Science, Medicine & Me (or You)

One of the problems, or challenges, if you prefer, with medicine is that few people who become doctors do it because they love science. They become doctors typically because they want to help people, a very fine reason. But this means that when the situation calls for a more scientific examination of the evidence before them, or of the value or pertinence of this or that finding or practice, your doctor is likely operating at a disadvantage.

Ultimately, tradition, law, and their insurance companies all but force them to stick to conventional, approved approaches to everything. In general, this is not a bad thing – you certainly don’t want your doctor freestyling it when it is your health on the line. If doctors everywhere treat a given constellation of symptoms in a particular way, that would probably be the place to start. But it’s not in itself science.

I recall a couple decades ago that every time we took a kid to the pediatrician – and we loved our pediatrician – she would feel compelled to advise us not to let the little ones sleep with us, family bed style. I can just hear her teachers, or her professional bulletins or her insurance company telling her it was best practice, that kids die every year smothered in a bed with an adult, and just don’t do it. Now, of course, pediatricians in the US (it was never policy in the rest of the world) have come to realize that the benefits to both the child and the parents of having the child in the parent’s bed far outweigh the miniscule risks. Such risks effectively disappear if the child and parents are healthy and the parents sober, while the sense of comfort and attachment gained by the child and the extra sleep gained by the parents is a serious win-win.

Now a scientifically inclined person might ask about the data and methodology behind the claim that hundreds of thousands of years of natural selection had somehow gotten the whole baby sleeps with parents thing wrong.  Maybe it has – but the issue should have at least been addressed. But it wasn’t, in America, at least up until a few years ago. So every American pediatrician was expected to toe the official line, and our doctors did. For, what if you hadn’t advised parents against ‘co-sleeping’ and a baby died? You’d be asking for a lawsuit.

Another example I’ve mentioned before is salt intake. This one is a little different, in that for some people, there seems to be a fairly strong correlation between salt intake and blood pressure, so at least being concerned about it isn’t crazy.

For most people, however, there is little or no correlation between salt intake and blood pressure, at least within realistic levels of consumption. In one of the earliest studies, rats were given the human equivalent of 500g of salt a day, and their blood pressure shot right up! But humans tend to consume around 8.5g of salt a day. Um, further study would be indicated?

The science would seem to support some degree of caution regarding salt intake for people with high blood pressure. Instead, what we get are blanket recommendations that everybody – everybody! – reduce salt intake. It will save lives! Medicine cries wolf. People learn to ignore medical advise. Further, Medical Science! fails to consider what it is asking for – a complete overhaul of people’s diets. Few real people are going to do this without serious motivation. Wasting ammo on a battle not worth winning.

Again, if doctors were essentially scientists attracted to medicine for all the opportunities for scientific discovery human health presents, such errors and poor judgement might be more limited. But doctors became doctors to help people, not to debate scientific findings with them. They want to DO something. Thus, conventional medical practice is full of stuff to do for every occasion. Whether or not there’s really any science behind it is not as important, it seems, as developing practices to address issues so that medicine itself can be practiced. Clearly, for the average doctor, having *something* to do is better than having nothing to do, even when that something isn’t all that well supported or even understood.

These thoughts are on my mind because of all the trouble I’m having with blood pressure medicines at the moment. Since there’s an obvious trade-off here – somewhat higher blood pressure with a higher quality of life versus acceptably lower blood pressure but with lower quality of life – I decided I needed to do a little basic research. Here’s where I’m at after a very preliminary web search:

What I’m looking for, and have so far failed to find, is a simple population level chart, showing the correlation between blood pressure and mortality/morbidity. Of course, any usefully meaningful data would be presented in a largish set of charts or tables, broken out by such variables as age, sex, and body mass index.  But I would settle at this point for any sort of data at all, showing how much risk is added by an additional 10 points or 10 percent, or however you want to measure it, above ‘normal’ blood pressure.

For example, I’m a 60 yr old man. Each year in America, some number of 60 year old men drop dead by high blood-pressure-related illnesses. OK, so, base data is at what rate do 60 year old men drop dead from high blood pressure related diseases? Let’s say it’s .1% (just making up numbers for now) or 1 out of every 1,000 60 year old men. That’s heart attack and stroke victims, with maybe a few kidney failures in there, severe enough to kill you, a 60 year old man.

Now we ask: what effect does blood pressure have on these results? Perhaps those 60 year old men running a 120/80 BP die at only a .05% rate – one out of every 2,000 drops dead from heart attacks, strokes or other stray high BP related diseases. Perhaps those with 130/90 (these results and possible ages would be banded in real life most likely, but bear with me) die at .09% rate, while those with 150/100 die at .2% rate, and those above 150/100 die at a horrifying 1% rate, or 10 times as much as the old dudes with healthy blood pressure. These numbers would all need to average out to the .1% across the population, but a high degree of variability within the population would not be unexpected.

Or maybe something else entirely.  But I have yet to find such charts. I’ve found interesting tidbits, like FDR’s BP in 1944 when his doctor examined a by that time very ill president “was 186/108. Very high and in the range where one could anticipate damage to “end-organs” such as the heart, the kidneys and the brain.” So I gather BP in that range is very bad for you, or indicates that something else very bad for you is going on (FDR had a lot of medical issues and smoked like a chimney).

Then there’s this abstract, suggesting in the conclusion that my quest is going to be frustrated:

Abstract

Objectives

Quantitative associations between prehypertension or its two separate blood pressure (BP) ranges and cardiovascular disease (CVD) or all-cause mortality have not been reliably documented. In this study, we performed a comprehensive systematic review and meta-analysis to assess these relationships from prospective cohort studies.

Methods

We conducted a comprehensive search of PubMed (1966-June 2012) and the Cochrane Library (1988-June 2012) without language restrictions. This was supplemented by review of the references in the included studies and relevant reviews identified in the search. Prospective studies were included if they reported multivariate-adjusted relative risks (RRs) and corresponding 95% confidence intervals (CIs) of CVD or all-cause mortality with respect to prehypertension or its two BP ranges (low range: 120–129/80–84 mmHg; high range: 130–139/85–89 mmHg) at baseline. Pooled RRs were estimated using a random-effects model or a fixed-effects model depending on the between-study heterogeneity.

Results

Thirteen studies met our inclusion criteria, with 870,678 participants. Prehypertension was not associated with an increased risk of all-cause mortality either in the whole prehypertension group (RR: 1.03; 95% CI: 0.91 to 1.15, P = 0.667) or in its two separate BP ranges (low-range: RR: 0.91; 95% CI: 0.81 to 1.02, P = 0.107; high range: RR: 1.00; 95% CI: 0.95 to 1.06, P = 0.951). Prehypertension was significantly associated with a greater risk of CVD mortality (RR: 1.32; 95% CI: 1.16 to 1.50, P<0.001). When analyzed separately by two BP ranges, only high range prehypertension was related to an increased risk of CVD mortality (low-range: RR: 1.10; 95% CI: 0.92 to 1.30, P = 0.287; high range: RR: 1.26; 95% CI: 1.13 to 1.41, P<0.001).

Conclusions

From the best available prospective data, prehypertension was not associated with all-cause mortality. More high quality cohort studies stratified by BP range are needed.

Ok, so here is some information. Let’s chart it out as best we can. Here is the diagnostic banding used by the medical profession here in the US. I note it is unadjusted for age or anything else, which is fine, got to start somewhere:

  • Normal blood pressure – below 120 / 80 mm Hg.
  • Prehypertension – 120-139 / 80-89 mm Hg.
  • Stage 1 hypertension – 140-159 / 90-99 mm Hg.
  • Stage 2 hypertension – 160 / 100 mm Hg or higher.

The meta-study above further divides the prehypertension range into a high and low as follows:

  • Low Prehypertension – 120–129/80–84 mmHg
  • High Prehypertension – 130–139/85–89 mmHg

This particular study does nothing with Stage 1 and 2 hypertension – too bad. But it’s mostly those prehypertension numbers I’m worried about personally. Anyway, here’s what we’ve got so far.

BP graph 1

We will here ignore what looks like a bit of statistical hoodoo – we’re blending different studies, calculating p-values and confidence intervals to the combined results – um, maybe? Perhaps if Mr. Briggs or Mr. Flynn drops by, they can give a professional opinion. Me, I’m just – cautious. So, what’s this telling us?

If I’m reading it correctly – not a given by any stretch – we’ve determined the total relative risk or RR (a term of art, but sorta means what it seems to mean) at the base state and the three partially overlapping prehypertension states based on both systolic and diastolic BP ranges, both on a ‘All Causes’ and a cardiovascular diseases basis. What this appears to say is that a meta analysis of 13 studies of nearly a million people over several decades shows that your risk of illness from any cause increases .03 RR points, or 3% over the base value, if your BP runs a little high, but that your risk of cardiovascular  disease increases 32%. Which doesn’t exactly make sense if one assumes cardiovascular diseases are part of ‘All Causes’ – and why wouldn’t they be? – unless slightly high BP somehow reduces the sum of all other risks. Also, the analysis run over the two sub-ranges of low and high prehypertension do not look like they could possibly add up to the values over the entire prehypertension range – which could well be an artifact of the statistical analysis used. If that is the case, does not logic indicate that the results are quite a bit less certain than the p-values and confidence intervals would suggest? Again, I am very much an amatuer, so I could be a million miles off, but these are the questions that occur to me.

The critical piece missing for my purposes: what scale of risk does the RR here represent? A 32% increase in a .01% chance of Bad Things Happening is hardly worth thinking about; a 32% increase in a 20% risk of Bad Things is a whole ‘nuther kettle of fish.

I’m about researched out for the moment, will continue to google around for more information when I get a moment.

UPDATE:

Is it obvious enough that I’m a LITTLE COMPULSIVE? Just found this, at the Wiley Online Library: 

BP chart 2

Don’t know if this is annualized (per year) numbers, or a total across the entire age range, that ‘all significant’ part worries me a little, but: this seems to be saying that I, a 60 year old man, could expect a 1.8% chance of cardiovascular disease (however that’s defined) if my blood systolic blood pressure falls between 120 and 139, or, more important to my purposes, minisculely more risk than if my BP was the more desirable 120.

This is in line with what one would expect from the data in the previous chart.

Still a lot more work to do here.

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Planning on Being Stupid?

It seems I’m planning on being stupid. Alas, I am not alone. On a grand cultural and political level, it often seems that stupidity is not always spontaneous, but rather many people plan and then execute being stupid. Examples include borrowing vast sums for degrees that will in no way aide you in making the vast sums you’ll need to pay back the loans. At no point in the process did the thought arise that this might not be a good idea? Politics presents many such examples: this time, the panic-driven government action will result in a solution to whatever (largely ginned up) crisis is being hard-sold today; this time, the various police institutions can/cannot be trusted more than anybody else; this time, our loyalty will be repaid by something other than the claim that the other guys would have done worse.

At some point, after enough repetitions, enough time to think it over, enough examples of the outcomes, one would almost have to conclude that either people are really, actively blind in a truly scary way or that the continued hope that, this time, the results will be different is, effectively, a plan of sorts. Perhaps these options are not mutually exclusive nor exhaustive…

But I digress. This is all about ME! And how stupid I’m planning to be.

At the moment, the plan is as follows: As soon as I get home, throw on some work clothes and head out front to work on prepping the forms for a small concrete pour (maybe 8 cubic feet) that is the next step in the Front Yard Improvement Project that was begun, oh, 3 years ago? If I can get it ready tonight, maybe I can pour this weekend when my teenage son will be available to help. He helped me pour the last somewhat larger stage:

IMG_3892
The concrete underlay for the ramp up to the front door, last year’s May/Junes project. David helped a lot, hefting bags, adding water, just doing stuff. He’s a year older and bigger this year, too. So I’ll get him to help this weekend when he gets back from a week’s camping.

This current step requires a bunch of hands-and-knees work measuring, laying out, hammering in stakes, laying in some rebar, as well as some digging (very little at this point). With luck and not counting the inevitable run(s) to the hardware store, maybe 3 hours of work? I tend to overestimate my efficiency, so – 4?

For many years, I’ve done stuff like this. Today, however:

  • it’s near 100F outside;
  • I’m 60 years old;
  • In possibly related news, my hands, back and knees have about a 2 hr limit on stuff like this. Any more than that, and I’ll pay for the next several days.

Why now, why not put it off? You might prudently ask.

These are the days, for next 2 months, where it is light enough after work to do anything. If I can get the forms & rebar done, I can pour concrete this weekend, then start in laying bricks in the evenings when I come home during the week. This stretch is nice and straight and orderly, so that I can mix a bag of mortar, put in 20-30 bricks in a couple hours, clean up and be in before dark. Do that a couple times a week for a few weeks, and I’m done.

Besides, been putting it off all spring. Truth is, I’ve been not feeling well. This has been going on for months or years, depending on how you want to count it. Think it has something to do with the array of blood pressure meds I’m on, but I’m not sure. Went through the whole stress test/EKG/bloodwork etc. maybe 9 or 10 months ago, and they seem to think I was fine. Yet, here I am, dragging around, falling asleep in the middle of the day, getting woolly-headed (a particularly discouraging thing for a guy who lives in his own head as much as I do), feeling generally weak and tired. Tasks both physical and mental that I used to throw myself at now seem to wear me out promptly or too difficult to even try.

However: Never give up! Never surrender!

So I think I’ll try, again, to muscle through it and see how it goes. Put on a hat, bring a big pitcher of water, and do it. Wish me luck.

It should be more like 90F by the time I get started. Balmy!

 

Update of the Random Sort

Last night, the lovely Mrs. YardsaleoftheMind and I went out for dinner. This is not all that remarkable in and of itself, but there’s a story:

A few months ago, we arranged an anniversary getaway to a cabin at Elim Grove attached to Raymond’s Bakery, in Cazadero near where the Russian River enters the Pacific. We highly recommend it if you find yourself looking for a B&B among the redwoods only a couple hours from San Francisco. Our dear son thought he’d send us out to dinner, so he searched for nearby restaurants, and set us up with reservations at El Paseo in Mill Valley

This was a lovely and kind thought. However, while Mill Valley is not all that far from Cazadero as the crow flies, it’s over an hour away as the car drives. Our dear son, who has not driven that area, would not know this.

I did not check this out before we left. So, after having driven the couple hours up to the cabin, we find out there’s no practical way to make it back down to Mill Valley that evening for dinner. We had to postpone it. Until yesterday evening.

The 40 mile drive from Concord to Mill Valley takes anywhere from just under an hour to an hour and a half or more depending on traffic. Bay Area traffic can be and often is evil, so we left in plenty of time to spare. And got there in a little over an hour.

With time to kill, we walked around beautiful, quaint and well-moneyed Mill Valley, a old city nestled in the Marin hills, beloved by hippies, former hippies and would-be hippies with money. That odd and frankly crazy blend of wealth and counter-culture that characterizes much of California’s self image is nowhere better expressed than here. Just as the hippies aged into the Greed is Good crowd on Wall Street in the 80s while somehow still imagining that they were not The Man to whom they had lately imagined they were sticking it, elderly boomers with millions grab will grab an organic frozen yogurt here and browse the boutiques for natural hemp clothing and handmade South American art. Their high priced lawyers will be engaged to sue to prevent some other resident’s latest act of architectural self-expression interfering with the view. And so on, after the manner of their kind. But it sure is beautiful and quaint – great place to stoll and grab dinner!

As we headed up Blythe (one of the main drags) we spotted an enormous, ugly church, which I immediately would have bet money on being Catholic. Sadly, I was right.

This picture of Our Lady of Mt. Carmel is very flattering. Built in 1968. The 60s live in Mill Valley in many ways.

The Lord’s ways are not our ways, it is always good to keep in mind. We walked up and tried the door – locked. As we walked around the building, we tried the various side doors. Finally, on the far left, the last door was open! We went inside to look around.

One woman knelt in the middle section of pews, but otherwise the church was empty. Coming in at a weird angle far off to one side, it took me a minute to notice the monstrance atop the tabernacle – Adoration was in progress! All the sudden, that became a very beautiful church!

We knelt and prayed for a bit, then took a look around. I walked past the lady in the pews, who smiled and whispered, asking how I knew Adoration was being held – I told her we didn’t know, just lucked into it. She said they were doing an all night Adoration.

As we left, another woman was arriving. God bless them – and I’m sure He does! – for being there for Him. How beautiful that these parishioners keep this devotion.

As we headed out, I noticed the epiphany chalk inscription above the door of what appeared to be the rectory. Cool! So, whatever the architectural and artistic limitation, the people at Our Lady of Mt. Carmel seem intent on keeping the faith. God bless them all!

We descended down to our dinner. El Paseo is heavy on the quaint in keeping with Mill Valley city ordinances no doubt, set back from the street accessible via a brick passage and pateo and ensconced in an old brick building. Sammy Hagar, who you might have heard of and who fits in marvelously with the overall 60s sort of vibe of Mill Valley, bought and renovated the restaurant some years ago. I honored him by refusing to drive 55 on our way there and back.

All in all, a lovely evening was had by my beloved and me. The food and service were excellent, and Mill Valley is still beautiful. Our son’s kind deed was finally realized.

Flash Fiction: CH 7

CH 1   CH 2   CH 3   CH 4   CH 5   CH 6

(One last installment before taking this private-ish, since I’m not getting to anything else…)

The alien me looked at me, his look of surprise no doubt mirroring exactly my own. He soon dropped his eyes and looked at himself, raising and slowly rotating his arms and  opening and closing his hands.

“They would not understand.” The team was talking, with an odd note of talking to itself.

Alien me started checking out the equipment, jumping up and down, doing a couple deep knee bends.

“After we infiltrated, we were able to convince the aliens that we were what they consider a similar life form.” Alien me was bending in ways that made me uncomfortable. “They viewed you, however, as raw material.”

Now alien me was stretching and bending in a simply impossible manner. I winced sympathetically at what had to be broken bones. The sort of startled expression never left its face.

“So we had to tell them about you, so they would believe us that you, too, were not a mere resource to be exploited.”

Alien me finally stopped its contortion routine, and returned to a standing posture normal for a human.

I relaxed a little. “It clearly saw me. It saw enough to understand I am intelligent.” I had been under a lot of stress, to put it mildly, and such things should not be possible, but I thought I heard a suppressed guffaw in the team’s voice.

“We have much more information about you, Commander, than that. We had access to all the files collected when Command put you back together physically and mentally before we joined you. We used that information along with our own findings over the previous 6 months to disassemble and reassemble you when you were being destroyed in the tunnel.”

The alien me began to change, elongating to about 3 meters high. Still standing atop the sand dune, the form became what a human would identify as feminine, with long yellow-blonde hair hanging to the ground.

“We had to share that information to keep them from destroying you.”

The new alien form began to repeat the routine, examining herself slowly, rotating her very human like arms and closing and opening her 6-fingered hands.

“So, you convinced them that I am a high enough life form to spare? Thanks. What do we do now? Arrange a cultural exchange?”

There was a note of – sorrow? pity? in the team’s reply. “We made them understand that you were not separable from us, and that we were unwilling to lose you.”

The alien woman was looking at her hands. She slowly brought them up to her face. She began to weep.

“When we disassembled and reassembled you, for a time we became the substrate for your consciousness. We did not mean to intrude, but we had no choice if we were to save you. In some ways, we now know you better than you know yourself.”

The alien woman had fallen to her knees on the sand, hands still over her eyes, still weeping. I could see her body move with each sob.

“We let them feel – our emotions. Your emotions. How you wanted to live, but were willing to die.”

She sat on her heels, her long yellow hair veiling her and swirling about on the sand.

“The aliens understood. They remembered. And they disassembled their form.”

The woman fell to the ground, still wracked by sobs.

“They felt remorse.”

 

Throwin’ Down the Boodog. Seriously.

My compulsive surfing of YouTube turned up this wonderful video of some real Mongolians preparing and eating the classic Mongolian delicacy boodog with the enthusiasm appropriate to such a feast. As previously discussed on this here blog, first, you kill the goat:

goat

The only tragedy from the non-goat perspective is that the dish is not pronounced Boo Dog, but rather, as you can hear on the video below, something more like buh-dig.

After watching the preparation and the party in the yurt, and seeing how it turned out, I’m thinking it’s not half as bad as it sounds: goat meat roasted in the goat’s own skin using hot rocks on the inside and a blowtorch on the outside.

Burning goat hair. That’s gotta smell – not good? But you end up with roasted goat with vegetables in a broth – sounds like dinner, and the people in the video seemed to like it just fine.

I did notice, however, a lot a vodka drunk straight from the bottle. We will generously assume it’s just traditional Mongol celebration drinking and not a necessary aide to getting the boodog down.

Anyway, I here repeat my call to use “Throwin’ Down the Boodog!” as the ultimate call to par-tay! Because boodog!

Since Youngest Son is off to a week of camping tomorrow early, we will be throwing down the Father’s Day boodog this evening. Since suburban Contra Costa County is woefully short goats, we will be throwing down with barbecued burgers, corn, guacamole and watermelon, and either some beer or margaritas.

So what do you think? Would you eagerly attend a real Mongolian barbecue to get a little of that boodog action?

Writing Update 6/15/2018

First off, again, thanks so much to my beta readers. I think I’ll have time this weekend to read and respond. I am so grateful for each of you taking the time to read and comment.

I will revise the Rock, and see what possible venues there may be for it, and suck it up and send it out. So far, I only have 1 rejection letter in my collection. That will not do!

Then I’ll pick out another story, and send  it out, if you all are game.

Image result for classic 50s sci fiNext, the flash fiction has now stopped being flash fiction, in the sense that instead of each ‘chapter’ merely being me answering the question: what happens next? I’ve started to think out 3-4 chapters ahead. (If you think there have been plot twists so far, ha! You ain’t seen nothing yet!). Since I’m setting up an epic ending in my head at least, I’d maybe better just write the thing as a story instead of doling it out as faux flash fiction….

OK? I’d be very flattered if anyone was disappointed…. If I go this route, I’ll do my best to finish the story and make it available to anyone who want to be a beta reader.

Finally, I’m actually considering, or perhaps more accurately, fantasizing about, taking 6 months off in order to write the long-imagined book on American Catholic Education. But I’m 60, and there’s hardly a guarantee I’d be able to find an appropriate job in 6 months if I did so. I – we, really, this is a family decision – am still half a decade at least away from being able to retire with any security. If I did this, I’d need all the things I currently lack: discipline, focus, rigor, emotional toughness.

If you’re the praying type, I’d appreciate your prayers on this.

 

Flash Fiction: CH 6

CH 1   CH 2   CH 3   CH 4   CH 5

The leading edge of the wave that was the blob broke against the wall behind which was the room sheltering me. I was still looking at the scene from the view the team provided me, above and outside. Not sure how the team was doing it. Did they send a contingent, configured as a drone, just to provide me a suitable view? Not likely. More likely, they’d assembled a perspective they thought I could deal with from the mass of data millions of units provided, even though none of them actually held that perspective. They’re trying to tell me the truth through a visual story that’s technically a lie. The team probably doesn’t see it that way. Yet another philosophical discussion for later.

Suddenly, I was dropped back into my own head, and found myself in darkness, curled up against a wall behind the barrier the team had thrown up. I felt a shock through the barrier, a rumble through the floor and heard a swirling sound, like sand and water tossed by a big wave.

Some finger of the wave that had been the alien blob had entered the hole and filled the room. After a moment, I could hear the motion calm, then a sound like the sea withdrawing from the beach. After a few seconds of silence, the team disassembled the barrier. I was able to stand and walk back to the opening outside.

Twilight had come. In the gloam I could see faint blue light forming ribbons which weaved their way slowly toward me. The vast floor of the ruins was buried under what looked like sickly yellow sand. Dim blue dots were scattered across the dune. Some moved to join the ribbons, but some blinked out.

dune 2

 

The river of blue stopped about 10 meters from me, and formed itself into a mass about the size of a jet pack. After a minute more, no more ribbons formed. Any blue lights remaining on the dune blinked out.

The darkness defeated my unaided eyes. The visor enhanced the failing light. The team, or whatever part of it made up that meter-tall mass, faded from blue into gray.

“We apologize, Commander.”

“For what?”

“When we tried to communicate with the aliens, we could not make them understand why we needed to live.”

“So – you’re sorry you killed them?” Man, in 6 months of training, we never got this deep. I was hoping the team was OK, just having a little moment.

“We didn’t kill them.”

I spread my arms, gesturing at the massive pile of yellow sand. I shrugged, and gestured again, palms to the sky.

And froze. A faint yellow glow lit the middle of the pile. As I watched, yellow threads arose from the sand, intertwined, and formed a shape. A human shape. A familiar human shape.

Me.

“We are sorry. We had to tell them about you.”