healthcare


This is a cool visual presentation of global health and wealth. I often find presentations of data to be either dense and non-intuitive or boring. This one is interesting and inspiring.

Hans Rosling also has a TED talk here that is really worth watching, on population, fertility, child survival rates, and wealth.

(By the way, I found this clip while looking for good map animations, which seem like a great way to present data. It’s pretty slow going so far, though. Any recommendations?)

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I’ve been working seriously on changing my posture for the last six months. I’ve been seeing a chiropractor, a massage therapist, and a physical therapist. On normal days I do about two hours of stretching and strengthening exercises–postural reprogramming stuff that they have assigned. On super busy days I do about an hour’s worth.

I’m strengthening the muscles that hold my shoulders and head back and up. I’m lengthening the muscles that pull them down and forward. I’m decreasing the exaggerated curvature in my thoracic spine (called kyphosis), especially focusing on the top few thoracic vertebrae. I’m increasing the twisting range of motion in my thoracic spine and ribs. I’m learning to relax muscles in my legs and butt, back and shoulder blades. I’m learning how to sit differently, stand differently, sleep differently, and especially walk differently. I have an alarm set to remind me about posture every 20 minutes that I’m awake.

The thing is, I’m almost 40 and I don’t have kids yet. I need my body to stay fit for at least another 20 years, and preferably more like 50 more. But nearly three years ago I started having some serious pain in my body–after 37 years of being as athletic as I pleased, I was suddenly limited in how much I could run, lift, swim, and sometimes even walk. One year I could go to a Lindy Hop event and dance all day and all night, and the next I had maybe two hours, maybe 15 minutes in me. Unacceptable.

And it turns out it’s because of my posture. Joints, muscles, and their connections do not work properly if not in the optimal relative position to each other. The habitual position of my joints had put enough strain on my body that I started having intense pain.

My chiropractor once told me, “You are the most compliant patient I’ve ever had.” My PT and massage therapist have said similar things. That is exactly what I’m aiming at–the most compliant patient. I do not just show up. I do not intend to waste my money or my life getting care and then not following through with the recommendations of my providers. If you tell me not to ride my bike for 3 months, I start walking or taking the bus. If you show me how to walk differently, I will walk differently. If you tell me to do 45 reps of some new, super-awkward exercise every day for the foreseeable future, I will do it. I am your perfect patient. I do it because I’m hoping you know what will help. I want to make you look brilliant. And I do it because if, after a couple of months, what you do and have me do has not helped noticeably, I will find someone else to work with, because I have tried you and your ideas out to the letter.

I turned 39 at 8:50 this morning. I’m on the cusp of middle age! As usual, I used my flights to and from Not Back to School Camp to brainstorm about my 40th year. Camp is a great end-of-year celebration and source of inspiration. I’m going to do a lot this year–finish my Master’s degree and see clients for at least 400 hours, for example–but I’ve decided not to put that stuff on my list. I want to concentrate on how I do it. I just watched the outgoing cohort finish up my program and they seemed really stressed out. I want to do it without overwhelming myself, in good health. I want to enjoy it. So I came up with one intention that sums it all up:

This year, I intend to take exquisitely good care of myself.

To me, that means that I think about myself like I do my best friends, with affection and optimism, with care. I am not a slave to being productive.

When I touch myself, I do so gently, with attention, not mechanically or absent-mindedly. Like I would someone I love.

I don’t eat crap.

I meditate 30 minutes every day.

I exercise 45 minutes every day.

I do my physiotherapy daily and get health care whenever I need it.

I get good attention, from friends, co-counselors, or a therapist, when I need it.

I take a day off every week.

I say yes to social invitations.

I sleep a bare minimum of 8 hours a night. That means giving myself an hour to chill out with nothing electric and no reading before bed, and an hour to lie in bed before I need to be asleep, so I don’t get worried about falling asleep quickly enough.

I keep my living space looking nice.

I have some ritual (yet to be designed) which helps me stop thinking about my clients when I leave the clinic.

I’ve also put a lot of thought into how I will prioritize my commitments. They will probably often conflict with each other and I’d like to be able to make choices about what to do and what to leave out with minimal stress. That part will be a work in progress for a while

I posted in February about how the committee that is redesigning the DSM is accepting feedback on their proposed changes. The Diagnostic and Statistical Manual of Mental Disorders is the book used around the world by clinicians to determine what kinds of human suffering count as mental disorders, what symptoms one has to show to qualify as having one of those disorders, and what what can get covered by insurance. The content of this book will shape the lives of those who will interact with the mental health system for the next generation. Being labeled with a mental disorder is a big deal, and which one you get can mean the difference between decent and indecent treatment. Personality Disorder? You’re pretty much screwed. Very few people think they can help you and no insurance will cover you. Adjustment Disorder? PTSD? You’re in luck, most likely. We’re all very hopeful for, and will pay for, your recovery.

If you’re life has in any way been affected by anything labeled a mental disorder, I encourage you to look at the appropriate proposed changes to your future and the future of your loved ones, and write them an email about what you think. You have until April 20, 2010.

Structural, Cross-Cutting, and General Classification Issues for DSM-5
Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence
Delirium, Dementia, Amnestic, and Other Cognitive Disorders
Mental Disorders Due to a General Medical Condition Not Elsewhere Classified
Substance-Related Disorders
Schizophrenia and Other Psychotic Disorders
Mood Disorders
Anxiety Disorders
Somatoform Disorders
Factitious Disorders
Dissociative Disorders
Sexual and Gender Identity Disorders
Eating Disorders
Sleep Disorders
Impulse-Control Disorders Not Elsewhere Classified
Adjustment Disorders
Personality Disorders
Other Conditions that May Be the Focus of Clinical Attention

Psychology hit the actual headlines last week, with Sharon Begley’s “The Depressing News About Antidepressants” in Newsweek. The story is that, if you look at all the evidence, not just the “successful” trials, SSRIs like Prozac and Paxil do not work better than a placebo for mild and moderate depression. Begley also tells the story as if she’s sorry to break the news and spoil the placebo effect. Here’s my version of the headlines from this story:

Pharmaceutical Companies Have Known For At Least Ten Years That SSRIs Work No Better Than Placebos: At least, anyone there who understood statistics and paid any attention to their research.

The Idea That SSRIs Are Better Than Placebos Was Propagated By Publishing Only the “Successful” Trials: This, obviously, was quite unethical.

The FDA Almost Certainly Knew That SSRIs Were No Better Than Placebos, Too: They had all of the research. Perhaps they did not read it.

People Who Read Psych Journals Knew SSRIs Were No Better Than Placebos Two Years Ago: The news caused a stir in my undergrad psych lab in 2008.

We Do Not Know What Causes Depression: The idea that depression has to do with the neurotransmitter serotonin was based largely on the (incomplete) evidence that SSRIs (selective serotonin re-uptake inhibitors) cured depression. In fact, we have pretty limited knowledge of what goes on inside a living brain. In fact, we have no ethical way to measure how much serotonin or any other neurotransmitter is where inside anyone’s living brain, so when a doctor tells you something like, “You are depressed because you have overactive serotonin re-uptake mechanisms,” they are passing on speculation, not science.

If You Recovered From Mild to Moderate Depression While On An SSRI, It Was Probably Your Own Hope That Lifted You Out: The thing about placebos is that they work pretty well. If you benefited from the placebo effect, it was your own strength, your own hope, that made the difference. You overcame that challenge. I think that’s pretty cool.

While SSRIs Do Not Treat Depression Better Than Placebos, They Do Have Side Effects: Here’s a list from wikipedia: Decreased or absent libido, Impotence or reduced vaginal lubrication, Difficulty initiating or maintaining an erection or becoming aroused, Persistent genital arousal disorder despite absence of desire, Muted, delayed or absent orgasm (anorgasmia), Reduced or no experience of pleasure during orgasm (ejaculatory anhedonia), Premature ejaculation, Weakened penile, vaginal or clitoral sensitivity, Genital anesthesia, Loss or decreased response to sexual stimuli, Reduced semen volume, Priapism (persistent erectile state of the penis or clitoris)anhedonia, apathy, nausea/vomiting, drowsiness or somnolence, headache, bruxism (involuntarily clenching or grinding the teeth), extremely vivid and strange dreams, dizziness, fatigue, mydriasis (pupil dilation), urinary retention, changes in appetite, changes in sleep, weight loss/gain (measured by a change in bodyweight of 7 pounds), may result in a double risk of bone fractures and injuries, changes in sexual behaviour,increased feelings of depression and anxiety (which may sometimes provoke panic attacks), tremors (and other symptoms of Parkinsonism in vulnerable elderly patients), autonomic dysfunction including orthostatic hypotension, increased or reduced sweating, akathisia, liver or renal impairment, suicidal ideation (thoughts of suicide), photosensitivity (increased risk of sunburn), Paresthesia, Mania, hypomania, sexual dysfunction such as anorgasmia, erectile dysfunction, and diminished libido, a severe and even debilitating withdrawal syndrome, a slight increase in the risk of self-harm, suicidal ideation, and suicidality in children, neonatal complications such as neonatal abstinence syndrome (NAS) and persistent pulmonary hypertension, and platelet dysfunction.

Until Your Medicated Kids Are Old, We Will Not Know What All of the Side Effects of Treatment by SSRIs Are: This is true for any new drug, and it’s worth considering. If your child is on Prozac or other new drug, they are essentially part of a massive experimental trial.

Pharmaceutical Companies Pay for Psychiatric Educations: Why would it surprise anyone that treatment equals drugs in this case?

Most Antidepressant Prescriptions Written by Health Care Providers With No Significant Psychiatric Training: GPs, OBGYNs, pediatricians, etc account for 80% of SSRI prescriptions.

This is part 3 of a series of things I learned during my Bachelor’s degree in psychology that I thought should have been headlines in the mainstream news. If you missed them, here’s part 1 and part 2. Again, if you’re interested or skeptical, leave me a comment with a specific question and I’ll give you my references.

Egaz Moniz Was Given the Nobel Prize for Medicine in 1949 for Developing the Prefrontal Lobotomy: This “psychosurgery” involved slicing or scrambling the front part of the brain, and tended to produce more manageable behavior in “patients.”

40,000 Human Beings Were Lobotomized in the United States Between 1936 and 1977: These were men, women, and children with “illnesses” like schizophrenia, PTSD, depression, anxiety, homosexuality, criminal behavior, and being hard to manage.

Antipsychotic Thorazine Hailed as “Chemical Lobotomy”: Yes, this was meant as a compliment.

200,000,000 Prescriptions for Antidepressants in the US in 2007: That’s quite a few prescriptions.

80% of Antidepressant Prescriptions in the US Not Written by Psychiatrists: Consider that it may be a good idea to at least see a specialist in mental illness before taking psychotropic drugs or giving them to your kids.

Some Psychopharmaceuticals as Effective as Exercise in Treating Depression: But who wants to exercise when you’re depressed?

Sleep Deprivation the Most Effective Treatment For Depression, By Far: Never heard of this one? Maybe it’ll hit the news when someone figures out how to make money from sleep deprivation.

The World Health Organization Found That Schizophrenics Recover, But Only in Countries Without Easy Access to Psychopharmaceuticals: Schizophrenics can recover? Well, yes, it looks like they can. And yes, the WHO data shows a correlation, not necessarily causation, but an interesting correlation!

Here’s part 2. (And if you missed it, here’s part 1.) Again, if you are either interested or skeptical, leave me a comment and I’ll point you to the evidence.

Statistically, Divorce is Not a Good Strategy for Getting a Better Marriage: 50 to 67% of first marriages end in divorce. 60 to 77% of second marriages end in divorce.

Your Brain Has Trouble Giving Information About Probabilities Due Weight, So Pay Attention to Base Rates: We have trouble taking the actual prevalence of events into account when making decisions. For example, people tend to be more afraid of dying in a plane crash (lifetime chance: 1 in 20,000) than dying in a car wreck (lifetime chance: 1 in 100) or even of a heart attack (lifetime chance: 1 in 5). One reason for this is that we confuse the ease with which we can think of an example to be an indication of how likely something is. Try this: What do you think is more common, words beginning with “r” or words with “r” as the third letter?

If You Test Positive For a Very Rare Disease, You Still Probably Do Not Have That Disease: This is a headline that should come from medicine, not psychology, but psychologists are better at probability than doctors, who are no better than laypeople, at least when it comes to thinking about this: Even with a very accurate test, if a disease is very rare, a positive result is still much more likely to be a false positive than an accurate positive. I’m going to explain this, but if you don’t get it, don’t worry. Just remember the headline. It’s true.

The table below shows a hypothetical situation with super-round numbers to make it easier to get. You have gotten positive results on a test that is 99% accurate for a disease that occurs only once in 10,000 people. Most people figure they are 99% likely to have the disease. They are wrong:

Test Results
Disease Present? Test Results Positive Test Results Negative Row Totals
Disease Present 99 1 100
Disease Not Present 9,999 989,901 999,900
Column Totals 10,098 989,902 1,000,000

Since your test results are positive, you are somewhere in the left-hand column. You are either one of the 99 who both have the disease and whose test results are positive, called “hits,” or one of the 9,999 who do not have the disease but whose test results are positive, called “false positives.” As you may see, even though your test results are positive, you still are 99% likely to be a false positive and not a hit, simply because the disease is so rare.

Yes, this is counter-intuitive. That’s why it’s important. And that’s why statistics are important. Again, if you don’t understand, don’t worry. If you don’t believe it, though, come up with a specific question, leave it as a comment, and I’ll answer it.

If You Need Help, Ask Someone Specific for Something Specific: Bystanders generally do not help people who are in trouble. The bigger the crowd, the less likely someone will help. It’s not because they are bad or lazy. It’s a specific kind of well-documented confusion. Kind of like in the clip below. What you need to know is, if you need help, even if it seems like it should be completely obvious to anyone around, like you’re having a heart attack, falling to the ground, gasping, whatever, point to a specific person and give them specific instructions: “You, in the red shirt. I’m having a heart attack. Call an ambulance.” Do not assume anything will happen that you did not specifically ask for. A corollary of this headline is, if you think someone might be in trouble, don’t assume they would ask you for help, and don’t assume someone else is helping them. Help them yourself. It could mean the difference between them living or dying.

Get Help For Your Marriage When the Trouble Starts (Or Before): On average, couples wait 6 years after their marriage is in trouble to get help. The average marriages last 7 years. That means that most people who come to couples counseling are deeply entrenched in problems that would have been relatively easy to resolve earlier. It is not uncommon for a couple to come in to counseling with a covert agenda to use the counselor to make their inevitable divorce easier. We can do this, but believe me we’d much rather meet you earlier and help you stay together! Also, I’m not joking about “or before.” Couples counselors are well-trained to give “tune-ups” to couples who are doing well. It’s a good idea.

Anger Is Not Destructive of Relationships, Contempt and Defensiveness Are: Everybody argues. Everybody screws up their communications. It’s the ability to repair things that is the key, and contempt and defensiveness get in the way of that.

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