Measles — And Vaccinations

There’s been a serious measles outbreak in Europe this year.  In the first half of 2018, there have been more than 41,000 reported cases of measles in Europe, and at least 37 deaths.  The 41,000 cases during the first half of 2018 is almost double the number of measles cases reported during the entire year of 2017 and is almost eight times higher than the reported measles figures for Europe in 2016.

pri_65784434There is a simple apparent cause for the European measles outbreak:  a drop in immunization rates.  Routine vaccinations of young children with the measles, mumps, and rubella vaccine — which is shown to be 97% effective in preventing measles — are falling in countries like Italy, Romania, and the Ukraine.  It’s not clear whether parents are simply not as attentive as they once were, or whether they think measles has been wiped out and vaccination isn’t necessary in the modern world, or they’ve fallen prey to scientifically dubious arguments that MMR vaccination leads to conditions like autism.

The decline in vaccinations in the general public is the key to measles outbreaks, because measles is one of the most virulent, communicable diseases around.  It’s spread by droplets in the coughs and sneezes of an infected person, and the U.S. Centers for Disease Control and Prevention estimates that a person with measles can infect 90 percent of the non-immune people who come within close contact.  And even though measles seems like a simple childhood disease, it can have serious complications, like pneumonia and encephalitis, in some cases.

According to the CDC, there are no measles outbreaks in the U.S.; as of August, there had been only 124 cases of measles in 22 states in 2018, and none in Ohio.   It’s a marked contrast to the figures reported in Europe.  The outbreak in Europe, however, shows that parents and doctors need to keep their guards up and ensure that kids get vaccinated.  And it shows something more:  in this interconnected world, we’ve got to be able to depend on each other to follow the health care basics.  If people stop getting the routine, proven vaccinations, measles may end up being the least of our concerns.

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“Traveler’s Constipation”

The New York Times carries one of those “ask a doctor” columns called “Ask Well.”  The other day it responded to the question:  “Is there such a thing as traveler’s constipation?”

Parenthetically, this reminded me of when I was in college and the Ohio State Lantern carried a similar, extremely popular feature, in which one of the doctors at the University responded to student health questions.  Since the questioners were college students, the tone of the inquiries wasn’t exactly elevated.  I remember that one of the questions fielded by the doctor came from an oddly observant student who wondered why some of his toilet deposits sank to the bottom of the bowl while others floated.  No doubt the doctors who agree to write such columns wonder, from time to time, whether this is really why they went through the hell involved in getting an M.D.

e2e8df6b6cfdc669ce638b702cfcacc6Anyway, back to the pressing issue of “traveler’s constipation” — the Times doc states that there is such a thing, and it afflicts a percentage of travelers.  In fact, several medical studies of the phenomenon have been conducted.  One of the studies, of 70 Europeans who had traveled to the U.S., was quite robust in its data acquisition.  The Times described it as follows: “In addition to the usual questionnaires, all subjects maintained diaries on their bowel habits, had stool samples evaluated for consistency according to a standardized methodology, and had their colonic transit time measured after ingesting radioactive tracers. Colonic transit time is the time required for stool to move through the large intestine.”  (You’d think that ingesting radioactive tracers that the subjects would know were moving through their guts and then maintaining diaries on bowel movements and having stool samples analyzed might interfere with normal functioning and produce false results, but apparently not.)  And there are actually products out in the market that are supposed to help deal with “traveler’s constipation.”

But although the studies reported in the Times detected some evidence of “traveler’s constipation,” which apparently is primarily noticed during the first days of travel and often correlates with jet lag, whether the condition is caused by travel isn’t exactly clear.  The studies note that travel also often involves changes in diet and exercise — sitting at an airport gate eating something purchased along the concourse isn’t exactly designed to promote “regularity” — and the Times doc also notes that a significant portion of people, from 12 to 19 percent, are generally constipated whether they are traveling are not.  That may explain why it’s not unusual to meet grumpy people in the world.

It’s also not clear whether the studies also looked at another potential cause for “traveler’s constipation” — namely, a concerted effort on the part of mind and body to avoid having to use a dubious public airport bathroom — that might contribute to the condition.  The good news, though, is that the Times doc concludes that “traveler’s constipation” is not a serious health problem.  In short, it too shall pass.

Coffin Nail Fail

Here’s some good news:  the Centers for Disease Control and Prevention National Center for Health Statistics reported this week that the percentage of the adult population that smokes cigarettes has reached its lowest level since the government began keeping track of that activity.

11034958_web1_m-smoking-edh-171122The CDC report concluded that, in 2017, 13.9 percent of the adult population in the United States smoked cigarettes.  That number is down from 15.5 percent in 2016, and has been steadily declining over the years.  Back in the 1960s, more than 40 percent of American adults smoked.  Ask anyone who was around during the ’60s, and you’ll hear stories that give you an idea about just how dramatically things have changed since then.  When UJ and I went with our grandparents to University of Akron Zips basketball games back in those days, for example, people could smoke in the hallways before entering the seating area.  At halftime when you walked through the hallway to get popcorn or a hot dog, you walked through a thick, gag-inducing wall of smoke emitted by throngs of smokers.  Now — unless you’re in a Las Vegas casino — you almost never encounter even a whiff of smoke in a public place.

Why are the numbers of smokers falling?  Some attribute it to aggressive ad campaigns against smoking and some attribute it to changes in general social mores; others think that a positive feedback loop may have occurred, where the decline in the number of smokers means people see fewer smokers and aren’t tempted to start smoking themselves in the first place.  There’s also another reason for the decline:  call it coincidence, but people who are smokers often seem to have fatal health problems, like the cancers that claimed three of the heavy smokers in my family.

While the overall trends are encouraging, there’s still work to be done.  Even though adult smokers now number less than 14 percent of the population, that still amounts to millions of people who are in the grip of a very bad habit.  And the statistics show a real disparity in the percentage of smokers by location, with city dwellers much less likely to smoke than residents of rural areas.  We need to continue to work on getting current smokers to quit, and convincing potential smokers to never pick up one of those coffin nails in the first place.

Cussing Care

For some of us, at least, it’s standard operating procedure to launch an obscenity when we stub our toes, bump our heads, cut our fingers while chopping food, or experience some other unexpected moment of physical pain.

Setting aside the morality or propriety of our bad habits, the practical question is:  does cussing a blue streak actually help to relieve the pain?

323541e1e64f03e581310e505382de0eOne recent study, conducted by Keele University in England, concludes that it definitely does.  In fact, the study determined that spewing crude language has measurable, therapeutic, physical effects.  When study participants were saying dirty words their heart rates increased, their perception of pain decreased, and they were able to endure pain much longer than was the case if they were saying neutral words.  (And if you read the article linked above and see how the researchers set up the study to test their hypothesis, you’ll conclude that you should never, ever volunteer to participate in a psychological experiment at Keele University.)

The study determined that foul-mouthed participants were able to endure pain longer because there is a significant psychological component to experiencing pain, and a person’s mood and other circumstances can have a clear impact.  Swearing triggers an aggressiveness response, and an aggressive mental attitude helps a person deal with pain much more effectively.  (This may be why football players, for example, seem to be able to endure pain during games that many of us would find disabling.)  And the study also found that the pain endurance levels were directly related to the perceived filthiness of the obscenity being used.  “Sanitized” curse words, like the British “bum,” were much less effective than actual obscenities, and the most effective pain relief of all came from using the “queen mother of curses.”

The “F Word” is ubiquitous and, as I’ve noted before, has broad utility in many different settings — but who knew that it was like aspirin in its pain relief capabilities?  So the next time you’ve got a bad headache or hit your thumb with a hammer, go ahead and let the f bombs fly!  Chances are you’ll feel a lot better.

Smokers On Ice

Walking home from work tonight, with the temperature plummeting rapidly and already down below 10 degrees, I saw one of the people at the outdoor bus stop in front of the Ohio Statehouse smoking a cigarette.  And I thought:  “Really? Smoking in these ridiculous temperatures?”

a9a4f5381b5f6269a640259f845f9c7f-dart-frogs-cold-handsKish makes fun of me, because as a long reformed ex-smoker — I puffed my last cigarette more than 25 years ago and am forever happy that I quit when I did — I’m always quick to wonder aloud how anyone can smoke, period, even though I smoked off and on for a number of years.  In that regard, I’m like the one-time sinner turned into a holier-than-thou convert.  But if smoking under normal conditions seems crazy, given its abundantly documented health risks, smoking a cigarette outside in these temperatures seems especially insane.  In fact, there is some evidence that smoking outside during freezing temperatures is even worse for you than smoking is generally.

In Columbus, you can’t smoke in most buildings as a matter of law, so at our firm, and in other businesses, the few remaining smokers have to go outside to indulge in their habit.  You’d think that, as the mercury plunges into bitterly cold territory, the smokers would decide to refrain from going outside into the deep freeze and maybe even consider quitting altogether.  But when you pass the smoking area outside, behind our building, there’s always a few people puffing away, even on a day like today.  They look terribly cold, and act like they feel terribly cold, but they’re out there smoking, anyway.  It’s a pretty good indication of how addictive smoking is for some people — and a pretty good advertisement for why you shouldn’t start smoking in the first place.

A Blunt Instrument

As of January 1, 2018, Seattle has placed a tax — it’s officially called a “sweetened beverage recovery fee” — on sugary sodas and “sports drinks” like Gatorade.  Costco, the big box membership club retailer, has responded by placing signs showing consumers the specific impact of the tax on the Costco price for the product — and it’s a whopper.

video__sugar_tax_sticker_shock_0_10405324_ver1-0_640_360The Costco signs show that the Seattle tax adds $10.34 to a Gatorade 35-bottle variety pack — the kind you might buy if you were responsible for buying refreshments for your kid’s sports team to consume after a practice.  The price of the product was $15.99, but with the new tax the price is now $26.33.  The tax added $7.56 to a 36-can case of Dr. Pepper, bringing the price from $9.99 to $17.55.  Costco also helpfully added signage to explain the tax-related increase to its customers and remind them that they can avoid paying the additional cost simply by going to a nearby Costco located out of the city limits.  Some customers have told local TV stations they plan on doing just that.  There’s also been lots of social media chatter about the Costco signs and the impact of the tax on prices.

What’s the point of the tax?  Seattle evidently is concerned about obesity, which some studies have linked, at least in part, to the consumption of sugary soft drinks.  Seattle hopes that by imposing a substantial tax on soft drinks and “sports drinks,” it will incentivize people to make healthier choices.  But get this:  the tax exempts sweetened products from certified manufacturers with annual worldwide gross revenue of $2 million or less, and products from certified manufacturers with gross revenue of more than $2 million but less than $5 million pay a much smaller tax.  That exemption is a purely political decision that doesn’t make sense as a public health issue, because the size of the producer obviously doesn’t change whatever the impact of the product might be.  Seattle’s approach also focuses only on sweetened drinks, and doesn’t address products like ice cream, candy bars, “snack foods,” or frozen pizza that might also be said to contribute to “unhealthy lifestyles.”  And, of course, it doesn’t begin to address other issues that contribute directly to obesity, such as lack of exercise.

Other cities, like Chicago, have tried soft drink taxes and dumped them in the face of business opposition.  Costco is providing a salutary service by alerting its customers to the specific cost impact of the tax so they can factor it into their decision-making.  The Seattle experiment, as illuminated by the Costco signs, reminds us, yet again, that taxes are a pretty blunt instrument when it comes to trying to change behavior and achieve broader policies — and that taxes are always going to be affected by political considerations, too.

Interior Exercise

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We’ve reached the depths of winter in the Midwest, and the part of that dismal season when changes in temperature mean melting snow, then refreezing, then melting again, then refreezing again.  It makes walking outside a treacherous exercise that is not for the faint of heart — especially if you’re walking on ever-slippery brick.

But there is an alternative to outdoor exercise for those of us who are too cheap to get health club memberships but who desperately need the exercise if they hope to stave off the condition of Rapid Waistline Expansion.  It’s called the stairs.  And if, like me, you toil in an older building where there are lots of stairwells with different designs, like the stairwell shown above, the stairs can be a pretty cool option aesthetically, too.

According to the medical experts, taking the stairs does have the effect of burning some calories — although not enough to allow you to rationalize eating a Snickers bar a day, unless you’re walking to the top of the Empire State building on your way to work — and other health benefits as well, including building and maintaining health bones, muscles, and joints and improved aerobic capacity.  I like doing it because it gets me moving and gets the blood flowing during the day, and I feel like I’m at least doing something to maintain or even improve my health while at the office.

Of course, it’s a lot easier taking the stairs going down, than going up.