and social reproduction." In the most reductive definition of class -- the one I used in my crude 1% + 10% + 90% formulation -- class is determined by wage work (or not), hence is a part of production (of capital), not social consumption (eating, etc.) or social reproduction (children, families, household work ). So, even if class in our political economy is the driver, it's not everything.
nonclassical , December 11, 2017 at 8:30 pmAmfortas the Hippie , December 11, 2017 at 4:20 pm
L.S. reminiscent of Ernst Becker's, "The Structure of Evil" "Escape from Evil"? (..not to indicate good vs. evil dichotomy) A great amount of perspective must be agreed upon to achieve "change" intoned. Divide and conquer are complicit, as noted .otherwise (and as indicated by U.S. economic history) change arrives only when all have lost all and can therefore agree begin again.
There is however, Naomi Klein perspective, "Shock Doctrine", whereby influence contributes to destabilization, plan in hand leading to agenda driven ("neoliberal"=market fundamentalism) outcome, not at all spontaneous in nature:
"Neoliberalism sees competition as the defining characteristic of human relations. It redefines citizens as consumers, whose democratic choices are best exercised by buying and selling, a process that rewards merit and punishes inefficiency. It maintains that "the market" delivers benefits that could never be achieved by planning.
Attempts to limit competition are treated as inimical to liberty. Tax and regulation should be minimised, public services should be privatised. The organisation of labour and collective bargaining by trade unions are portrayed as market distortions that impede the formation of a natural hierarchy of winners and losers. Inequality is recast as virtuous: a reward for utility and a generator of wealth, which trickles down to enrich everyone. Efforts to create a more equal society are both counterproductive and morally corrosive. The market ensures that everyone gets what they deserve."Rosario , December 11, 2017 at 10:55 pm
Well done, as usual.
On Case-Deason: Sounds like home. I keep the scanner on(local news) ems and fire only since 2006(sheriff got a homeland security grant). The incidence of suicide, overdose and "intoxication psychosis" are markedly increased in the last 10+ years out here in the wilderness(5K folks in whole county, last I looked). Our local economy went into near depression after the late 90's farm bill killed the peanut program then 911 meant no hunting season that year(and it's been noticeably less busy ever since) then drought and the real estate crash(we had 30 some realtors at peak..old family land being sold off, mostly). So the local Bourgeoisie have had less money to spend, which "trickles down" onto the rest of us.:less construction, less eating out even at the cheap places, less buying of gas, and on and on means fewer employees are needed, thus fewer jobs. To boot, there is a habit among many employers out here of not paying attention to labor laws(it is Texas ) the last minwage rise took 2 years to filter out here, and one must scrutinize one's pay stub to ensure that the boss isn't getting squirrelly with overtime and witholding.
Geography plays into all this, too 100 miles to any largish city.
... ... ...Lambert Strether Post author , December 11, 2017 at 11:20 pm
I'm not well versed in Foucault or Lacan but I've read some of both and in reading between the lines of their writing (the phantom philosophy?) I saw a very different message than that often delivered by post-modern theorists.
As opposed to being champions of "self-actualization/identity" and "absolute relativism", I always got the impression that they were both offering stark warnings about diving too deeply into the self, vis-a-vis, identity. As if, they both understood the terrifying world that it could/would create, devoid of common cause, community, and ultimately empathy. A world where "we" are not possible because we have all become "I".
Considering what both their philosophies claimed, if identity is a lie, and the subject is always generated relative to the other, then how the hell can there be any security or well being in self-actualization? It is like trying to hit a target that does not exist.
All potentially oppressive cultural categorizations are examples of this (black, latino, gay, trans, etc.). If the identity is a moving target, both to the oppressor and the oppressed, then how can it ever be a singular source of political action? You can't hit what isn't there. This is not to say that these groups (in whatever determined category) are not oppressed, just that formulating political action based strictly on the identity (often as an essential category) is impossible because it does not actually exist materially. It is an amalgamation of subjects who's subjectivity is always relative to some other whether ally or oppressor. Only the manifestations of oppression on bodies (as brought up in Lambert's post) can be utilized as metrics for political action.
... ... ...oaf , December 12, 2017 at 7:11 am
I thought of a couple of other advantages of the "embodiment" paradigm:
Better Framing . Wonks like Yglesias love to mock working class concerns as "economic anxiety," which is at once belittling (it's all about f-e-e-e-lings *) and disempowering (solutions are individual, like therapy or drugs). Embodiment by contrast insists that neoliberalism (the neoliberal labor market (class warfare)) has real, material, physiological effects that can be measured and tracked, as with any epidemic.
... ... ...
"we have measurable health outcomes from political choices" So True!!!
Thank you for posting this.
Dec 13, 2017 | www.bbc.com
It is hardly surprising then, that we tend to assume that white teeth are not only attractive, but healthy. The hue of our teeth depends on their intrinsic color, influenced in part by our genes and our age, combined with stains from smoking, eating, drinking and taking certain medications. As you get older your teeth often become yellower as the enamel begins to wear away, exposing the dentine beneath .
Stains then overlay the yellowing teeth, with foods such as tomato-based sauces and coffee leaving behind colored compounds called chromogens, while bacteria or fungi can cause green, greyish, furry looking stains .
Many of the experiments on tooth colour have been conducted in laboratory test tubes, rather than in the mouths of living people. Often cows' teeth are used because they give researchers with a larger surface area to study, but sometimes extracted human teeth are tested too.
Surprisingly, black tea doesn't stain the teeth unless preceded by white wine
One study conducted by Mark Wolff from New York University soaked cows' teeth for an hour in black tea, red wine or white wine in various configurations. It was no surprise that the red wine left the strongest stains. Surprisingly, the black tea didn't stain the teeth unless it had been preceded by white wine . It seems the acid content of the wine was making the enamel slightly more porous, allowing the tea to leave its mark.View image of An empty coffee mug stained with coffee (Credit: Alamy)
These food and drink-based stains may discolor teeth, but they don't indicate that the teeth are unhealthy. You can have pearly white teeth and still have gum infections or cavities. Likewise, you can have perfectly healthy teeth which are off-white, yellowish or even brownish.
There is even one type of stain that some researchers believe might protect against tooth decay. This is the dark edge you sometimes see along teeth at the margins of the gum line. It can look like a series of dark dots. It's known as "black stain".
While the cause of black stain has debated for more than a century, the latest thinking is that it's a special kind of dental plaque comprising calcium, phosphate, various bacteria and some form of iron or copper compound , which gives rise to the black colour.
Curiously, some studies – although not all – have found that children with black stain are less likely to have tooth decay . It's thought that microbes in the stain might be somehow protective.
Just as white teeth aren't necessarily healthy, off-colour teeth aren't necessarily bad either
Of course, in some cases discolouration can indicate decay or other disease, so it is worth getting stains checked out by a dentist. But just as white teeth aren't necessarily healthy, off-colour teeth aren't necessarily bad either.
Mar 23, 2017 | www.nakedcapitalism.comdjrichard, March 22, 2017 at 5:35 pmhuman , March 22, 2017 at 7:46 pm
Just a bit of a thought experiment, building on some thinking from a comment yesterday by jefemt
Paradoxically, we appear to be seeing a coalescence and consolidation of insurers, we will end up being delightfully exceptional, again -- effectively being single-payer, private sector, paying a monopoly an add-on cost of 35-40% to a parasitic industry whose executives and employees do not contribute to the CARE equation.
Taking jefemt's thinking further, imagine the health insurance provider was not only monopolistic (owned the entire market), but was also a GSE (government sponsored enterprise). Now take it one more step and imagine it was an actual part of the government and not merely a GSE.
Conceivably, it wouldn't even have to live off appropriations from congress, assuming it was equally as extractive from the private sector as it is now (i.e. revenue model is the same). Talk about good living. Who knows, maybe they pocket their proceeds into some kind of surplus in Treasury dept.
But let's assume they had to give up on revenue models. [Afterall, it's easier to find partners in congress when you have an appropriations process that binds you to them.] Then they would be exposed. Somebody would get the bright idea that this agency doesn't need as much staffing since they are no longer revenue oriented. That indeed, they could have the same staffing profile as the agency responsible for medicare. Indeed they could be folded into medicare.
I was thinking of this too as a reponse to Why Steve Bannon Wants You to Believe in the Deep State" [Politico]. "Like the Death Star, the American Deep State does not, of course, exist. "
Indeed, I think of the insurance industry as being part of the deep state already. It seems that congress's preference is that this part of the deep state is outsourced. So that's it not a GSE, and not even a monopoly, but maintained as an oligopoly. And then, well hey whatever surplus it can hoover up is fair game. After all free-hand of the market and all that. [And heaven knows, we don't want to crowd that out.]
In contrast to other parts of the deep state that don't really have a revenue model. In which case, those parts need to be insourced by the Fed Gov.Ernesto Lyon , March 23, 2017 at 12:09 am
The CIA has a long history of drug trafficking. The FBI traffics in blackmail. The NSA in network surveillance. DIA, special ops. NRO, satelite throughput. 11 more in the US of A and countless more globally. They all have opaque resources outside of regular channels.
Great documentary about the 80's cocaine business in Miami called "Cocaine Cowboys." It's real life Scarface. Guess who the Feds sent to get a handle on the cocaine smuggling? See-eye-aye man George H.W. Bush. Coincidence?
Nov 25, 2017 | angrybearblog.com
I have been doing my typical reading on healthcare in the US and ran across several articles which seemingly come together at various points in the dialogue and are written by different authors. I decided to tie them together into a much wider and telling story.
An interesting point being was made by MedPage Today's Dr. Milton Packer on his blog, " people suffer and die because Payors (Healthcare Insurance) is cost effective ." He starts his discussion on the opiate epidemic in the US, opiates are being prescribed by doctors for pain relief and . . .
"Patients are becoming addicted to opiates after the initial 10 day prescription with one-fifth of patients still using opiates a year later. There is no need to prescribe opiates as other less addictive pain-relief formulations are available, which are not commonly prescribed." This raises the question of why?
Payers will not pay for the alternatives. The less-addictive opiates are more expensive and payers have declined to support them. Patients get addicted because prescribing for the lower cost and highly addictive opiates saves the payers money initially (me) .
September 17, 2017, the New York Time and ProPublica (independent, nonprofit investigative journalism organization) collaborated on an article concerning the opiod epidemic in the US.
At a time when the United States is in the grip of an opioid epidemic, many insurers are limiting access to pain medications that carry a lower risk of addiction or dependence, even as they provide comparatively easy access to generic opioid medications.
The reason given: Opioid drugs are generally cheap while safer alternatives are often more expensive.
While the pharmaceutical manufacturers, distributors , and doctors have come under scrutiny; insurance companies and the pharmacy benefit managers (CVS Caremark, Express Scripts and OptumRx) make the final decisions as to what is covered. It could be something as simple as a higher tier and deductible to block usage.
A little side trip here and a continuation of the above. A week or so ago, I ran across another MedPage Today article by Dr. Packer; " Who Actually Is Reviewing All Those Preauthorization Requests and How the System Works ." Dr. Packers was giving a talk on advances in medicine with regard to heart failures to a room of about 20 or so doctors who were retired.
Since many of them were no longer involved in active patient care, he wondered why they might want to hear a presentation on new advances in heart failure. Here was their answer:
Doctors: " We no longer care for patients, but we care about what's going on. You see, most of us are employed by insurance companies to do preauthorization for drugs and medical procedures ."
" Dr. Packer: I just gave a talk about new drugs for heart failure. Are you responsible for preauthorizing their use for individual patients? "
The answer; "Yes."
" So did I say anything today that was helpful? I talked about many new treatments. Did I say anything that you might use to inform your preauthorization responsibilities? "
"Oh, we've heard about those drugs before. We are asked to approve their use for patients all the time; but, we don't approve most of the requests. Nearly all of them are outside of the guidelines we are given."
" I just showed you evidence that these new drugs and devices make a real positive difference in people's lives. People who get them feel better and live longer. "
"Yes, you were very convincing. But the drugs are too expensive. So we typically reject requests, at least the first time. We figure that, if doctors are really serious, then they should be willing to make the request again and again."
" If the drugs will help people, how can you say no? "
"You see, if it weren't for us, the system would go broke. Every time we say yes, healthcare becomes more expensive, and that isn't a good thing. So when we say no, we are keeping the system in balance. Our job is to save our system of healthcare."
" But you are not saving our healthcare system. You are simply making money for the company that you work for. And patients aren't getting the drugs that they need. "
"You really don't understand, do you? If we approve expensive drugs, then the system goes broke. Then no one gets healthcare."
"Plus, if I approve too many expensive drugs, I won't get my bonus at the end of the month. So giving out too many approvals wouldn't be a smart thing for me to do. Would it?"
Now before you start on insurance companies and doctors; understand, this is not as free a market place as many would assume.
In all of their political wisdom, Congress favors pharmaceutical companies over doctors, insurance companies, and the welfare of the constituents.
Through legislation, Congress has made it impossible for insurance companies to negotiate pharmaceutical pricing in Medicare Part D insurance and also the ACA .
Furthermore with the consolidation happening in healthcare, negotiation by insurance companies with a consolidating and growing healthcare industry is becoming more and more difficult as the former does not have as great of leverage. You have read my argument calling out of Single Payor, Medicare-for-All, Public Option, etc. as the cure for today's healthcare issues and rising cost not being enough as the ACA and Part D were specifically blocked or the cost issue unaddressed in the legislation written by Congress. If these issues are not addressed from the very beginning, we will be fighting the same issues with rising costs a decade later with other programs.
At this point, I begin to disagree with Dr. Packers as he goes on to say:
" So we spend more for healthcare than any other country in the world; but, Americans do not get the care they need. There is a simple reason. Treatment decisions are not being driven based on a physician's knowledge or judgment. They are being driven by what payers are willing to pay for. "
It is true that patients may not get some of the healthcare they need at the time due to denial, which can be appealed to the ACA, and can be a tiring process. It could be approved, passed on to patients, resulting in higher premiums the following year, and the Part D Risk Corridor program pay for it if excessive for the present year. What Dr. Packers does not mention is the rising prices and cost of drugs being blamed by pharmaceutical company on R&D, tooling up to manufacture, etc. The counter argument is much of the R&D is funded by the US government through tax deductions and write-offs for pharmaceutical R&D and capital Overhead. Pharmaceutical profits are double digit at ~25% beating out hospital supplies and healthcare insurance, which is already limited in what can be charged back to the insured by the MLR. To blame insurance companies totally for the higher costs in healthcare is false. Furthermore, a doctor's decision do not always lead to less costly cures or practices.
Maggie Mahar of Health Beat Blog would take the subject of costs a step farther and state Medicare will approve anything the FDA approves for usage regardless of the quality of outcome when measured against older proven treatments. Notably the VA does limit its pharmacy and its care is rated higher than that of today's commercial, for-profit healthcare to which most citizens are exposed.
Dr. Donald Berwick, President Obama's proposed appointment for Medicare and who was in charge of Medicare and Medicaid for 17 months stated;
"20 to 30 percent of health spending is 'waste' that yields no benefit to patients, and that some of the needless spending is a result of onerous, archaic regulations enforced by Medicare and Medicaid.
He listed five reasons for what he described as the 'extremely high level of waste.' They are overtreatment of patients, the failure to coordinate care, the administrative complexity of the health care system, burdensome rules and fraud .
Much is done that does not help patients at all and many physicians know it."
That is the same Medicare/Medicaid being touted by many proponents today as an alternative.
Speaking of costs and pricing for pharmaceuticals, there have been recent incidents of skyrocketing costs on particular drugs. A short while ago, I wrote a post concerning the appointment of Alex Araz as the new HHS Secretary replacing Dr. Tom Price. Formerly, Alex Araz was the CEO of the pharmaceutical giant Eli Lilly & Co.'s U.S. division . He also served under George W. Bush administration as the HHS General Counsel and Deputy Secretary. During that stint, he received praise for his management competence with the HHS; although, he did not have a healthcare background prior to this position.
Here it gets interesting when examining what took place during his tenure with Eli Lilly. One of the leading costs identified in pharmaceuticals increases has been in the rising cost of diabetes medication.
"While the Tweeter-in-Chief, Trump tells us presidential campaign contributor Alex Azar will be a 'star' who will lower prescription prices,"
Public Citizen's Peter Maybarduk (Director) had this to say: " Eli Lilly is notorious for spiking prices of a century-old isolated hormone during Azar's tenure as president and vice president. Eli Lilly raised the price of Humalog by 345%, from $2,65