Friday, August 28, 2009

Health Care and Physician Shortage

Doctors are forecasted to be in short supply. Although plenty of physicians are currently in practice across the country, surveys indicate that the availability is on the decline. According to, over the past several years, a growing number of national and state or specialty specific studies indicate
that the U.S. physician workforce is facing current or future shortages. Since 2002, there have been at least 24 studies of current or future state physician workforce needs. In
nearly all of these studies, the underserved and elderly populations are most likely to be affected. Additionally, many of the state reports point out shortages in specialties that are featured in the specialty report section, including allergy and immunology, cardiology, child psychiatry, dermatology, endocrinology, neurosurgery, primary care, and psychiatry. If physician supply and use patterns stay the same, the United States will experience a shortage of 124,000 full-time physicians by 2025. The report details shortages by state and specialty and can be found at .

According to (American Medical News--AMN), the number of physicians, especially primary care physicians, in the pipeline is not sufficient to keep pace with the needs of a growing and aging population. The problem is not that the supply of physicians, including those in primary care, isn't growing -- because it is. It's just not growing fast enough. Physicians, like the rest of the population, are reaching retirement age in large numbers. In 2017, more than 24,000 will turn 63, and the number of new physicians entering practice each year is about 26,000--just about enough to maintain the status quo. If suddenly, 20,000 to 60,000 more doctors retire because the stock market is back up, America will be in trouble.

The problem, according to AMN, has been highlighted by efforts at health system reform that, if successful, likely will require additional primary care physicians. Among the steps suggested to bolster the supply is to increase graduate medical education slots and to expand the use of support staff, including physician assistants and nurse practitioners, where numbers of new graduates are soaring. Some physicians describe another method -- reach out to students in medical school early, expose them to the health professions and "nurture the heck out of them". This approach has been under way for several years in rural areas and areas with high concentrations of minorities -- parts of the nation that have long faced a dearth of health care professionals.

There are reasons that physicians leave the medical practice, according to AMN. A chaotic work environment -- with insufficient time for proper patient care and lack of control over work -- takes a toll on primary care physicians. Studies show that more than half of these physicians feel time pressure during office visits, while 48% said their work pace is chaotic and 78% said they have little control over their work. These conditions were strongly associated with low physician satisfaction, high stress, burnout and intent to leave. Health system reform efforts to provide coverage to the uninsured make it especially important to attract and retain primary care physicians. A major issue in health reform is who is going to care for those millions of uninsured people, so recruitment and retention in primary care is a major issue for the country.

According to, an alternative suggestion is worth strong consideration. If experts are predicting a shortfall of doctors under the current workforce model, maybe it's the model, and not the number of doctors, that needs to be fixed. The analysis goes like this: While there is a healthcare services shortage, that doesn't necessarily translate into a doctor shortage. There are a number of ways to meet that demand for services, and the mistake reformers of any industry often make is to look for answers from existing models and stakeholders. The alternative is to ask what doctors are doing today that could be shifted to other workers who may be more affordable, but could have very specific technical expertise in treating certain select conditions, and do it very well, like a form of outsourcing.

Some care can be shifted from some of physicians' workloads onto nonphysician practitioners, such as nurses, physician assistants, and technicians, and shifting certain types of care to retail clinics and other settings outside of physician offices. Healthcare services are already being provided outside of doctors' offices more frequently, according to It's not just happening in retail clinics—over-the-counter at-home tests and medical devices now let patients diagnose, monitor, and treat conditions that were formerly the physician's domain. If the shortage projections are accurate, increasing medical school enrollment and funneling more money into physician development aren't alone enough to meet the growing demand for medical services. So if there will not be enough physicians, consideration must be given on how to care for an aging population in that environment. The key in all this is to enhance, not replace, physician services. If physicians view nonphysicians and retail care as threats, then care will continue to be disjointed and the strain on the system will grow. But if physicians recognize the opportunity for collaboration, they can work with new nonphysician providers to coordinate care and focus even more on the high-level services at which they best serve.

But Americans get it, according to The American people in general get it – they are weary of waiting months for a doctor appointment. Rural Americans, in particular, get it- they are often unable to find a physician at all. Citizens of Massachusetts get it – they are having a hard time locating a physicians in spite of a state health care plan that promise universal coverage. Americans seeking care during the night, at dawn, on weekends , and on holidays get it – they must go to hospital emergency rooms to get help. Older doctors get it – they are working flat out to handle their current load of patients. Younger doctors get it - they are unwilling to work as low paying primary care physicians, swamped with patients and with limited family or personal life. Primary care physicians get it – their numbers are dwindling and they may become obsolete in the next two decades at present rates of decline. General surgeons get it – according to the American College of Surgeons, their declining numbers have created a “crisis.” Physician groups with retiring partners get it – they are unable to recruit replacements. The Physicians’ Foundation, which represents 500,000 doctors in state and local medical societies gets it – they have just completed a national survey of 270,000 primary care doctors and 50,000 specialists indicating that doctors are in despair, having difficulty recruiting, are thinking of retiring or quitting or seeing fewer patients, and are not recommending medical careers for younger people. Community hospitals get it – they find themselves unable to recruit, retain, or even afford physicians to staff for essential services, serve their communities, and cover their emergency departments. Physician recruiting firms get it - they have to hunt high and low to find the right persons for their clients. The nursing profession and the physician assistant association gets it – they are mobilizing to produce more physician extenders. The nation’s largest staff recruiting firm, AMN, and its subsidiary Merritt, Hawkins, and Associates, gets it. As the economy grows, the nation spends more money on health care, and there is a double whammy because of a an accompanying shortage of nurses of an even greater magnitude than the doctor shortage. A great overview can be found at .

The bottom line is that America needs more doctors and nurses. Providing medical care to an aging population and an ever increasing overall population of over 300 million people demands action that will help solve some of the critical issues of shortages in the medical field.

Until next time. Let me know what you think.

Tuesday, August 25, 2009

Health Care and Insomnia

Ever have a problem falling asleep at night? Has your sleep been missing for a while and you find yourself laying in bed wide awake for hours on end when you should be sleeping? How much sleep is enough varies from person to person, according to the Mayo Clinic. More than one-third of adults have insomnia at some time, while 10 to 15 percent report long-term (chronic) insomnia. Insomnia includes having trouble falling or staying asleep. It's one of the most common medical complaints. With insomnia, you usually awaken feeling unrefreshed, which takes a toll on your ability to function during the day. Insomnia can sap not only your energy level and mood, but also your health, work performance and quality of life.

According to, Insomnia is a symptom, not a stand-alone diagnosis or a disease. By definition, insomnia is "difficulty initiating or maintaining sleep, or both" and it may be due to inadequate quality or quantity of sleep. Insomnia is not defined by a specific number of hours of sleep that one gets, since individuals vary widely in their sleep needs and practices. Although most of us know what insomnia is and how we feel and perform after one or more sleepless nights, few seek medical advice. Many people remain unaware of the behavioral and medical options available to treat insomnia. Insomnia is generally classified based on the duration of the problem. Not everyone agrees on one definition, but generally:
--Symptoms lasting less than one week are classified as transient insomnia,
--Symptoms between one to three weeks are classified as short-term insomnia, and
--Those longer than three weeks are classified as chronic insomnia.

Insomnia affects all age groups, according to Among adults, insomnia affects women more often than men. The incidence tends to increase with age. It is typically more common in people in lower socioeconomic (income) groups, chronic alcoholics, and mental health patients. Stress most commonly triggers short-term or acute insomnia. If you do not address your insomnia, however, it may develop into chronic insomnia. Many of the causes of transient and short-term insomnia are similar and they include:
--Jet lag
--Changes in shift work
--Excessive or unpleasant noise
--Uncomfortable room temperature (too hot or too cold)
--Stressful situations in life (exam preparation, loss of a loved one, unemployment, divorce, or separation)
--Presence of an acute medical or surgical illness or hospitalization
--Withdrawal from drug, alcohol, sedative, or stimulant medications
--Insomnia related to high altitude (mountains)

The majority of causes of chronic or long-term insomnia are usually linked to an underlying psychiatric or physiologic (medical) condition. The most common psychological problems that may lead to insomnia include:
--Mania (bipolar disorder), and
In fact, insomnia may be an indicator of depression. Many people will have insomnia during the acute phases of a mental illness.

Physiological causes span from circadian rhythm disorders (disturbance of the biological clock), sleep-wake imbalance, to a variety of medical conditions. The following are the most common medical conditions that trigger insomnia:
--Chronic pain syndromes,
--Chronic fatigue syndrome,
--Congestive heart failure,
--Night time angina (chest pain) from heart disease,
--Acid reflux disease (GERD),
--Chronic obstructive pulmonary disease (COPD),
--Nocturnal asthma (asthma with night time breathing symptoms),
--Obstructive sleep apnea,
--Degenerative diseases, such as Parkinson's disease and Alzheimer's disease (Often insomnia is the deciding factor for nursing home placement.)
--Brain tumors, strokes, or trauma to the brain.

In addition to the above medical conditions, certain groups may be at higher risk for developing insomnia:
--Shift workers with frequent changing of shifts,
--Seniors citizens,
--Adolescent or young adult students,
--Pregnant women, and
--Menopausal women.

Certain medications have also been associated with insomnia. Among them are:
--Certain over-the-counter cold and asthma preparations.
The prescription varieties of these medications may also contain stimulants and thus produce similar effects on sleep.
--Certain medications for high blood pressure have also been associated with poor sleep.
--Some medications used to treat depression, anxiety, and schizophrenia.

Also, according to, common stimulants associated with poor sleep include caffeine and nicotine. You should consider not only restricting caffeine and nicotine use in the hours immediately before bedtime but also limiting your total daily intake. People often use alcohol to help induce sleep, as a nightcap. However, it is a poor choice. Alcohol is associated with sleep disruption and creates a sense of non-refreshed sleep in the morning. A disruptive bed partner with loud snoring or periodic leg movements also may impair your ability to get a good night's sleep. More indepth info is available at .

According to the Mayo Clinic, sleep is as important to your health as a healthy diet and regular exercise. Whatever your reason for sleep loss, insomnia can affect you both mentally and physically. People with insomnia report a lower quality of life compared with people who are sleeping well. Complications of insomnia may include:
--Lower performance on the job or at school.
--Slowed reaction time while driving and higher risk of accidents.
--Psychiatric problems, such as depression or an anxiety disorder.
--Overweight or obesity.
--Poor immune system function.
--Increased risk and severity of long-term diseases, such as high blood pressure, heart disease and diabetes.

According to, your family doctor may ask you and your bed partner some questions about your sleep habits (such as when you go to bed and when you get up), any medicine you take, and the amount of caffeine and alcohol you drink. Your doctor may also ask if you smoke. Other questions may include how long you've been having insomnia, if you have any pain (such as from arthritis), and if you snore while you sleep. Your doctor may also ask about events or problems in your life that may be upsetting you and making it hard for you to sleep. If the cause of your insomnia is not clear, your doctor may suggest that you fill out a sleep diary. The diary will help you keep track of when you go to bed, how long you lie in bed before falling asleep, how often you wake during the night, when you get up in the morning and how well you sleep. A sleep diary may help you and your doctor identify patterns and conditions that may be affecting your sleep.

Changing your sleep habits and addressing any underlying causes of insomnia can restore restful sleep for many people, according to the Mayo Clinic. Good sleep hygiene — simple steps such as keeping the same bedtime and rising time — promotes sound sleep and daytime alertness. If these measures don't work, your doctor may recommend medications to help with relaxation and sleep. Behavioral treatments teach you new sleep behaviors and ways to make your sleeping environment more conducive to sleep. Studies have shown behavior therapies are equally or more effective than are sleep medications. Behavior therapies are generally recommended as the first line of treatment for people with insomnia.

According to the Mayo Clinic, sleep hygiene teaches habits that promote good sleep:
--Relaxation techniques. Progressive muscle relaxation, biofeedback and breathing exercises are ways to reduce anxiety at bedtime. These strategies help you control your breathing, heart rate, muscle tension and mood.
--Cognitive therapy. This involves replacing worries about not sleeping with positive thoughts. Cognitive therapy can be taught through one-on-one counseling or in group sessions.
--'Stimulus control.' This means limiting the time you spend awake in bed and associating your bed and bedroom only with sleep and sex.
--Sleep restriction. This treatment decreases the time you spend in bed, causing partial sleep deprivation, which makes you more tired the next night. Once your sleep has improved, your time in bed is gradually increased.
--Light therapy. If you fall asleep too early and then awaken too early, you can use light to push back your internal clock. During times of the year when it's light outside in the evenings, you go outside for 30 minutes or obtain light via a medical-grade light box.

According to the Mayo Clinic, taking prescription sleeping pills, such as zolpidem (Ambien), eszopiclone (Lunesta), zaleplon (Sonata) or ramelteon (Rozerem), also may help you get to sleep. However, in rare cases, these medications may cause severe allergic reactions, facial swelling and unusual behaviors, such as driving or preparing and eating food while asleep. Side effects of prescription sleeping medications are often more pronounced in older people and may include excessive drowsiness, impaired thinking, night wandering, agitation and balance problems.
Doctors generally don't recommend relying on prescription sleeping pills for more than a few weeks, but several newer medications are approved for indefinite use. If you have depression as well as insomnia, your doctor may prescribe an antidepressant with a sedative effect, such as trazodone (Desyrel), doxepin (Sinequan, Adapin) or mirtazapine (Remeron). Over-the-counter sleep aids contain antihistamines that can induce drowsiness. But antihistamines may reduce the quality of your sleep, and they can cause side effects such as daytime sleepiness, dry mouth and blurred vision.

According to, most adults need about 7 to 8 hours of sleep each night. You know you're getting enough sleep if you don't feel sleepy during the day. The amount of sleep you need stays about the same throughout adulthood. However, sleep patterns may change with age. For example, older people may sleep less at night and take naps during the day. Insomnia is not really a serious problem for your health, but it can make you feel tired, depressed and irritable. It can also make it hard to concentrate during the day. Insomnia is the body's way of saying that something isn't right. The treatment of insomnia can be simple. Often, once the problem that's causing the insomnia is taken care of, the insomnia goes away. The key is to find out what's causing the insomnia so that it can be dealt with directly. Simply making a few changes in their sleep habits helps many people.

Until next time. Let me know what you think.

Monday, August 24, 2009

Health Care and Chemical Dependency

Dependency on chemical substances is a problem faced by all adult age brackets and across all economic lines. There is no class distinction with those who are hooked on drugs or alcohol. The term "Chemical Dependency", according to Dual Recovery Anonymous (DRA), is often used in conjunction with and at times interchangeably with the terms: chemically dependent, chemical dependence, alcoholism, addiction, substance abuse, substance dependence, drug habit, and drug addiction. chemical dependency, refers to a primary illness or disease which is characterized by addiction to a mood-altering chemical. Chemical dependency includes both drug addiction and alcoholism (addiction to the drug alcohol). A chemically dependent person is unable to stop drinking or taking a particular mood-altering chemical despite serious health, economic, vocational, legal, spiritual, and social consequences. It is a disease that does not see age, sex, race, religion, or economic status. It is progressive and chronic and if left untreated can be fatal.

According to DRA, when a person is chemically dependent, they have lost the power of choice over using mood-altering chemicals. They may be able to stop for awhile, but they will return to its use again and again despite their best intentions and exertions of logic and willpower. For these reasons, chemical dependence (alcoholism and drug addiction) is said to be a cunning, baffling, and powerful disease. Chemical dependency is characterized by continuous or periodic: impaired control over drinking and/or drug use (prescribed or illegal), preoccupation with the mood-altering chemical, use of the addictive substance despite adverse consequences, and distortions in thinking--most notably denial.

According to, disease concept of chemical dependency is the concept that a disorder (such as chemical dependency) is like a disease and has a characteristic set of signs, symptoms, and natural history (clinical course, or outcome). The disease concept has long been accepted by the medical community. The concept proposes that a disease is characterized by a specific set of signs and symptoms and that the disease, if left untreated, will progress to some endpoint or outcome (clinical course). However, controversy arises when the medical community is faced with new abnormal conditions, owing mostly to the new technologies in genetic engineering. This controversy becomes especially apparent when examining psychological disorders. In the past, psychological disorders were thought in general to be due to both psychological and social abnormalities. Although these psychosocial problems are still of utmost importance, researchers have since discovered that many psychological disorders, such as alcoholism, also have genetic causes. Recent studies have identified a genetic area (locus) where a gene is located that can transmit alcoholism from affected father to son. Mental health professionals also know from clinical experience that alcoholics demonstrate a characteristic set of specific signs and symptoms. Additionally, it is well established that the ultimate clinical course for untreated alcoholism is death. Therefore alcoholism, once thought to be a disorder of those with a weak will, or "party people" can now be characterized as a disease.

The disease concept of chemical dependency, according to, is gaining worldwide acceptance, but does have some critics who argue instead that addiction must be understood as a general pattern of behavior, not as a medical problem. Advocates of the disease concept of chemical dependency model maintain that the identification of biological causes or correlations is crucially important for treatment. They argue that if clinicians can understand the intricate details concerning the mechanisms associated with drug effects, then measures to interrupt the effects can be devised. These interventions can be both medical (developing new drugs to chemical block effects of illicit drugs) and psychological. According to the disease concept model, psychological intervention includes a vital educational component that teaches people with chemical dependency the concept of understanding addiction as disease. As a result of this understanding, affected people then view their dependency as a disease, similar to other diseases with a biological cause (heart disease, cancer, high blood pressure), and with a specific set of signs and symptoms and an outcome in the future (clinical course). Proponents of this approach believe that this understanding can help affected people to follow treatment recommendations, and can reduce shame and guilt commonly associated with chemical dependence. Alcoholics Anonymous is a prominent example of an organization that embodies the disease concept of chemical dependency.

According to DRA, denial as a stage of chemical dependency is a defense mechanism that includes a range of psychological maneuvers designed to reduce awareness of the fact that alcohol and drug use is the cause of an individual's problems rather than a solution to those problems. Typically an alcoholic or addict is the last to admit that they may have a drinking or drug abuse problem. Denial becomes an integral part of the disease process of chemical dependency, a major obstacle to recovery, and a precipitous factor in relapse events. Denial, is the cunning, baffling, and powerful part of chemical dependency that tells the addicted person that they do not have a problem. If a chemically dependent individual is "in denial" about their alcoholism and addictions they cannot become engaged in a recovery process. One cannot work on a problem unless they accept that it exists. Though the disease can't be cured, it can be arrested and treated (kept in remission). The disease is far more complex than the mere use and abuse of mood-altering chemicals and recovery is far more complex then just becoming abstinent. Unfortunately, many addicts and alcoholics believe that if they can just get drug and alcohol free they will be o.k. and can turn their life around. Detox alone is rarely enough. In order to maintain abstinence one must make personal, interpersonal, and lifestyle changes. These take time-- in fact, most professionals and recovering addicts and alcoholics believe that recovery from the disease of chemical dependency is a life-long process.

According to the Ohio State University Medical Center (OSUMC), substances frequently abused include, but are not limited to, the following: alcohol, marijuana, hallucinogens, cocaine, amphetamines, opiates, anabolic steroids, inhalants, methamphetamine, tobacco. Cultural and societal norms influence acceptable standards of substance use. Public laws determine the legal use of substances. The question of whether there is a normative pattern of substance use remains controversial. Substance-related disorders are caused by multiple factors including genetic vulnerability, environmental stressors, social pressures, individual personality characteristics, and psychiatric problems. However, determining which of these factors are primary and which are secondary has not been determined, in all cases.

The following are the most common behaviors that indicate an individual is having a problem with substance abuse, according to the OSUMC. However, each individual may experience symptoms differently. Symptoms may include:
--Getting high on drugs or getting intoxicated (drunk) on a regular basis
--Lying, especially about how much they are using or drinking
--Avoiding friends and family members
--Giving up activities they used to enjoy such as sports or spending time with non-using friends
--Talking a lot about using drugs or alcohol
--Believing they need to use or drink in order to have fun
--Pressuring others to use or drink
--Getting in trouble with the law
--Taking risks, such as sexual risks or driving under the influence of a substance
--Work performance suffers due to substance abuse before, after, or during working or business hours
--Missing work due to substance use
--Depressed, hopeless, or suicidal feelings
The symptoms of substance abuse may resemble other medical problems or psychiatric conditions. Always consult your physician for a diagnosis.

According to the OSUMC, specific treatment for substance abuse/chemical dependence will be determined by your physician based on:
--Your age, overall health, and medical history
--Extent of the symptoms.
--Extent of the dependence.
--Type of substance abused.
--Your tolerance for specific medications, procedures, or therapies.
--Expectations for the course of the condition.
--Your opinion or preference.

A variety of treatment programs for substance abuse are available on an inpatient or outpatient basis according to the OSUMC. Programs considered are usually based on the type of substance abused. Detoxification (if needed, based on the substance abused) and long-term follow-up management are important features of successful treatment. Long-term follow-up management usually includes formalized group meetings and developmentally age-appropriate psychosocial support systems, as well as continued medical supervision. Individual and family psychotherapy are often recommended to address the developmental, psychosocial, and family issues that may have contributed to and resulted from the development of a substance abuse disorder.

Many have a hard time believing that their addiction has caused a permanent change in their brain chemistry, preventing them from being able to use normally again. According to, they have to test this for themselves many times before they prove to themselves that they cannot drink and/or use drugs in a non-addicted way. Until they are convinced that they cannot control their use, they rarely begin the road to recovery. Chemically dependent people can control their disease by learning better ways to address their problems and by learning ways to avoid returning to the use of alcohol and/or drugs. By achieving an ultimate goal of abstinence, the chemically dependent person can possibly control the disease.

Until next time. Let me know what you think.

Thursday, August 13, 2009

Health Care and High IQs

There are alot of smart people in the world, and in general the intelligence quotient (IQ) of someone may determine how well he or she may perform in certain situations. In general, there is almost certainly a correlation between a high IQ score and being more intelligent according to However, if you have even average intelligence, you can find examples of cultural biases on many IQ tests. Furthermore, there are specific test-taking skills that have been proven to raise scores on many tests, including IQ tests. This last point makes perfect sense, doesn't it? If you know how to most efficiently "work" a test, you are likely to score higher, and even a cup of coffee may boost your score. The very fact that your score can vary from test to test shows that there are factors which can be manipulated to raise your score. While there is a general correlation between IQ score and intelligence, certainly it is an imperfect one.

According to, the term "IQ score" is widely used but poorly defined. There are a large number of tests with different scales. The result on one test of 132 can be the same as a score 148 on another test. Some intelligence tests don't use IQ scores at all. Mensa was founded in England in 1946 by Roland Berrill, a barrister, and Dr. Lance Ware, a scientist and lawyer. They had the idea of forming a society for bright people, the only qualification for membership of which was a high IQ. Today there are some 100,000 Mensans in 100 countries throughout the world. There are active Mensa organizations in over 40 countries on every continent except Antarctica. The word "Mensa" means "table" in Latin. Membership in Mensa is open to persons who have attained a score within the upper two percent of the general population on an approved intelligence test that has been properly administered and supervised. There is no other qualification or disqualification for membership eligibility. The society welcomes people from every walk of life whose IQ is in the top 2% of the population.

Is there evidence that people with higher intelligence have better lives or are happier? How do you scientifically measure "better life" in any case? Is there a negative correlation? Many with a high IQ have committed suicide, such as Virginia Woolf, Ernest Hemingway, and Sylvia Plath, but this is just anecdotal. Various studies have shown that both people with both a high IQ and a low IQ are slightly more likely to commit suicide. Even if these studies prove true, this doesn't prove causation, but only correlation according to A recent study, reported in the journal Psychological Science, found that while IQ level did correlate with academic performance, there was a much stronger correlation with self discipline. Students with high self-discipline have much better grades than high-IQ students. They also found that there was no correlation between IQ and discipline. They are traits that vary independently. Studies in the 1980s found that the ability of young children to delay gratification was positively correlated with academic achievement a decade later. These studies involved offering children a cookie now while giving them the choice to forgo the cookie and instead have two cookies later, and the ability to delay gratification is obviously a component of self discipline.

According to, the world record for highest IQ is interesting because it may be that we will never know who really, truly has the highest IQ. According to the Guinness Book of World Records, it is Marilyn Vos Savant. In 1985, Guinness World Records accepted that she had answered every question correctly on an adult Stanford-Binet IQ test at the age of just 10, a result that gave her a corresponding mental age of 22 years and 11 months, and an unearthly IQ of 228. For many people, the story of Savant and “Ask Marilyn” are just two more pieces of evidence in a larger, decades-long argument about the accuracy and objectivity of intelligence testing. Even Guinness has succumbed. In 1990, two years after inducting Savant into its Hall of Fame, the publisher, in its parlance, “rested” its high IQ category altogether, saying it was no longer satisfied that intelligence tests were either uniform or reliable enough to produce a single record holder. Depending on how you look at it, Savant will either never be beaten, or was not worth beating in the first place. Also, there are those who dispute even these findings based on the type of testing done and whether any other historical figures, like Albert Einstein, would have beaten out Marilyn Vos Savant.

According to, knowing all this makes high IQs and the story of Marilyn vos Savant seem rather different. Has her IQ been a burden as much as a blessing? According to John Rust, at Cambridge, to produce an extraordinary IQ score a mind must have two unusual qualities. The first is “mechanical facility” – useful but sometimes harmful in extreme cases, hence the preponderance of people with Asperger’s syndrome who have high IQs. And you must also excel at a wide variety of tasks. Intelligence tests measure a range of mental abilities, whereas most people naturally, and happily, concentrate on just a few. Abnormally high IQ scores, by their nature, often speak of a brain too general to be of much use.

A study of one million Swedish men has revealed a strong link between cognitive ability and the risk of death, suggesting that government initiatives to increase education opportunities may also have health benefits, according to A lower IQ was strongly associated with a higher risk of death from causes such as accidents, coronary heart disease and suicide; the link between IQ and mortality could be partially attributed to the healthier behaviours displayed by those who score higher on IQ tests. People with higher IQ test scores tend to be less likely to smoke or drink alcohol heavily, they eat better diets, and they are more physically active. And, they appear to have a range of better behaviours that may partly explain their lower mortality risk. Preschool education programs and better nourishment can raise IQ scores according to other studies about intelligence.

In the US, according to, where more than nine million men underwent various forms of IQ and ability tests during the second world war, the enthusiasm for testing has been matched only by the ferocity of arguments over what exactly it proves. IQ tests for children, the SAT Reasoning Test for college applicants and psycho­metric testing by companies may have been designed with the goal of identifying individual talent, but often their larger consequence has been to highlight differences already inherent in society. Variations between the sexes and ethnic groups have led to toxic arguments about bias and inequality and power: who gets to define intelligence? Who designs the tests? In its various iterations, the debate about IQ testing in the US normally returns to the persistent, albeit shrinking, lag between results for white and black populations.

An interesting article by Bruce Charlton, Editor in Chief of the journal Medical Hypotheses and a university academic living in the UK, published this year in the Mensa magazine talks about the pros and cons of having a high IQ, although overall he feels having a high intelligence quotient is a good thing. His blog article is a fair assumption found at and has some valid points to be made about IQ and social skills, religion, and other facets of having a high IQ.

But according to, intelligence is a tool, but just one of the tools we have to shape our lives with. Like money or power or abilities, it is a benefit in the abstract. It only becomes beneficial in reality if applied in ways that better our lives. Raw computing capacity doesn't make a computer or a human effective if there aren't the other necessary components. Look at what people of average intelligence, like Henry Ford, have accomplished before you place too much emphasis on a high IQ.

Overall, the relationship between health care quality and high IQ may be relative to several factors including gender, race, financial status and a host of other unrelated variables. Does having a higher IQ provide anyone with better health or with more emotional stability? Studies appear to give an edge to those who are smarter as a generalized grouping, but not on any single or individual basis. So, is it better to be smarter? The obvious answer is YES. But is a high IQ going to provide you with unlimited perfect health for your entire life? Odds are you would lose that bet. No matter how your intelligence stacks up against the rest of the population, common sense goes a long way to provide you the ability to make wise choices when considering how to maintain personal health and medical needs. Use your brain wisely, regardless of your IQ.

Until next time. Let me know what you think.

Wednesday, August 12, 2009

Health Care and High Blood Pressure

Blood pressure is the pressure of the blood against the walls of the arteries, according to the American Heart Association (AHA). And, blood pressure results from two forces. One is created by the heart as it pumps blood into the arteries and through the circulatory system. The other is the force of the arteries as they resist the blood flow.
--The higher (systolic) number represents the pressure while the heart contracts to pump blood to the body.
--The lower (diastolic) number represents the pressure when the heart relaxes between beats.

According to the AHA, the systolic pressure is always stated first. For example: 118/76 (118 over 76); systolic = 118, diastolic = 76. Blood pressure below 120 over 80 mmHg (millimeters of mercury) is considered optimal for adults. A systolic pressure of 120 to 139 mmHg or a diastolic pressure of 80 to 89 mmHg is considered "prehypertension" and needs to be watched carefully. A blood pressure reading of 140 over 90 or higher is considered elevated (high). High blood pressure usually has no symptoms. In fact, many people have high blood pressure for years without knowing it. That's why it's called the "silent killer." Hypertension is the medical term for high blood pressure. It doesn't refer to being tense, nervous or hyperactive. You can be a calm, relaxed person and still have high blood pressure. A single elevated blood pressure reading doesn't mean you have high blood pressure, but it's a sign that further observation is required. Ask your doctor how often to check it or have it checked. Certain diseases, such as kidney disease, can cause high blood pressure. In 90 to 95 percent of cases, the cause of high blood pressure is unknown. The only way to find out if you have high blood pressure is to have your blood pressure checked. Your doctor or other qualified health professional should check your blood pressure at least once every two years, or more often if necessary. Optimal blood pressure with respect to cardiovascular risk is less than 120/80 mm Hg. However, unusually low readings should be evaluated to rule out medical causes.

One of the most dangerous aspects of hypertension, according to WebMD, is that you may not know that you have it. There are generally no symptoms of high blood pressure, so you usually don't feel it. In fact, nearly one-third of people who have hypertension don't know it. The only way to find out if you have high blood pressure is to get your blood pressure checked on a regular basis. This is especially important if you have a close relative who has high blood pressure. If your blood pressure is extremely high, there may be certain symptoms to look out for, including:
--Severe headache
--Fatigue or confusion
--Vision problems
--Chest pain
--Difficulty breathing
--Irregular heartbeat
--Blood in the urine
--Pounding in your chest, neck, or ears
If you have any of these symptoms, see a doctor immediately. You could be having a hypertensive crisis that could lead to a heart attack or stroke. Untreated hypertension can lead to serious diseases, including stroke, heart disease, kidney failure and eye problems.

According to WebMD, blood pressure may increase or decrease, depending on your age, heart condition, emotions, activity, and the medications you take. One high reading does not mean you have the diagnosis of high blood pressure. It is necessary to measure your blood pressure at different times while resting comfortably for at least five minutes to find out your typical value. To make the diagnosis of hypertension, at least three readings that are elevated are normally required. In addition to measuring your blood pressure, your doctor will ask about your medical history (whether you've had heart problems before), assess your risk factors (whether you smoke, have high cholesterol, diabetes, etc.), and talk about your family history (whether any members of your family have had high blood pressure or heart disease). Your doctor will also conduct a physical exam. As part of this exam, he or she may use a stethoscope to listen to your heart for any abnormal sounds and your arteries for a bruit, a whooshing or swishing sound that may indicate that the artery may be partially blocked. Your doctor may also check the pulses in your arm and ankle to determine if they are weak or even absent. If you're diagnosed with high blood pressure, your doctor may recommend other tests, such as:
1.) Electrocardiogram (EKG or ECG): A test that measures the electrical activity, rate, and rhythm of your heartbeat via electrodes attached to your arms, legs, and chest. The results are recorded on graph paper.
2.) Echocardiogram: This is a test that uses ultrasound waves to provide pictures of the heart's valves and chambers so the pumping action of the heart can be studied and measurement of the chambers and wall thickness of the heart can be made.

Changing your lifestyle can go a long way toward controlling high blood pressure, according to the Mayo Clinic. But sometimes lifestyle changes aren't enough. In addition to diet and exercise, your doctor may recommend medication to lower your blood pressure. Which category of medication your doctor prescribes depends on your stage of high blood pressure and whether you also have other medical problems. The major types of medication used to control high blood pressure include:
--Thiazide diuretics. Diuretics, sometimes called "water pills," are medications that act on your kidneys to help your body eliminate sodium and water, reducing blood volume.
--Beta blockers. These medications reduce the workload on your heart and open your blood vessels, causing your heart to beat slower and with less force.
--Angiotensin-converting enzyme (ACE) inhibitors. These medications help relax blood vessels by blocking the formation of a natural chemical that narrows blood vessels.
--Angiotensin II receptor blockers. These medications help relax blood vessels by blocking the action — not the formation — of a natural chemical that narrows blood vessels.
--Calcium channel blockers. These medications help relax the muscles of your blood vessels. Some slow your heart rate.
--Renin inhibitors. Aliskiren (Tekturna) slows down the production of renin, an enzyme produced by your kidneys that starts a cascade of chemical steps that increases blood pressure.

Once your blood pressure is under control, your doctor may have you take a daily aspirin to reduce your risk of cardiovascular disorders, according to the Mayo Clinic. To reduce the number of daily medication doses you need, your doctor may prescribe a combination of low-dose medications rather than larger doses of one single drug. In fact, two or more blood pressure drugs often work better than one. Sometimes finding the most effective medication — or combination of drugs — is a matter of trial and error. If your blood pressure has remained stubbornly high despite taking at least three different types of high blood pressure drugs, one of which should be a diuretic, you may have resistant hypertension. Resistant hypertension is blood pressure that's resistant to treatment. People who have controlled high blood pressure but are taking four different types of medications at the same time to achieve that control also are considered to have resistant hypertension. Having resistant hypertension doesn't mean your blood pressure will never get lower. In fact, if you and your doctor can identify what's behind your persistently high blood pressure, there's a good chance you can meet your goal with the help of treatment that's more effective. You may need to see a hypertension specialist if your primary care doctor isn't able to pinpoint a cause. It may also be that another condition you have that you may not be aware of, such as sleep apnea or kidney problems, is causing your high blood pressure. You may need to be more aggressive in following lifestyle recommendations.
Your doctor or hypertension specialist can evaluate whether the medications and doses you're taking for your high blood pressure are appropriate. You may have to fine-tune your medications to come up with the most effective combination and doses. Your doctor may also prescribe other medications, including a more potent or longer acting diuretic if you're not already taking one. Your doctor may also suggest nonthiazide diuretic drugs, such as spironolactone (Aldactone) or eplerenone (Inspra), which change the way your body absorbs sodium and excretes potassium by blocking the hormone aldosterone. People with resistant hypertension often have higher levels of aldosterone.

In addition, according to the Mayo Clinic, you and your doctor can review medications you're taking for other conditions. Some medications, foods or supplements can worsen high blood pressure or prevent your high blood pressure medications from working effectively. Be open and honest with your doctor about all the medications or supplements you take. If you don't take your high blood pressure medications exactly as directed, your blood pressure can pay the price. If you skip doses because you can't afford the medication, because you have side effects or because you simply forget to take your medications, talk to your doctor about solutions. Don't alter your treatment without your doctor's guidance.

According to the Mayo Clinic, lifestyle changes can help you control and prevent high blood pressure — even if you're taking blood pressure medication. Here's what you can do:
--Eat healthy foods, such as fruits, vegetables, whole grains and low-fat dairy foods. Get plenty of potassium, which can help prevent and control high blood pressure. Eat less saturated fat and total fat.
--Decrease the salt in your diet.
--Increase physical activity. Regular physical activity can help lower your blood pressure and keep your weight under control.
--Limit alcohol.
--Don't smoke. Tobacco injures blood vessel walls and speeds up the process of hardening of the arteries.
--Manage stress, and get plenty of sleep if possible.
--Monitor your blood pressure at home.
--Practice relaxation or slow, deep breathing.

Maintaining a healthy blood pressure through proper medication and lifestyle choices will decrease the chances of major life threatening disease. Visit your primary care health provider to find out how your BP is doing, and listen to the doctor. Make sensible decisions about diet and exercise, and get away once in a while to relax. The best way to avoid problems with blood pressure issues is to use the tools available to manage your health.

Until next time. Let me know what you think.

Tuesday, August 11, 2009

Health Care and the Five Senses

What's that smell? Do you hear that noise? Taste this! Look at me! Feel this, isn't it soft? When you hear, or even use these phrases, you probably don't stop to think about why we use them, according to Well, it's because of your senses; and without you even knowing, your sense organs (nose, eyes, ears, tongue, and skin) are taking in information and sending it to the brain for processing. If you didn't have them, you would not be able to smell, see, hear, taste, or touch anything. Talk about a boring life! Your senses are the physical means by which all living things see, hear, smell, taste, and touch. Each sense collects information about the world and detects changes within the body. Both people and animals get all of their knowledge from their senses, and that is why your senses are so important.

The human body is a phenomenal creation, and it has the ability to detect many sources of stimulation. According to, the standard list of five senses doesn't really give our bodies credit for all of the amazing things they can do, and there are at least a dozen different things you can sense. In order for you to have a sense, there needs to be a sensor. Each sensor is tuned to one specific sensation. For example, there are sensors in your eyes that can detect light. That is all that they can detect. To track down all of the different senses a person has, the easiest thing to do is to catalog all of the different sensors.

All senses depend on the working nervous system, according to Your sense organs start to work when something stimulates special nerve cells called receptors in a sense organ. You have five main sense organs. They are the eyes, nose, ears, tongue, and skin. Once stimulated, the receptors send nerve impulses along sensory nerves to the brain. Your brain then tells you what the stimulus is. For example, your sound receptors would be bombarded by billions of sound waves. When these signals reach the part of the brain called the cerebral cortex, you become conscious of the sounds. Also, consider more info about how the senses work at this website: .

According to, here is a reasonable list of the sensors:
--In your eyes, you have two different types of light sensors. One set of sensors, called the rods, senses light intensity and works well in low-light situations. The other type, called cones, can sense colors (and actually, there are three different types of cones for the three primary colors) and require fairly intense light to be activated.
--In your inner ears, there are sound sensors. Also in your ears are sensors that let you detect your orientation in the gravitational field -- they give you your sense of balance.
--In your skin, there are at least five different types of nerve endings:
-Heat sensitive.
-Cold sensitive.
-Pain sensitive.
-Itch sensitive.
-Pressure sensitive. These cells give you the sense of touch, sense of pain, sense of temperature and sense of itch.
--In your nose, there are chemical sensors that give you your sense of smell.
--On the tongue, there are chemical receptors that give us our sense of taste.

In your muscles and joints, according to, there are sensors that tell you where the different parts of your body are and about the motion and tension of the muscles. These senses let us, for example, touch our index fingers together with our eyes shut. In your bladder, there are sensors that indicate when it is time to urinate. Similarly, your large intestine has sensors that indicate when it is full. There are also the senses of hunger and thirst. And, according to, hearing, sight, taste, touch, and smell are known as our external senses. They provide information about the outside world. Pain, balance, thirst, and hunger are considered to be our internal senses. They provide information about the body and its needs. For example, the sense of hunger shows that the body needs food.

According to Answers at, the primary senses help you survive and process huge amounts of information on a 24/7 basis. Consider the following:
1.) Eyes: See, interpret color, depth perception, interpret sensory input and new information.
2.) Ears: Hear sound, balance with equilibrium regulate pressure of sinus and adjusting with change in pressure.
3.) Nose : Used to smell scent, smell is the strongest link to memory; it is processed by the olfactory system in your brain, used to interpret the different smells.
4.) Tongue: In general used to taste, used to differentiate between taste due to tastebuds all sectioned on their own on the tongue surface. Also, it senses whether food is hot or could. also helps in the swallowing procedure as it forms and moves the bolus (the shape food takes before swallowed).
5.) Skin:
--Protection: an anatomical barrier from pathogens and damage between the internal and external environment in bodily defense; Langerhans cells in the skin are part of the adaptive immune system.
--Sensation: contains a variety of nerve endings that react to heat and cold, touch, pressure, vibration, and tissue injury.
--Heat regulation: the skin contains a blood supply far greater than its requirements which allows precise control of energy loss by radiation, convection and conduction. Dilated blood vessels increase perfusion and heat loss while constricted vessels greatly reduce cutaneous blood flow and conserve heat. Erector pili muscles are significant in animals.
--Control of evaporation: the skin provides a relatively dry and impermeable barrier to fluid loss. Loss of this function contributes to the massive fluid loss in burns.
--Aesthetics and communication: others see our skin and can assess our mood, physical state and attractiveness.
--Storage and synthesis: acts as a storage center for lipids and water, as well as a means of synthesis of vitamin D by action of UV on certain parts of the skin.
--Excretion: sweat contains urea, however its concentration is 1/130th that of urine, hence excretion by sweating is at most a secondary function to temperature regulation.
--Absorption: Oxygen, nitrogen and carbon dioxide can diffuse into the epidermis in small amounts, some animals using their skin for their sole respiration organ. In addition, medicine can be administered through the skin, by ointments or by means of adhesive patch, such as the nicotine patch or iontophoresis. The skin is an important site of transport in many other organisms.
--Water resistance: The skin acts as a water resistant barrier so essential nutrients aren't washed out of the body.

Overall, the sensory perceptions you encounter all day long, and even when you are asleep, maintain an ongoing awareness to your brain about your surroundings; and they work in concert to keep you safe, provide warning, provide the ability for your brain to process information, and much more. Whenever one or more of your senses is damaged, your body and brain provide an adaptability for you to compensate for that loss for survival and ongoing healthy living. When the senses are working together, your physical and mental abilities have the capacity to help you maintain a healthy lifestyle.

Until next time. Let me know what you think.

Thursday, August 6, 2009

Health Care and Vacation

Everyone loves a vacation. Americans are known to for going on vacation during various times of the year, and usually those times coordinate with work schedules or school calendars. Spring break, summer time, and major holidays are the most frequent times. You can spend a little or a lot, and you can have tons of activities or do nothing at all--just relax. Vacations are what you make them, and many times can be the best way to get time away from work, school, or the hectic pace of everyday life. Vacations can be lots of fun, or they can create havoc if you encounter problems along the way with travel, location, or any one of a myriad of possibilities that can happen. More often than not, though, most people have a great time on vacation.

A major key to ensure a great vacation is to prepare for any medical or health care issue that may arise. The National Institutes of Health (NIH) have great tips to follow:
--Bring nonprescription medications that you might need with you.
--Check your health insurance carrier regarding your health care coverage (including coverage for emergency transport) while traveling out of the country.
--Consider traveler's insurance if you are going abroad.
--If you are leaving your children, leave a signed consent-to-treat form with your children's caretaker.
--If you are planning a long flight, minimize jet lag by scheduling your arrival at your destination as close to your usual bedtime as possible, according to the time zone to which you are flying.
--If you are taking medications, talk to your health care provider before leaving. Carry any medications with you -- not in your luggage.
--If you are traveling to another country, research the accessibility and quality of health care there.
--If you have an important event at your long-distance destination, plan to arrive 2 or 3 days in advance, if possible, so that you will be fresh for your appointment.
--Take immunization records, along with any other important medical records, especially when traveling to another country.
--Take a medical first aid kit.
--Take insurance ID cards.
--Take sunscreen, hat, and sunglasses.
--Take the name and phone numbers of your pharmacist and health care provider.
--When traveling to an underdeveloped country, make sure that everyone in your traveling party is adequately immunized against any infectious disease you might encounter. Some countries require certificates of vaccination against diseases such as cholera, typhoid fever, hepatitis A and B, meningococcal meningitis, tetanus, and yellow fever. Check with your health care provider. The Centers for Disease Control maintains updated advisories and immunization requirements for travelers to all parts of the world.

--Avoid mosquito bites, which can spread infections, by wearing proper clothing and using insect repellant.
--Cooked foods are usually safe, but raw foods and salads (lettuce, raw vegetables, fruit with peel, unpasteurized milk, milk products, undercooked seafood or meat) may lead to gastrointestinal problems. Eat in restaurants that have a reputation for safe cooking.
--Consider automobile safety and use seat belts when traveling.
--If you are visiting an area where diarrheal illnesses are common (Mexico, for example), speak with your health care provider about getting a prescription for antibiotics. Fill the prescription and take it with you in case you fall ill.
--If you come down with diarrhea, drink plenty of bottled liquids. Broths and carbonated beverages are good for maintaining your strength.
--Prevent infections with hand washing.
--Upon arrival, check the local emergency number. Not all communities use 911.
--When traveling long distances, expect your body to adjust to a new time zone at the rate of about 1 hour per day.
--When traveling to less economically developed countries, don't drink the water if you want to avoid the risk of diarrhea. Remember the ice may also be contaminated if there is concern about the water quality. Bottled water may be safe, as long as it is factory bottled. Traveler's diarrhea can also result from drinking beverages that contain ice. Bottled carbonated sodas, beer, and wine (without ice) are safe.
--When traveling with children, make sure that they know the name and telephone number of your hotel in case they get separated from you. Give them enough money to make a phone call, and make sure they know how to use the phones if you are in a foreign country.

Before you head out on the road, provides great feedback on how to prepare: 1.) Plan ahead. Visit your doctor and find out which vaccines you should receive before you travel. If you're traveling to an area where a particular disease is prevalent (malaria, for example), ask your doctor for prescriptions to prevent the disease or combat its symptoms. Find out about health risks, including contagious and insect-borne diseases, weather-related health issues and current health alerts before you leave home. Be sure to learn about which medications you can carry into your destination country by checking with its embassy.
2.) Make sure you have not only your prescription medications in original bottles, but also any over-the-counter medications you might need while on vacation. If you're traveling overseas, bring copies of each prescription and ask your doctor to write a letter describing any controlled substances and / or injectable medications on his or her letterhead so that you can bring these items with you.
3.) Insure yourself. If you are a U.S. citizen and Medicare is your only health insurance, you definitely need to buy travel health insurance if you plan to leave the U.S. If you have other health insurance coverage, check with your provider to find out whether you're covered for medical care and medical evacuation if you become ill while on vacation.
4.) If your policy does not cover these situations, purchase an emergency medical coverage plan before you leave home. To get the maximum possible coverage, do not purchase this policy from your airline, tour operator or cruise line; use a third-party provider. Read the entire policy carefully before you pay for it to be sure you're covered for pre-existing conditions, health care while you are away and medical evacuation if you need to return home for treatment. To learn more, read the U.S. State Department's country-specific medical insurance information.
5.) Pack defensively. Your travel medical kit should include prescription medications, health insurance cards, proof of immunization (if needed), travel insurance documents and emergency medical supplies. Depending on your destination, also bring:
--Insect repellent
--Anti-diarrheal medication
--Pain / fever medication (e.g. ibuprofen)
--Antihistamines and / or decongestants
--Antacid tablets
--Motion sickness medication
--First aid supplies

Additionally, have great advice to stay healthy when on vacation. It's so easy to fall into unhealthy habits when you travel. Heavy restaurant meals, little scheduled exercise, strange sleeping arrangements and late nights exploring new towns can lead to feeling rundown. To keep your immune system in tip-top shape (and to keep from returning home five pounds heavier!), it's important to maintain your at-home healthy habits even when you're on the road. Consider these six tips to do just that:
1. Wash your hands a lot! One of the most important ways to reduce infectious disease transmission is to wash your hands carefully and frequently with soap and water, according to the Centers for Disease Control and Prevention. Hand washing--or using hand-sanitizer gel with alcohol--will help stop common cold germs in their tracks, too.
2. Stay hydrated. Although the World Health Organization says that low humidity on airplanes does not cause internal dehydration, it's still healthier to ask your friendly flight attendant for a cup of ice water instead of caffeine-filled sodas or alcohol. Make sure you have plenty of bottled water in your hotel room and drink it throughout your trip.
3. Pack healthy snacks. In your carry on, bring some apples, dried fruit, protein bars, peanut butter crackers or small tins of nuts, so you won't feel the need to make a purchase at one of those ubiquitous mega-cinnamon roll stands in the airport.
4. Make smart choices at restaurants. If you eat healthy meals at home, there's no reason why you can't at restaurants, as well. Skip the bread basket, order lean meats and veggies, and if you must have dessert, propose ordering one for the whole table to share.
5. Work out at your hotel or cruise-ship fitness center. If you have a choice among hotels, find one with cardio equipment, strength-training equipment or a decent-sized pool for lap swimming. Nearly every cruise ship these days has a fitness center or track on an outdoor deck. You've got no excuse! But you could also consider bringing along an exercise band for strength training; doing simple push-ups, squats and lunges in your room; scouring the television listings for a cable yoga class; or taking a jog around your hotel neighborhood. Heck, even a walk on the beach is good for you!
6. Get good shut-eye. This is easier said than done, especially if you want to see and do everything on vacation! But do your best to hit the sack early so you can have loads of energy for your days full of sightseeing.

Vacations mean fun. But make sure your fun is not interrupted by medical problems as a result of not taking care of important health care concerns, especially on a preventive basis. Certain emergencies may not be avoided, but common sense goes a long way to keep you safe and healthy when you are on vacation. Enjoy your trip. Have fun, but be smart about it.

Until next time. Let me know what you think.