Low back pain is a condition so common that, intermittently, I suffer from it myself. It comes and goes for no apparent reason, lasting a few days at a time. Nearly 40 years ago I realized that, though I had liked to think of myself as nearly immune from nervous tension, anxiety could cause it.
I was in a far distant country and I had a problem with my return air ticket. At the same time I suffered agonizing low back pain, which I did not connect with the problem of my ticket. When the problem was sorted out, however, my back pain disappeared within two hours.
In general, low back pain is poorly correlated with X-ray and MRI findings. Epidemiological research shows that the self-employed are much less prone to it than employees, and also that those higher in the hierarchy suffer it less than those lower – and not because they do less physical labor. Now comes evidence, in a recent paper from Australia published in the Lancet, that the recommended first treatment usually given for such pain, acetaminophen, also known as paracetamol, is useless, or at least no better than placebo (which is not quite the same thing, of course).
I’d like to thank my PJ colleague David Steinberg for his great work in developing and editing these excellent fitness articles from the indomitable Mark Rippetoe. I was skeptical of Rippetoe’s approach at first — he challenged my routine — but it didn’t take many articles for him to win me over. I’m not running anymore and our recent move from the San Fernando Valley to Inglewood reminded me that it would be useful to have much more strength in my emaciated, workaholic writer’s skeleton frame.
In planning my next year’s Resolutions list, I’ll be formulating my own fitness and strength routine based on Rip’s books and these articles. Anybody want to join me?
- Strength vs. Endurance: Why You Are Wasting Your Time in the Gym
- Squats, Presses, and Deadlifts: Why Gyms Don’t Teach the Only Exercises You Need
- The 1 Reason You Aren’t Getting Stronger
- Forget What You’ve Heard: 4 Reasons Why Full Squats Save Your Knees
- Maybe, You Should Gain Weight
- The Deadlift: 3 Reasons Why Just Picking Up Heavy Things Replaces Most of Your Gym
- 3 Reasons Why You Need to Lift the Barbell Over Your Head
- ‘Training’ vs. ‘Exercise’: What’s the Difference?
- Why You Should Not Be Running
- You Only Need These 6 Things For a World-Class Home Gym
- Why Being Sore Doesn’t Mean You’re Getting Stronger
- Strength Training for People My Age
- Bodyfat and Age: Just How Important Is Thin?
- The 3 Most Effective Ways to Waste Time in the Gym
Also don’t miss David’s 3-part video series where he received some first-hand coaching from Rippetoe to put his method into practice, embedded on each of the next 3 pages:
I return to work today after a week recovering from a major procedure. I underwent gastric bypass surgery to treat, among other things, my adult onset type 2 diabetes.
While no surgery occurs without pain, discomfort, disorientation, and some period of recovery, I can say that my experience has been as good as it could have been given the circumstances. My doctors, their staff, the insurance company, and the healthcare provider have all performed professionally and effectively.
That said, as a guy daily occupied with the effect of government upon the human experience, I certainly perceived areas where the healthcare system would undoubtedly improve if less encumbered by government. First, I noted inefficient compartmentalization.
To give you an idea of what I mean, consider the path taken to get this surgery done. First, I needed to see my primary care physician for a referral. Then I needed a consult at a weight loss clinic. Then I spent three months checking off a long list of labs, dietitian visits, psychological evaluation, and preparatory classes and consults. Despite the fact that nearly all this occurred under the umbrella of the same healthcare provider, every single time I saw a different person – even within the same clinic, it was like I was being seen for the very first time. I had to answer the same questions, fill out the same forms, tell the same story, over and over again. I can only imagine how frustrating this is for patients dealing with chronic illness.
To a certain extent, this redundancy can be justified. Some of it no doubt serves patient privacy and security. For instance, asking for my birthdate or address could be a verification check to ensure I am the right patient. However, I have a hard time believing that explains most of the redundancy. Most of it seems to be a product of compartmentalization, a lack of access to information previously disclosed. Other industries model customer service solutions which could easily be applied to healthcare.
When you go to the airport in any major city, you can check in at a kiosk and get your boarding pass without seeing a clerk. You can even check in online ahead of time, from your phone while in transit if necessary. Why can’t we do this in healthcare? I get to an appointment on time, but have to wait ten minutes in line behind other patients with more complex needs, and end up checked in late. There’s no need for that.
There is no new thing under the sun, least of all panic at the approach of an epidemic of a deadly disease. In 1720, the preface to Loimologia, Nathaniel Hodges’ account of the Great Plague of London in 1665, first published in Latin in 1672, referred to the outbreak of plague in Marseilles:
The Alarm we have of late been justly under from a most terrible Destroyer in a neighbouring Kingdom, very naturally calls for all possible Precautions against its Invasion and Progress here…
In fact, though no one was to know it, no epidemic of plague was ever to occur in Western Europe again; and it is doubtful whether the precautions referred to made much difference.
The death rate from the Ebola virus is probably greater than that from bubonic plague, though of course the plague spread much faster and killed far more people in total than Ebola ever has: and at least we, unlike our plague-ridden ancestors, know the causative organism of the Ebola disease, even if we are not certain how the virus first came to infect Mankind.
Dan McGurk from Toledo had one wish for his 30th birthday — that singer Kid Rock would come to his birthday party to help him celebrate.
“Hi, my name’s Dan and I’m the No. 1 Kid Rock fan,” said McGurk, who has Down Syndrome, in a YouTube video that garnered thousands of hits.
In the video, McGurk shows off his bedroom that is filled with Kid Rock gear — t-shirts, albums, a blanket, and walls covered with posters. “Please be there for my 30th birthday. … I hope you’ll come!” McGurk begged in the video.
This week, McGurk’s dream came true. During a celebration at Clarkston Union restaurant in downtown Clarkston, Michigan, Kid Rock surprised the 30 year old, joining the party and singing “Happy Birthday” as the birthday cake was served. The look on McGurk’s face when he sees Kid Rock is priceless. The singer put his arm around the man and hugged him and then sat down to chat with McGurk for a bit.
“I love that it worked out for me that I was going to be home,” said Kid Rock, who hails from Detroit. “Are you surprised?”
“Yeah! Yeah…yeah!” McGurk said. The two high-fived.
McGurk said that he had seen Kid Rock six times. “I’m the biggest #1 fan of you!”
Kid Rock didn’t come to the party empty-handed. He presented McGurk with a hat, a numbered poster (which he took the time to explain to McGurk), and a custom Kid Rock guitar, which he signed, after receiving permission from McGurk. “I’ll sign it for you if you want me to. You don’t want me to mess it up,” he said.
Before the evening ended, McGurk got Kid Rock to promise to let him hang out with the band the next time they played in Detroit. “He’s smart!” Kid Rock said.
Watch the sweet moment on the next page.
Time is money.
Money is scarce these days, everywhere but D.C. You want to be stronger, so you go to the gym. The best use of your time there is the simple progressive barbell training program we have discussed before, one that drives an upward strength adaptation with a programmed increase in load over a full range of motion using as much of your muscle mass as possible. This approach allows you to lift a gradually increasing amount of weight, thus making you stronger. Stronger means only one thing: you can apply more force with your muscles. The process of getting stronger improves the capacity of every aspect of your physical existence. So, getting stronger in the gym is the best reason to go there.
But it is incredibly easy to waste precious time once you’re inside.
Here are the top three ways:
Long regarded as the first thing you should always do inside the gym, stretching — for most people, and by “most” I mean you, probably — is not only unnecessary, it may be counterproductive.
What a way to start an essay, eh? The most fashionable aspect of modern fitness is the newly rechristened “mobility.” Same thing as “flexibility,” except that it sounds more Californian.
And here I go again, pooping on the most popular thing in the gym. It is a part of every trendy approach to fitness in existence, from CrossFit and “functional training” to Pilates and yoga. In fact, Pilates and yoga are mobility/flexibility/stretching, and that’s about all.
It has been assumed by almost everybody for the past 40 years that every workout should begin with the physical preparation known as “stretching.” Stretching is an attempt to increase the range of motion (ROM) around a joint, like the knee, hip, ankle, shoulder, elbow, or around a group of joints like the spinal column. The common method used is to force the joint into a position of tolerable discomfort and hold it there for a while, thus hopefully increasing the ROM.
More recent approaches to increased flexibility have used techniques that affect the muscles themselves, which actually control the ROM around the joints. Massage, Active Release Therapy, “foam rolling,” and other techniques applied to the muscle bellies themselves are actually much more effective for increasing a tight ROM than stretching. The Hip Bone’s Connected to the Thigh Bone, the Thigh Bone’s Connected to the Knee Bone, etc. So stretching is really all about the muscles, anyway. Every operating room professional knows the truth here: perfect “mobility” is obtained only under general anesthesia.
The assumption is always that your current ROM needs to be increased. Here are some Facts, cheerfully provided without citations, so that you can look them up if you want to:
1. Hypermobility is a medical condition – a Pathology, in fact – that often involves defects in the proteins that form the ligaments, the connective tissues that connect the bones to each other at the joints. The problem with being too flexible is that it results in unstable joints, which can assume positions they are not anatomically designed to occupy. A subsequently injured joint is not healthy: it is injured. This is not good. And here you are, trying to become hypermobile.
2. Tendons and ligaments do not “stretch out.” You cannot make them longer, and it would not improve their function if you could. Their function is to transmit force; in the case of tendons, which connect muscles to bones, the force of muscular contraction is transmitted to the bone it’s attached to, thus moving the bone. Tendons are indeed elastic, in that a sudden dynamic load causes a very small temporary change in length and a subsequent rebound, seen typically in the Achilles tendon complex. But during normal muscle contraction, if the tendon stretched excessively not all of the force would move the bone — some would be lost as the tendon changed length. Like a chain, a tendon pulls the bone with all the force of the contracting muscle because it does not stretch during the contraction.
Ligaments behave likewise. They anchor the joint as it moves, so that the bones which articulate at the joint change their relationship only with respect to their angle. This allows the joint to serve as a fulcrum in a system of levers. When ligaments move enough to allow the joint to change from its normal inter-articular arrangement, it is said to be “dislocated.” You’ve heard of that, right? When tendons and ligaments are stretched excessively, they rupture.
Most importantly, you cannot change the length of either a tendon or a ligament with stretching of any type, massage of any type, or therapy of any type. And why would you want to? Tendons and ligaments are force transmission components. They are very very tough, and they cannot be permanently lengthened by non-invasive means. The only connective tissues that you can affect with stretching are the fascias, the thin “silverskin” that covers the muscle bellies. If they become a problem, usually caused by tiny scars called “adhesions” that form between them and their underlying muscle or between adjacent fascias, they can be stretched with the previously-mentioned forms of therapy.
3. Since neither ligaments or tendons are designed to stretch, an increase in flexibility primarily involves the muscles that control the position of the skeletal components they operate. Sometimes, but not that often, the muscles behave in a way that requires you to teach them to lengthen more readily. And the best way to do this is with the aforementioned Full Range of Motion Barbell Exercise. Since full ROM is, by definition, all you need to do, anything beyond that is either a simple waste of time, or a counterproductive waste of time.
4. Stretching does nothing to a.) prevent soreness, b.) alleviate soreness, c.) or improve strength or any other measure of fitness. In fact, the vast majority of the studies done on stretching not only support this summary, but also indicate that stretching prior to either training or performance produces a significant decrease in power production. That’s right: tighter muscles can contract harder and faster, and even you can see the application for this in performance athletics.
The upshot is this: if you are already flexible (okay, “mobile”) enough to operate efficiently within the ROM of your required training and performance movements, you are flexible enough (your “mobility” is sufficient). And you don’t need to stretch. If you want to, go ahead and enjoy yourself, but you are not using your time wisely.
You might have supposed that trust in the medical profession would have risen as medicine became more effective at warding off death and disease, but you would have been mistaken. In fact, precisely the reverse has happened throughout the western world, but particularly in the United States. Half a century ago, nearly three quarters of Americans had confidence in the medical profession qua profession; now only about a third do so.
According to international surveys reported in an article in a recent New England Journal of Medicine, Americans are among the most mistrustful of doctors of any western people. Asked whether, all things considered, doctors in their country could be trusted, 58 percent of Americans answered in the affirmative; by contrast, 83 percent of the Swiss answered positively. Positive answers were returned by 79, 78, and 76 percent of the Danish, Dutch and British respectively. Americans were 24th of 29 nations polled in their trust of doctors. Furthermore, just fewer than half of Americans in the lowest third of the income range thought that doctors in general could be trusted, and younger Americans were also less likely to trust their doctors than older ones.
Curiously enough, though, Americans were among the most satisfied of nations with their last encounter with their doctor. Only the Swiss and Danes were more satisfied than they, and then not by very much (64, 61 and 56 percent respectively). In other countries, then, people were more likely to trust doctors in general than be satisfied by their last visit to the doctor; in America, it was about the same proportion.
What, if anything, does this mean?
One lamentable feature of the contemporary West is the ruthless efficiency of the nanny state. It works overnight. You wake up, slouch over your coffee and corn flakes, and read of the new Bad Thing that must be stopped Right Now. In Britain, the latest activity slated for oblivion is smoking in public parks. Readers, I’m sure, do not need to be reminded that parks are outdoor places; the traditional excuse of “secondhand smoke” does not appear to apply (although it is possible to find “studies” on the dangers of “thirdhand smoke”).
Nevertheless, British officials moved quickly. In September 2013, the mayor of London, alleged conservative Boris Johnson, ordered a “major review of health in the capital,” according to The Independent. The results are already in: Lord Darzi, Britain’s former health minister and the appointed chair of Johnson’s special commission, has said smoking needs to be banned in London’s parks and public squares. There is news that ”councils throughout England are also understood to be analysing how the proposals could be applied locally, paving the way for potentially the biggest crackdown on smoking since the Smoke Free legislation of 2007.”
My PJ colleague Walter Hudson published a compelling argument regarding physician-assisted suicide in response to the ongoing dialogue surrounding terminal cancer patient Brittany Maynard. His is a well-reasoned argument regarding the intersection of theology and politics, written in response to Matt Walsh’s Blaze piece titled “There is Nothing Brave About Suicide.” Both pieces are a reminder that, in the ongoing debate over whether or not Maynard has the right to schedule her own death, little has been said regarding the role the medical profession plays in the battle to “Die with Dignity.” Walsh argues:
None of us get to die on our own terms, because if we did then I’m sure our terms would be a perfect, happy, and healthy life, where pain and death never enter into the picture at all.
It’s a simplistic comment that ignores a very real medical fact: Death can come on your own terms. And that doesn’t have to mean suicide.
My mother was a nurse for 20 years. During that time she worked in a variety of settings, from hospitals, to private practice, to nursing homes. Much like Jennifer Worth, the nurse and author of the Call the Midwife series, my mother practiced at the end of Victorian bedside nursing and the dawn of Medicare. As a result, the abuses she witnessed in the name of insurance claims were grotesque. For instance, if a patient required one teaspoon of medication, an entire bottle would be poured into the sink and charged to that patient’s insurance company. This was just the tip of the iceberg of unethical practices that would become priority in the name of the almighty “billing schedule.”
How informed is informed consent and does it matter much, or as much as medical ethicists say it does? Do doctors have a duty only to make sure that their message is sent, or also a duty to make sure that it is received, and if received that it is retained? The prayer of General Absolution in the Book of Common Prayer refers to those things which we have done and ought not to have done, and those things which we ought to have done and have not done. When it comes to informed consent, there are also those things which patients have heard and ought not to have heard, and those things which they ought to have heard and have not.
This is proven in a recent paper in the British Medical Journal. Patients with stable angina in ten hospitals in the United States were asked what they thought the benefits were of the percutaneous coronary procedures they were about to undergo. The scientific evidence on this matter is more or less universally accepted: such procedures improve angina symptoms but do not increase life expectancy or reduce the rate of heart attacks.
Testicular cancer survivor Thomas Cantley is pushing a giant ball across America to raise awareness for men’s health.
He quit his job and sold his house to push a six-foot ‘testicle’ from Los Angeles to New York City after he was diagnosed with testicular cancer, according to his website.
He’s travelled more than 1,500 miles so far, but the story doesn’t say how much money he’s raised. “Awareness” is a more difficult measure, but there is a giant rolling testicle involved.
Traveling slightly north, we have this potentially related story from Wake Forest:
Researchers at the Wake Forest Institute for Regenerative Medicine in Winston-Salem, North Carolina, are assessing engineered penises for safety, function and durability. They hope to receive approval from the US Food and Drug Administration and to move to human testing within five years.
Professor Anthony Atala, director of the institute, oversaw the team’s successful engineering of penises for rabbits in 2008. “The rabbit studies were very encouraging,” he said, “but to get approval for humans we need all the safety and quality assurance data, we need to show that the materials aren’t toxic, and we have to spell out the manufacturing process, step by step.”
The penises would be grown using a patient’s own cells to avoid the high risk of immunological rejection after organ transplantation from another individual. Cells taken from the remainder of the patient’s penis would be grown in culture for four to six weeks.
This is great news for men with congenital defects or disfiguring injuries, but I fear what will happen when the porn industry inevitably gets hold of this technology.
Screenwriters are not known for being sticklers for facts. And when it comes to disasters, writes University of Texas Professor David A. McEntire, “many of Hollywood’s portrayals are based on myths and exaggerations….” That’s certainly the case when it comes to disease disaster films. Here are 10 “fun” movies that are of no use whatsoever in terms of helping viewers respond wisely to a pandemic.
10. Panic in the Streets (1950)
“Patient Zero” is carrying the pulmonary version of bubonic plague. A public official (played by Richard Widmark) has 48 hours to find him before the disease spreads throughout the city. Director Elia Kazan delivers a moody, atmospheric, underappreciated film. But if this is how the police, public health officials and reporters will really act during a crisis, well, we’re all doomed.
I didn’t fully appreciate how spiritually free I am as an American woman until I set foot on an El Al plane.
“Do you speak Hebrew?” the fretting woman in front of me asked.
“No, not really.”
“It’s okay, I speak English,” she hurriedly replied, obviously looking for a friendly face. “These Orthodox,” she motioned to the people sitting next to her, “they don’t like sitting next to women.”
“Well, that’s their problem.” My response was pointed, matter-of-fact, American.
She smiled as if a light bulb went off in her head. “You’re right!” Her expression grew cloudy. “But what if I take off my sweater? They won’t like that I expose my shoulders with my tank top.”
Again, I simply replied, “That’s their problem.”
She smiled, empowered. Removing her sweater, she took her seat and stood her ground.
And at that moment I thanked God I was raised in pluralistic America, and realized, oddly enough, that the Holy Land was giving me my first chance to practice the biblical feminism I’ve preached.
Israel is a Western nation in that women have equal rights by law. Israel is also a confluence of religious and ethnic cultural attitudes, not all of which are friendly to women. Two days into our trip to Jerusalem, a family member who also happens to be a retired journalist explained the latest story to hit the nightly news. A man accused of spousal abuse was released to return home. Later that evening, police found his wife had been shot dead. The husband confessed to the murder. Apparently, domestic violence and death is a relatively small but significant problem in Israel. When I asked my former journalist why, he pointed to the influence of Middle Eastern (both Arabic and radical Islamic) patriarchal culture as the primary source.
Yet, even religious Jews in Israel (and around the world), despite their insular nature, are far from immune to sexual abuse. Sex scandals among the Haredim (ultra-Orthodox) show up frequently on the evening news. In this case it’s not the Arab/Muslim influence, but perverted behaviors that arise from rabbinic abuse of biblical teachings. How do you expect a man to relate to a woman sexually when he’s not even allowed to look her in the eye?
We live in the age of acronym. To read a medical journal is sometimes like trying to decipher a code; once, when I was a judge in a competition of medical poetry, I read a poem composed entirely of figures and acronyms:
RTA [road traffic accident]
ETA [expected time of arrival] 13.20 hrs
CGS [Glasgow Coma Scale] 3…
The last line of the poem, inevitably, was:
Sometimes one has the impression that the acronym has been devised before the thing that it is attached to has been decided. In a recent paper in the New England Journal of Medicine, for example, I came across the acronym SWEDEHEART. It stood for the Swedish Web System for Enhancement and Development of Evidence-based Care in Heart Disease Evaluated According to Recommended Therapies. If the web system come before the acronym, however, you could see why the latter was necessary, the former being longer than the average tin-pot dictator’s list of honorific titles.
The paper in which the acronym occurred was yet another in which a common medical practice was shown to be valueless, or very nearly so. It turns out yet again that doctors do things not because they do the patients any good, but because they can do them.
When Hamlet tells Claudius that Polonius, whom he has just killed, is at dinner being eaten rather than eating, Claudius is puzzled. Hamlet explains that the worms are eating Polonius, and Claudius, still puzzled, asks Hamlet what he means by this
Nothing [replied Hamlet] but to show how a king may go a progress through the guts of a beggar.
In other words, we all come to the same end.
I thought of this passage when I read a paper about the death of Richard III in a recent edition of the Lancet. His remains were found recently buried under a car park in Leicester, a dismal provincial town in England, one of many ruined by planned modernization. The car park had once been a priory.
A long historical battle has raged over Richard’s real nature, whether he was hero or villain as per Shakespeare (few people think he might have been something in between the two). Certainly his remains, now more than 500 years old, have not been treated with undue respect: a team of forensic pathologists and archaeologists have examined them minutely for clues as to how he died at the battle of Bosworth Field in 1485.
Apple’s HealthKit — coming this week to iOS 8 for iPhone, iPad, iPod Touch, and next year to Apple Watch — is becoming much more than a simple fitness tracker:
Stanford University Hospital doctors said they are working with Apple to let physicians track blood sugar levels for children with diabetes. Duke University is developing a pilot to track blood pressure, weight and other measurements for patients with cancer or heart disease.
The goal is to improve the accuracy and speed of reporting data, which often is done by phone and fax now. Potentially doctors would be able to warn patients of an impending problem. The pilot programs will be rolled out in the coming weeks.
Apple last week mentioned the trials in a news release announcing the latest version of its operating system for phones and tablets, iOS 8, but this is the first time any details have been made public. Apple declined to comment for this article.
Apple almost never comments. The company’s former PR chief, Katie Cotton, elevated not saying anything to an art form. But that’s another story.
Mu question after reading this story is, just how many sensors are they packing into Apple Watch, and what do they plan to pack into future iterations?
The question is important because public health emergencies allow governments to ignore the usual restrictions or restraints upon their actions. In public health emergencies, governments can override property rights and abrogate all kinds of civil liberties such as freedom of movement. They can .r our goods and tells us where to go and where to stay. They do so only for our own good: health being the highest good, of course.
A recent edition of the New England Journal of Medicine discusses the issue in the context of the declaration of a public health emergency in Massachusetts by the governor of that state, Deval Patrick.
In most people’s minds, no doubt, a public health emergency would be something like the Black Death, the epidemic of plague that wiped out a third of Europe’s population in the fourteenth century. A natural disaster of large proportions might also count, not only because of the death and injury caused directly by the disaster, but by the epidemics which often follow such disasters.
What, then, was the public health emergency that “obliged” Patrick to declare that it existed and that he could and should take uncontrolled administrative measures to halt it?
I read the comments on these articles, you know. “Rip’s a fat guy. Don’t believe anything he says about fitness.” “Fit people don’t look like Rip’s fat ass. Run awaaaaay!!” As I sit here finishing the last of an unclaimed birthday cake from Kroger, listening to Chicago’s “Free Form Guitar” on repeat, this harshness brings a tear to my chubby, piggish little eyes. People are so hateful sometimes. Usually they’re just stupid and ignorant, and that can be interpreted as hateful.
But not by me, Nosiree. I know how people are, and they just haven’t thought clearly about several important aspects of human existence. First, I’m not a model, although my rugged good looks qualify me for such work (I was kidding about the birthday cake and the eyes). I’m a coach, a lecturer, and an author. I’m paid for what I know, not how I look. Tom Landry didn’t look like Randy White, but that didn’t keep him from being effective. My job is not to have abs, and it’s not even to show you how to get them. My job is to teach you how to get strong with barbell training, and why you should, and I’m quite good at it.
I have been doing this since 1978, and I’ve forgotten more about strength and conditioning than many coaches will ever have an opportunity to learn. But I’m 58, I’ve accumulated a lot of injuries, I can’t train as hard as I used to, I like to eat and drink, and I have a little belly. That doesn’t keep me from being an effective coach, lecturer, and author. And it’s amazing to me that I actually have to explain this to people who haven’t thought about what a coach does. They’re not hateful, just slow.
This is important too: I’m no longer primarily concerned with my appearance, and many of you in this particular audience aren’t either. Vanity is a luxury we don’t have time for — a costly, unnecessary luxury for truly mature individuals who are content to be merely strong, healthy, and physically competent. I’m not interested in being a fat slob, and as long as I’m training and thinking clearly about what I eat and drink, I won’t be. My primary interest now is that my continued physical existence be such that I’m still having fun.
Ladies and gentlemen, that doesn’t require “abs.”
For several years now the inimitable Theodore Dalrymple has provided PJ Media and PJ Lifestyle with erudite, witty commentaries on controversies in the worlds of health, drugs, and disease, as well as their impact on culture. Here’s a collection featuring links to many of the questions he’s addressed, often in response to some shaky thinking in a new study or an ideologically slanted medical journal article.
What health and medical questions would you like to see him and other writers explore in the future? Please leave your suggestions in the comments.
2011 and 2012
- Is Salt Really Bad for Your Heart?
- Are There Health Effects Due to the Financial Crisis?
- Should the ‘Morning After’ Pill Be Available to All Ages?
- Can Children Be Manipulated into Eating Their Veggies?
- Should We Be Worried about Bird Flu?
- Is Surgery Not Always Necessary for Appendicitis?
- Genomic Medicine: A Great Leap Forward?
- Aspirin: The Elixir of Life?
- Do Nicotine Patches Actually Work?
- Does ‘Good Cholesterol’ Really Help Prevent Heart Attacks?
- Should Women’s High School Soccer Be Banned To Reduce Knee Injuries?
- Is Grief Always Depression?
- Does Fish Oil Prevent Alzheimer’s Disease?
- Do Proactive Measures by Doctors Aid in Smoking Cessation?
- Can Dark Chocolate Reduce High Blood Pressure?
- How Come People Rarely Die of Dementia in Poor Countries?
- Should You Take Antibiotics?
- Is Obesity a Disease or a Moral Failing?
- Are Obese Kids Victims of Child Abuse?
- Need A Few Arguments Against Tattoos?
- Are the Treatment and Prevention of Obesity Different Problems?
- Why Are Psychiatric Disorders Not the Same as Physical Diseases?
- Do Today’s Medical Ethics Prevent New Breakthroughs?
- Should We Be Worried About Parasites from Cats?
- Do Doctors Turn Their Patients into Drug Addicts?
- Should Doctors Lie to Their Patients About Their Survival Chances?
- As Life Expectancy Increases Will the Elderly Become a Greater ‘Burden on Society’?
- What Is the Best Way to Treat Diabetes?
- What Can Be Done to Reduce Post-Hospital Syndrome?
- How Can a Mammogram Kill You?
- Human Feces as Medicine?
- What Will Happen if I Consume Too Much Calcium?
- Is Marijuana a Medicine?
- Why Is Immunization so Controversial?
- Is America at the Point Where HIV Testing Should Be Routine?
- Is Physical Therapy Overrated?
- How Many Smokers Could Quit If Someone Paid Them $10 Million?
- Is Nutrition Really the Key to Good Health?
- Is It Even Possible to Accurately Measure Physical Pain?
- Can Doctors Determine Who Should Be Allowed to Carry a Concealed Gun?
- Does Practice Really Make Perfect for Doctors?
- Should Doctors Be Allowed to Choose Not to Treat Fat People?
- Should Pre-Term Infants Receive Risky Oxygen Treatments?
- We Mock Prudish Victorian Euphemisms, But Are We Really Any Better?
- How Often Do Medical Emergencies Occur on Flights?
- What Is the Safest Day of the Week for Surgery?
- Are Antibiotic-Resistant Diseases Mother Nature’s Revenge?
- How Dangerous Is Obstructive Sleep Apnea During Surgery?
- Can Advances in Medical Technology Make Us Less Healthy?
- Does Badgering Patients to Exercise and Eat Better Actually Work?
- Should an Alcoholic Be Allowed to Get a Second Liver Transplant?
- Can Living With Chickens Protect Against Face-Eating Bacteria?
- Does the Sleep Aid Zolpidem Impair Driving the Next Day?
- Does Too Much Sugar Increase the Risk of Dementia?
- Men: Need Another Excuse to Put Off That Prostate Exam?
- Is Drug Addiction Really Like ‘Any Other Chronic Illness’?
- How Many Doctors Support Suicide for the Terminally Ill?
- What Are the Dangers in Screening for Diseases?
- Was Sir Winston Churchill Right About Exercise?
- Should Doctors Relax the ‘Dead-Donor Rule’ to Increase Organ Transplants?
- Is Living Near an Airport Dangerous for Your Health?
- Can Money Become Medicine?
- Gastric Bypass or Laparoscopic Gastric Band?
- How Do You Measure a Good Doctor Vs a Bad One?
- Should You Eat Lots of Nuts?
- As More People Live Longer Why Are Rates of Dementia Falling?
- Should Treatment of Obesity Begin Before Birth?
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image illustration via shutterstock / Sherry Yates Young
When I visited the John F. Kennedy hospital in Monrovia during the long Liberian Civil War, it had been destroyed by a kind of conscientious vandalism. Every last piece of hospital furniture and equipment had been disabled, the wheels sawn off trolleys and gurneys, the electronics smashed. This was not just the result of bombardment during the war but of willful and thorough dismantlement.
There were no patients and no staff in the hospital; it was a ghost establishment, completely deserted. I was severely criticized for suggesting in a book that the painstaking destruction of the hospital, which shortly before had performed open heart surgery, was of symbolic significance.
I was pleased to see from an article in a recent edition of the New England Journal of Medicine that it had re-opened, but saddened to see that its problems were now of an even more terrifying nature than those it encountered during the civil war: for the hospital is at the center of the epidemic of Ebola virus disease, and two of its senior physicians, Sam Brisbane and Abraham Borbor, have recently died of it. The article in the journal lamented their passing and praised them for their bravery in not deserting their posts; they both knew of the dangers of refusing to do so.
Readers may recall my description of aortic valve replacement last year and a warning of the importance of treating heart disease seriously. Here’s another lesson from medical misadventure: if you are going to have a stroke, it is best to have it on an operating room table. And best of all, avoid strokes if at all possible. As miserable and expensive as last year’s surgery and recovery was, I think I would make that trade.
This started as the classic symptoms of a heart attack on the evening of August 2: chest pain, pressure, left-arm pain, a sense of confusion. So I had my wife drive me to an urgent care facility, where they decided that I was beyond the level that they could treat other than giving me aspirin and nitroglycerin, and calling the Ada County Paramedics to transport me to St. Alphonsus hospital. In retrospect, my wife could have driven me there directly in less time, and saved the insurance company $1300.
Every few months I receive a computerized invitation from my doctor asking me to have a colonoscopy to screen for polyps in my bowel. I always tell myself that I am too busy just now, I will have it another time. But really I don’t want to have it at all, and I know that when the next invitation comes I will be too busy then as well.
I am also eager to find a rational reason, or at least a rationalization, for my refusal. I thought I found it in a paper from Norway in a recent edition of the New England Journal of Medicine.
The authors examined the death rate from colorectal cancer in Norway among the 40,826 patients between 1993 and 2007 who had had polyps removed at colonoscopy in that country (the records are more or less complete). They compared the number of deaths in that population with the expected death rate from the disease in the population the same age as a whole. The paper reports that 398 deaths were expected and 383 deaths were observed.
This small difference does not mean that colonoscopy does not work in preventing death from colorectal cancer, of course. This is because the relevant comparison is with people who had polyps not removed by colonoscopy rather than with the population as a whole.
The 40,826 patients who had polyps removed at colonoscopy, however, were not a random sample of the adult population because Norway does not have a screening program for colonic polyps. The patients had colonoscopy in the first place because they were symptomatic, for example bleeding per rectum. They were therefore much more likely to suffer from polyps or cancer in the first place than the rest of the population.
I happened to notice recently a report in a French newspaper of a study just published in the British Medical Journal, a study that had purportedly shown an increased incidence of cardiac death in people who took an antibiotic called clarithromycin. As I had myself taken this drug a couple of times in my life (though not, of course, quite as prescribed, because no one ever takes drugs quite as prescribed), I felt a certain personal interest in the question.
I needn’t have worried because the paper, from Denmark, claimed that the increased risk of cardiac death occurred only while the patient was taking the drug, not afterwards. But the closer I looked at the paper, the more darkness it seemed to shed on what doctors ought to do.
Denmark is a small country with a population of about 5.5 million, but it has the best health records in the world. This means that statisticians are able to churn out comparisons as Danish dairy farmers churn out butter.
By now you’ve probably seen 1,000 ice bucket challenge videos auto-play on your Facebook newsfeed by now. Everyone is doing it — kids, pets, celebrities, politicians, you name it. Yesterday I heard my neighbor do it on our front porch, but as I heard him explain, they didn’t have a bucket, so he used a “very cold” can of Coke instead. I’ve seen a few outtake lists, where instead of people having a bucket of water poured over them, the person pouring instead had the entire bucket full of water dropped onto their heads — it was painful to watch, I can’t imagine how painful it was to experience. The challenge has some haters, namely people annoyed at how many of those taking the challenge aren’t donating, and are instead wasting water. This meme popped up in my newsfeed this morning:
To which I say: Lighten up. The ice bucket challenge has gone viral like no other charitable cause I’ve ever seen, and has netted millions of dollars for ALS charities, over $15 million at last count (compared with less than $50,000 during the same period last year). I have no dog in this argument: I haven’t done the ice bucket challenge personally (please don’t nominate me, I’m poor and really dislike cold water), but I really applaud those participating and donating.