The distinction between what the law permits and what the law enjoins is often blurred. An absence of proscription is sometimes mistaken for prescription. The more the law interferes in our lives, the more it becomes the arbiter of our morality. When someone behaves badly, therefore, he is nowadays likely to defend himself by saying that there is no law against what he has done, as if that were a sufficient justification.
The recent Supreme Court decision in the cases of Burwell v. Hobby Lobby Stores and Conestoga Wood Specialties Corp. v. Burwell illustrates the difficulties when two or more rights clash irreconcilably. The complex issues involved were the subject of an article in a recent edition of the New England Journal of Medicine. The matter is still far from settled. It seems to me likely that the Supreme Court will one day reverse itself when its philosophical (or ideological) composition has changed.
The two corporations were owned by strongly religious people. Corporations of their size were enjoined by the government to provide their staff with health insurance which would cover contraceptive services. However, some contraceptive methods violated the religious beliefs of the owners of the companies. Did the companies have the right to except these methods from the policies that they offered to their staff (who, incidentally, numbered thousands, many of whom would not be of the same religious belief)?
Vacations can be wonderful experiences, but all too often they start out at an airport, which can be one of the most frustrating, uncomfortable, and stressful places on earth. Here’s the top ten ways to make your airline travel a good experience. Or at least not a nightmare.
10. Pack a small refreshment bag for the end of the flight.
Purchase the wisp toothbrushes that come with toothpaste already installed. Buy a packet of facial wipes. Take a last visit to the bathroom before landing to wash up, brush your teeth, comb your hair and prepare for your day. No matter how tired you are or how long the flight, the refreshment of a small amount of grooming helps energize you and get you ready to face your journey’s destination. Just avoid changing clothes. It never turns out well unless you’re David Spade in Tommy Boy…
In principle medical research is supposed to result in unequivocal guidance to doctors as to how to treat their patients. As often as not, however, the waters are muddied as much as cleared. Two papers in a recent edition of the New England Journal of Medicine about atrial fibrillation and the cause of stroke illustrate this. It has long been known that people with a clinically-detected chaotic heart rhythm called atrial fibrillation (AF) have an increased incidence of stroke by embolism; and likewise that no cause of such stroke can be found in up to 40 percent of patients who suffer from one. Their strokes are called cryptogenic. The two papers addressed the question whether, if you monitor patients with cryptogenic stroke for long enough, some or many of them will turn out to suffer from AF. This is important, because it is generally agreed that, in patients with clinically detected and symptomatic AF, anti-coagulation reduces the subsequent risk of stroke. AF, however, is not an all or none phenomenon. Some people suffer it continuously, but others only occasionally and for only a few seconds at a time. The additional risk of stroke in the latter is unknown, but is an important question because the anticoagulation designed to reduce the risk of stroke is not itself without risk, including that of another kind of stroke, the haemorrhagic kind. In other words, the risk caused by treatment could outweigh its benefits.
If the future were knowable, would we want to know it? When I was young, a fortune teller who predicted several things in my life that subsequently came true predicted my age at death. At the time it seemed an eternity away, so I thought no more of it, but now it is not so very long away at all. If I were more disposed to believe the fortune teller’s prediction than I am, would I use my remaining years more productively or would I be paralyzed with fear?
In a recent edition of the New England Journal of Medicine a question was posed about a 45-year-old man in perfect health (insofar as health can ever be described as perfect) who asked for genetic testing about his susceptibility to cancer, given a fairly strong family history of it. Should he have his genome sequenced?
A geneticist answered that he should not: to have his entire genome sequenced would lead to a great deal of irrelevant and possibly misleading information. But if the family history were of cancers that themselves were of the partially inherited type – more factors than genetics are involved in the development of most cancers – then the man might well consider having the relevant part of his genome, namely that part with a known predisposing connection to the cancers from which his family had suffered, sequenced.
This is not a complete answer, however. Two obvious questions arise: is additional risk clinically as well as statistically significant, and if the risk is known can anything practicable and tolerable be done to reduce it? There is no point in avoiding a risk if to do so makes your life a misery in other respects. You can avoid the risk altogether of a road traffic accident or being mugged on the street by never leaving your house, but few people would recommend such drastic avoidance.
Training with weights produces muscle soreness. Many people don’t like to be sore, and that’s why they won’t train for strength. Running also makes you sore, but not as bad and not all over the body, like weights, so running is more popular. Other people have noticed that riding a bike doesn’t produce sore muscles, so they ride a bike for exercise instead of lifting weights or running. But to some people — and this may come as a surprise to most of you — getting sore becomes the whole point of exercise. They wear their soreness like a badge of honor, and regard sore muscles as the price they must pay for continued self-improvement.
Here are some facts.
Delayed-Onset Muscle Soreness (DOMS) is a phenomenon associated with certain types of muscular work. It can occur as the result of exercise or manual labor, and is a perfectly natural consequence of unaccustomed physical exertion. There are a couple of different theories about its actual cause at the cellular level, which are beyond the scope of this article. Suffice it to say that DOMS has nothing to do with lactic acid production during exercise, and that it is an inflammatory response to certain types of muscular work which therefore responds to NSAIDs like naproxen, ibuprofen, and aspirin.
Pressure to control the consumption of tobacco has grown in tandem with the pressure to liberalize the consumption of marijuana. Perhaps this is not a paradox in the most literal sense, but it is certainly very striking. The yin of prohibition, it seems, always goes along with the yang of permission.
An article in a recent edition of the New England Journal of Medicine discusses the forthcoming tussle between what it calls Big Marijuana – the commercial interests, analogous to Big Tobacco, that will inevitably grow if marijuana ever becomes as accepted as tobacco once was – and the public health authorities. For while the smoking of marijuana does not yet cause anything like as many health problems as tobacco or alcohol, it would do so if its use were as general as the use of tobacco or alcohol. A little statistic that was published some time ago in the Lancet caught my eye: the French police attribute 3 percent of fatal road accidents to intoxication with cannabis and 30 percent to intoxication with alcohol. If, as seems likely, ten times as many Frenchmen drive drunk as drive stoned, marijuana is as dangerous as alcohol where driving is concerned.
The authors of the article point out that commercial growers and marketers of marijuana are likely, given the chance, to resort to all the techniques and obfuscations employed by the tobacco companies. They will minimize the harms done by marijuana while trying to increase the concentration of the very substance in their product that does the harm. The concentration of tetrahydrocannabinol (THC) in modern cannabis plants is already much higher than it was when hippiedom first struck the western world; Uruguay, where the cultivation and sale of cannabis has recently been legalized, is attempting to control the strains of cannabis that can be sold, with what success remains to be seen.
As long as men have experimented upon animals to gain knowledge of physiology or pathology there have been others who have decried the practice. Among them was Doctor Johnson, who said of vivisection that “if the knowledge of physiology has been somewhat increased [by it], he surely buys knowledge dear, who learns the use of lacteals at the expense of his humanity.”
Doctor Johnson argued that the cure of not a single medical condition had been discovered by the use of animal experimentation, and even if that is no longer the case there are nevertheless those who maintain that the benefits of animal research are small by comparison with their cost in the suffering of sentient beings that such research entails.
Two authors in a recent edition of the British Medical Journal, one of them an eminent epidemiologist and the other a sociologist, attempt to answer the question of whether or not animal research is a boon to medicine. Their conclusion is that it is much less so than is commonly supposed, and in some cases it is actually harmful. Since the only possible moral defense of vivisection is that it promotes medical advance, it should be stopped if it does not.
The authors point out that, according to a survey of medical scientists who perform animal experimentation, more are motivated by a desire to advance knowledge or careers than by a desire to help suffering humanity, and are actually rather indifferent to the practical use or otherwise of their work.
This is perhaps just as well, at least for their own peace of mind, because the practical value to patients of most animal experimentation is nil. This is for more than one reason.
If a Martian were to land on earth to study humanity, one of the things that would no doubt surprise him about our race is the pleasure it takes in contemplating its own extinction by various catastrophic means: the crash into earth of a giant asteroid, climate change or the spread of new, virulent and untreatable diseases, especially caused by viruses that emerged from the African jungle.
Of all the viruses to have emerged of late, Ebola is the most frightening. It comes in several varieties of different virulence, with (according to a recent article in the New England Journal of Medicine) death rates from a “low” 40 percent to over 70 percent. Among monkeys the death rate can be 100 percent.
Before Ebola there was Marburg, so named because it was first recognized among laboratory workers in Marburg, Germany. This virus is spread from fruit bats to monkeys to humans, and I happened to be in Rhodesia (as it was then still called) when there was an epidemic there of the disease and 33 percent of the patients died. I remember the reaction in the hospital between panic and pride that it should be in the eye of a world-publicized storm. The question on everyone’s mind was whether it could spread on a large scale from Africa to Europe and North America. Could the virus escape its ecological niche?
This past Sunday, American audiences finally had their chance to wave goodbye to Nurse Jenny Lee, the lead character in the famed Masterpiece series Call the Midwife. However sad it may be, the departure of the show’s Hollywood-bound lead actress Jessica Raine was, ironically, in no way a traumatic one.
Most American shows die when their lead actor disappears. Dan Stevens’ untimely departure from Downton Abbey still enrages fans over a year later. Yet, while Nurse Jenny Lee will be a much missed character, fans are far from outraged at her departure. Perhaps this is because Call the Midwife was never just about Jennifer (Lee) Worth, but about the many lives she encountered and a profession that is finally being given the credit it so sorely deserves. But there is more to the massive success of what began as a 6-episode BBC show about nursing in mid-century London’s bombed-out East End than giving credit where credit is due.
In an era of roughshod marketing tactics and semiotic overload, Call the Midwife, with its pure, heartfelt approach to the vicissitudes of life, is therapeutic television. We are a desensitized audience: No one cries when a pregnant mother is stabbed to death on Game of Thrones. Yet, everyone, including the burly guys on set, shed a tear at every birth on Call the Midwife. We are treated to an East End rife with chamber pots, not sexy chamber maids, and yet audiences are drawn to the show in droves. We love the midwives, even when they are dressed in habits and wimples; they are the ideal face of medicine, mother, and God in an era when we’ve been taught to doubt all three. Like a nurse checking our pulse, Call the Midwife reminds us that we are human after all, and perhaps not as sick as we’ve been led to believe.
And yet, while TV execs struggle with sex and violence in the name of Tweet power, they remain blind to Call the Midwife’s axiom for success: There is powerful endurance in simple truth. Call the Midwife will survive without the character of Jenny Lee because the show has embraced Jennifer Worth’s own mystical sense of timelessness. It is the stuff that fueled her memoirs of both London’s East End and her time as a nurse caring for the dying. Brilliantly captured in the season finale, this sense of the eternal in both life and death is what makes Call the Midwife a healing balm of a show and transcendental television in its finest form. Forget bloody battles and wild, nameless sex. Call the Midwife empowers its audience with the strength to face, not escape, life’s pressures, and the faith to believe that while “weeping may happen for a night, joy breaks forth in the morning.”
Now and then in life, love catches you unawares, illuminating the dark corners of your mind, and filling them with radiance. Once in a while you are faced with a beauty and a joy that takes your soul, all unprepared, by assault.
I remember the written response of the senior doctor in the prison in which I worked to an editorial in the British Medical Journal lamenting the difference between health care in prison and health care in the “community.” Yes, he replied, where else in the country but in prison could everyone get to see a doctor within an hour of complaining of something?
I thought of this as I read an article recently in the New England Journal of Medicine about Hepatitis C infection and the American correctional system.
About 3 million Americans are infected with the Hepatitis C virus, mainly because of having shared needles in intravenous drug abuse, but also through transfusions before blood was screened for the virus. Those who are tattooed have two or three times the average rate of infection.
Ten-to-fifteen percent of cases of untreated infection (among males) will go on to get cirrhosis of the liver, and of them an increasing proportion will develop liver cancer as the years go by. Hepatitis C infection is now the largest single cause of the need for liver transplants.
Recently, my wife approached me with the unwelcome news that our health insurance plan — which we like — will likely be cancelled next year. Her employer, a healthcare provider, generously provides benefits even for those working part-time. Due to the devastation wrecked upon the industry by Obamacare, they anticipate the need to drop coverage for all employees working less than 60 hours per pay period. My wife works 56. Since my employer’s offering proves virtually worthless, far too expensive for far too little coverage, we will be left effectively uninsured.
We may consider Samaritan Ministries as an alternative to insurance. Resembling the mutual aid societies which were common throughout America before the rise of the welfare state, Samaritan Ministries operates as a “health care sharing” service. Here’s how it works:
Each member commits to sending a set “Share” amount each month. These “Shares” are sent directly through the mail from one household to another, to the members with “Needs”. Samaritan Ministries uses a database that randomly matches Shares to Needs, so that the Sharing is coordinated and Shares go to the appropriate members with Needs.
Born to a world dominated by employee-provided health insurance, we may find the notion of health care sharing bizarre or even suspect. But is it really any more odd than our rapidly corrupting government?
It’s with some irony that a Christian ministry has essentially gone Galt. While Ayn Rand may have balked at the religious context in which Samaritan Ministries operates, she also may have tipped her hat at their defiance of convention.
The service “even satisfies the Federal health care law’s (Affordable Care Act) requirement that you have insurance or pay a penalty-tax (see 26 United States Code Section 5000A, (d), (2), (B)).”
Would you consider a health care sharing service like Samaritan Ministries? How might the business model be applied to other needs?
Not everybody who wants to train for strength can fit a gym membership into their lifestyle. Scheduling problems, the cost, travel problems from home or work, the absence of an adequately equipped facility in the market, or simply the dislike of a commercial gym environment motivates many people to invest in a home gym.
A serviceable home gym for barbell training need not be a gigantic investment, and in fact should be very simple. A bar, some plates, a rack of some type to facilitate the squat and the pressing exercises, a simple flat bench for the bench press, and a platform for deadlifts are all that is absolutely required. For power cleans and snatches, a few bumper plates are quite useful but not absolutely necessary.
The equipment is simple, and need not be expensive, but there are a few tricks.
1. The Bar
This is the wrong place to save money. Of all the pieces in the gym, the quality of the bar is the most critical. The plates just hang there, the platform just lays there, but the bar is your connection to the force against which you lift — gravity.
Saving money is a good idea. Generic drugs are cheaper than the name-brand products, and they are essentially the same product. This is not true of Olympic barbells. In most cases, you get exactly what you pay for. Unless you get lucky — and these days of rapid expansion in the interest in barbell training, such luck is hard to come by — and find a good used bar cheap, expect to pay around $300 for a good bar.
Why? Because steel is expensive, competent manufacturing is expensive, and warehouse space costs money. A cheap bar will bend, and a badly bent bar is junk. A bar within about 3mm of perfectly straight is useable as a straight bar, while a bar bent more than 4-5mm out of straight is considered bent. When loaded with plates, a badly bent bar will rotate to a position of stability — it will “right” itself, with the ends of the bar pointing down and the bend in the middle pointing up. This is fine for a squat, if you have marked the bar so that you can take it out of the rack in this stable position. But if you unrack the bar for a squat, press, or bench press, or pull it from the floor in its unstable configuration, the bar will spin in your hands or on your back to right itself. This is not good, and can cause safety problems during the lift.
Most commercial gyms have a few bars, and usually all of them are bent, because they bought cheap junky bars not knowing any better or not caring about it. Bars get bent in commercial gyms by being dropped on benches, or inside the rack by jackasses that aren’t invested in the equipment. Even expensive bars will bend when 315 pounds is dropped across a bench. But cheap bars will bend if left loaded in the rack overnight.
You can check a bar for straightness by placing it on the floor and spinning it in the middle with your foot (if the revolving sleeves aren’t frozen, which is also bad). If it wobbles, it’s not straight. Or, you can see the wobble when you rotate it in the rack — the end of the bar will describe a circle in the air larger than the diameter of the sleeve, and the middle of the bar will move back and forth, the greatest deviation being at the point of the bend. One of the advantages of a home gym is that you get to work with a straight bar every time you train.
Bars are available in several diameters. The Olympic weightlifting federations specify a 28mm bar, while the International Powerlifting Federation wants the diameter to be between 28 and 29mm. The standard bar length is a little over seven feet, has “2-inch”/50mm diameter sleeves for loading the plates on, and weighs 20kg/44.1lbs. The thicker the bar, the stiffer the bar, so Olympic lifters doing the faster snatch and clean & jerk like the whippiness of a 28mm bar, and powerlifters need a stiffer bar because they handle heavier weights more slowly. Olympic lifting uses a 25mm bar for the women’s division (smaller hands need a smaller bar), and a competitive lifter will need one of these. For home gym purposes, a 28.5mm or 29mm bar will be the most durable and provide the best service over time.
Never buy a 32mm bar. They are either junk, or a specialty squat bar that a home gym doesn’t need. Usually they are junk. Scrap metal.
Sometimes the New England Journal of Medicine reads like a journal of failed bright ideas. I do not remember ever having read of so many failed trials of treatment as I have recently, but perhaps that is a sign of increasing scientific honesty. After all, it is as important to know what does not work as what does, especially when what does not work is very expensive to administer.
Septic shock is a condition of dangerously low blood pressure brought about by serious infection. About 750,000 cases a year are treated in the United States alone, with a death rate above 20 percent, that is to say at least 150,000 people die of it each year. This is a number well worth reducing.
More than a decade ago the results of a trial were published in which it was shown that aggressive treatment according to a pre-arrange protocol could reduce the death rate from septic shock by about a half. In those days (medicine 10 years ago seems that of a bygone era), the death rate in septic shock was much higher than it is today, which may in part explain the success of that trial compared with the failure of a more recent trial published recently in the NEJM.
Getting to sleep at night has never been one of my talents. As a kid, fears kept me awake. As a teenager, I found the night the most intense time and didn’t understand why one was supposed to sleep during it. As an adult… if it wasn’t one thing that kept me awake at night, it was another.
Just recently I’ve been on a new regimen, and it’s actually working. There are three things I’ve been doing differently, and I’ve been sleeping with little or no trouble most nights. As for why I made these three changes, it did not come from any conscious decision but, apparently, from something on a subconscious level, some push for greater purity, a byproduct of which has been successful sleep.
I should add that if exercise is not one of the three things, it’s not because I don’t practice it but because I’ve already been practicing it for decades. I find it indispensable to decent mental and physical functioning. No, by itself it did not solve my sleep problem; but without it I wouldn’t have slept at all.
“You need to have a good mood. Good family, good children, good work, and then you’ll be happy,” he added. “You need to be a sociable person. I love and respect all people. After what happened to me, I don’t only value my own life more, but I deeply value the lives of all human beings. It’s very important to have good company and good friends. I view everything with optimism, it’s very important.”
As a grandchild of a survivor, I’ve always had a special interest in Holocaust studies. I have read many memoirs and attended numerous classes on the subject. But, from the very first class in a small Israeli school in the suburbs of Afula, to the courses I attended in a large North American university — I had always felt that something I had learned from my Grandfather was missing from these lectures.
For years, I had trouble pinning down that missing piece. It frightens me that my grandfather’s gift may have been lost all together: No one would have known that there once lived a man named Srulik Ackerman, who challenged our understanding of human nature, and with that, could bring hope in even the darkest of times.
…after just a few minutes with my Grandpa you would see the mystery that had perplexed me for so many years. The first thing that would strike you would be his wide, welcoming smile. Grandpa smiled and laughed more than anyone I knew. He took every opportunity to tell jokes and bring joy to others. Without a doubt, Grandpa was the happiest person that I had ever met.
How was that possible? I spent two years writing his memoir, hoping to discover his secret. But, even after the book was complete, I still had no idea what gave him such unparalleled resilience.
So, I decided to ask him directly. “How do stay happy on a daily basis?” I asked during one of our conversations.
Do yourself and your kids a favor: Get to know a Holocaust survivor so you, too, and your children can understand how a human being can survive and thrive in the face of death. There aren’t many survivors left, but there are countless resources through which you can interact with their thoughts and experiences. Tomorrow, the United States Holocaust Museum is sponsoring a Google+ Hangout with Holocaust survivors specifically geared towards school-aged children. Take advantage of this opportunity to get to know the real “secret” to happiness.
And don’t forget to thank them for sharing it.
“It just comes down to love. I mean, if you love your child then you should do anything in the world for your child. And it’s as simple and as pure as that.”
This is not parental love. This is misguided, tragic indulgence. It’s as simple and pure as that. Parental love prepares a child for adulthood–momentary happiness has little to do with it.
Parental love sees beyond what a child currently wants, or thinks he wants, and gives him what he needs. What this child needs is unconditional love and a chance for his brain to mature and his body to fully develop.
It’s far beyond the comprehension of a child to see himself as an adult. To a child of nine, eighteen is a lifetime away. Neither Keat nor his parents can fathom what his life will be like as an adult. The physical and mental consequences of a chemically altered body through puberty cannot be fully understood and weighed.
What if Keat had Body Integrity Identity Disorder? The same feelings of being born wrong exist. A person with this disorder believes he or she would be happier without the appendages they were born with. Would these parents still be good parents by indulging this disorder with amputation before puberty?
I thought about this as I read Mark Rippetoe’s fascinating discussion of why running is not the panacea that so many people think it is:
This highly informative discussion is intended for those people who have taken seriously the advice of doctors, physical therapists, exercise physiologists, and the popular media’s dutiful reporting on these sources of common misinformation about what kind of physical activity is best for your long-term health and continued ability to participate in the business of living well.
Rippetoe goes on to make the case against running and for strength training. Okay, fair enough. I get that we need to be strong, especially as we get older; and strength training helps with this. But I can’t help that feel that a balanced approach is also good if you want to address Rippetoe’s concern that “the more you run, the better you are at running and the worse you are at being strong.”
I have a number of training goals and they change all the time. For example, right now, I want to run a 13 minute mile which I know is not good, but is about the best I can do. It’s important to me. Why? Because running is a skill that can help in situations such as running fast away from something or someone, or running to catch a subway or bus, or running after a kid or adult who needs help, etc.
Do I need to run long, slow distance? No, probably not. I also want to know self-defense because it is important to me and I would like to take more Krav Maga lessons. I suppose these goals take away from strength building but I don’t have time for all of it. So what do you focus on? If being good at strength building builds strength, that’s good, but will it help me to run faster or be better at self-defense? Wouldn’t practice of these “sports” or exercise be the most helpful? Or maybe a balanced approach that focused on strength and practicing running and Krav Maga would be best. If we only strength train, is that enough or does it depend on one’s goals?
image via shutterstock / Maridav
That is a question posed by this CNBC article looking at the differences in how many services male and female doctors perform with Medicare patients:
The diagnosis: a serious case of medical gender gap.
Male doctors on average make 88 percent more in Medicare reimbursements than female physicians, according to an analysis of recently released government data, which suggests that the gender of a medical provider could play a role in the number of services they provide patients.
The NerdWallet research found that male physicians on average were paid $118,782 in Medicare reimbursements by the federal government in 2012, compared with $63,346 for women doctors.
Naturally, the “alarming” headline of the article is that male doctors are paid more in Medicare reimbursement than female doctors. However, the real question might be:
“This certainly begs the question of whether men and women practice medicine differently,” Ositelu said. “The bottom line is patients may experience higher costs through doctors who bill for more services per patient.”
Higher costs or tests run that save lives or just make them better? Why are more procedures worse? Maybe men are more willing to ask for procedures that their female counterparts do not? Also, note that men see many more Medicare patients, an average of 512 per male doc and only 319 per female doc. Why is that? Are females less willing to see Medicare patients or less able to take on more of them as clients? And if you see more patients, don’t you charge for more services? This is a troubling article, one that doesn’t look at the quality of medicine and the reasons behind why procedures are being performed, but rather, wonders why women docs are getting less money than men from the government Medicare program.
image via shutterstock / Edyta Pawlowska
There are few phrases more dangerous in medicine than “it stands to reason,” because what stands to reason may in fact not be a good idea, however brilliant it may once have seemed. This is because reality is always more complex than our theories about it; grey is theory, said Goethe, but green in the tree of life.
Perhaps the greatest single intellectual advance in the medicine of the last century was the realization that “it stands to reason” is no reason at all; everything must be studied in the light of experience. There was a good example of this necessity in a recent edition of the New England Journal of Medicine, which studied the effect of giving patients doses of aspirin or clonidine before and after undergoing non-cardiac surgery.
One of the most serious and feared complications of such surgery is heart attack, especially as the age at which people are operated on has increased. There are good theoretical reasons for believing that either aspirin or clonidine, or both, given peri-operatively might reduce the rate of heart attack in the first month after operation. Aspirin prevents the blood platelets from sticking to one another and the lining of the blood vessels, agglomeration of platelets being one of the mechanisms of heart attack; clonidine blocks the activity of the sympathetic nervous system whose overactivity is thought to be another such mechanism. Therefore it stands to reason, if anything does, that making the platelets less “sticky,” or the sympathetic nervous system less active, before, during and after operation might reduce the rate of post-operative heart attack. But does it?
A large trial was conducted in 135 hospitals in 23 countries, comparing the rates of heart attacks of people given aspirin, clonidine or placebo before and after operation. 10,010 patients were recruited in all, and the rate of follow-up was so high (99.9 percent) that it resembled the results of a Soviet-era election. Surprisingly, more than 40 percent of the patients were already taking low-dose aspirin prophylaxis when they entered the trial; but they were treated in exactly the same fashion as their peers who were not on aspirin.
If you are a competitive distance runner or cyclist who is serious about your sport, this article has not been written for you. This highly informative discussion is intended for those people who have taken seriously the advice of doctors, physical therapists, exercise physiologists, and the popular media’s dutiful reporting on these sources of common misinformation about what kind of physical activity is best for your long-term health and continued ability to participate in the business of living well.
Endurance exercise is the most commonly recommended form of activity for health and “wellness.” Every time you see an exercise recommendation denominated in minutes, you are seeing a recommendation for long slow distance exercise — LSD, or “cardio” in the modern vernacular. Running, bicycling, rowing, or their health-club analogs on machines at the gym are what they mean when they say “exercise.”
Depending on who you listen to, 20 minutes per day, 3 hours (120 minutes) per week, or any permutation thereof as a prescription for fitness/health/wellness is the standard in both the fitness and health care industries, and getting stronger is always of secondary importance.
The endurance exercise approach ignores several basic facts:
1. Strength is the ability to produce force with your muscles against an external resistance, like those with which we interact in our environment as we go through our days, living our lives productively. And endurance exercise is directly antagonistic to strength, because an endurance adaptation occurs at the expense of strength.
The body’s basic response to a stress of any type is to recover from that stress in a way that makes it less likely to be a stress when next exposed to it. In other words, we adapt to stress by becoming better able to withstand it. This means that the adaptation to the stress is specific to the type of stress. An endurance stress is low-intensity and highly repetitive, meaning that each of the individual physical efforts that make up the run is easy — none of them are physically difficult from a strength perspective. If they were, you couldn’t do them over and over again for an hour. This means that the hard part is the cumulative effects of the run, not the strides themselves, which are easy.
Since the individual efforts that compose the run are easy, they do not depend on, nor are they limited by, the runner’s strength. Therefore, running cannot make you stronger, since it does not stress your ability to produce increasing amounts of force. Rather, it only depends on your ability to keep producing small amounts of force for an hour.
But more importantly, since running for an hour requires a different adaptation from the muscles, that adaptation will be favored by the muscles and will actively compete for precedence over a strength adaptation — especially if you’re not doing any strength training, or doing it wrong.
Quite literally, the more you run, the better you are at running and the worse you are at being strong.
For Easter this year, Whole Foods sold Organic Timothy Grass for kids’ Easter baskets. The story sounds good, as usual—plastic is toxic and the stuff in the Easter baskets lingers for years on the planet. Not mentioned is how prevalent shredded, recycled paper has become for baskets or how the plastic grass lasts and gets reused year after year. That is, the menace of plastic grass is overstated. Also not mentioned in the real grass is great story, the price of the real grass.
As I first learned about the grass clippings in a Tweet from @johnrobison, “Salute the marketing geniuses at @WholeFoods for selling grass clippings for $23.96 a pound – More than good steak!”
A few months ago, Rhonda Robinson posted about a poor neighborhood that “ran off” a Trader Joe’s opening. The gist of the article and comments assumed the neighborhood had elevated politics over health and made a bad decision. She concluded, “The Portland African American Leadership Forum would much rather see empty decaying buildings in their neighborhood than give up their victim card.”
I doubt the neighborhood would rather keep vacant buildings. I also doubt that they objected to a grocery store opening. They likely objected to a Trader Joe’s opening.
One of the few laws of political science is that when governments make mistakes, they tend to be whoppers. Luckily for them, the public’s memory is short, and the outrage of today soon declines into the apathy of tomorrow.
From several articles published in a recent edition of the British Medical Journal, it appears that many governments around the world, including those of Britain and the U.S., may have made such a mistake in stockpiling billions of dollars’ worth of anti-flu medications, bought principally from Roche, the largest pharmaceutical company in the world as measured by capitalization.
First the governments overestimated the virulence of the new flu epidemic the drugs were supposed to counter, no doubt a forgivable mistake in the circumstances; but then it stockpiled the supposedly anti-flu drugs on the basis of inadequate evidence. It took published studies at face value without apparently realizing that the drug companies had withheld a great deal of data – 150,000 pages of it, as it turned out. When, after what seems like a rear-guard action to prevent it, the drug companies released all the data, re-calculation showed that the drugs were not quite useless, but had practically no value from the public health point of view. At best they reduced the duration of symptoms by a few hours and in some cases prevented the development of symptomatic disease. But they also caused serious side effects, and neither prevented deaths nor serious complications nor the rate of hospitalization. They did not prevent the spread of the infection either.
My home state of Colorado is a guinea pig for the pros and cons of marijuana legalization. Other states are observing closely to see if they should move down the path towards legalization.
There’s plenty of bad news to go around. Police in other states are pulling over Colorado drivers with no justification other than the green license plate. (We’re all stoners now, I guess.) A college student named Levy Thamba fell to his death from a high balcony during spring break after eating a marijuana cookie. And last week a Denver man who ate pot-infused candy became incoherent and paranoid and shot his wife to death.
Is there good news? Turns out there is. Colorado Springs is the source of the Charlotte’s Web strain of medical marijuana that has sent parents with gravely ill children flocking to the city for treatment.
The strain was developed by Joel Stanley and his brothers in their Colorado Springs medical marijuana facility. They’d read that marijuana strains that are high in a chemical called CBD can help to shrink tumors and prevent seizures. The chemical in marijuana that gets users high is called THC, and since it has an adverse affect on seizures the Stanley’s bred it out of the plant.
Their first patient, 5 year old Charlotte Figis, was so affected by a genetic seizure condition called Dravet’s Syndrome that she was not expected to live much longer. Today, she’s almost seizure free. The Stanley brothers named the strain after their first little patient, and it’s showing the world what medical uses marijuana can offer.
Today there are nearly a hundred families with gravely ill children who have relocated to Colorado Springs, purchasing a treatment for their children that would have landed them in prison just a few years ago. Medical marijuana is well known to help in the treatment of nausea in cancer and AIDs patients, but the strains now being investigated may uncover new lifesaving medicines such as Charlotte’s Web.
The recreational use of marijuana is proving to be the problem it was predicted to be, but while the stoners fill the headlines the researchers in medical marijuana are quietly making amazing advances in the treatment of illnesses. That’s some very good news indeed.
Image via CNN Health.
“Physical fitness.” “Physical activity.” “Working out.” “Exercise.” “Training.” These are all terms that get haphazardly applied to the things we do when we intend to make some type of improvement in our body’s physical capacity. They all have separate and very specific meanings, and understanding them is important if you are to make the right choice about which one to apply to your situation.
“Physical activity” is a rather low standard to hold oneself to, since it merely means movement. Physical activity, according to the American Heart Association website, is defined as “anything that makes you move your body and burn calories.” The world is full of unhealthy people, some of whom are sedentary and some who move all day. Mere movement does not correlate with a significant improvement in physical capacity. It may be a step in the right direction, but a look at its specific recommendations indicates that any steps would be tiny ones.
“Physical Fitness” has a more specific definition. By Kilgore and Rippetoe in 2006 in the Journal of Exercise Physiology Online [9(1):1-10]:
“Possession of adequate levels of strength, endurance, and mobility to provide for successful participation in occupational effort, recreational pursuits, familial obligation, and that is consistent with a functional phenotypic expression of the human genotype.”
This is a description of what fitness entails, and describes a reason to be fit based on the genetics we possess. But it doesn’t say anything about how to accomplish this task, either the process or the components thereof.
Most people decide that the thing to do to get fit is something called “working out.” A “workout” is a term that refers to the period of time spent exercising — the exercise event. Us guys go to the gym for the purpose of “getting a workout” before we know much about it. To most of us guys, getting a workout means hitting the bag, running a few laps, getting sweaty, tired, and maybe doing arms a little. A few curls.
That makes “working out” the same thing as “exercise.” The term “exercise” best describes a physical activity performed for the sake of the effect it produces on your body today — right now — or immediately following the workout. If you’re just exercising, the workout itself is the point. Yoga, Pilates, cardio on the treadmill, a group class of any kind — basically punching your time card at the gym is “exercise.” For most people, “exercise” probably involves doing the same thing in the gym every time you go, because the effect is predictable. You want to get hot, sweaty, and tired, because it makes you feel that something positive has occurred. And it has. For many people, the acute effect of “exercise” is all that is necessary for an improvement in their physical wellbeing.
The modern fitness industry is built exclusively around the “exercise” model.