North Korea: Puzzling, fascinating

I'm probably not the only person who's curious about North Korea. Not just because of the news, but also because the gradual Wal-Martification of the rest of the world has made North Korea seem that much weirder. I recently read Guy Delisle's nifty Pyongyang, a graphic novel recounting the author's experiences working there, and today, Slate's "Today's Pictures" has a few tantalizing shots from North Korea. If you search on "Pyongyang" at Flickr, you can see some more glimpses into this frighteningly odd society.

Consumer-directed health plans: early reviews mixed

WaPo has an article about a study of people enrolled in so-called consumer-directed health plans. Basically, we're talking about people who are enrolled in high-deductible, low-premium health insurance plans and who pay their share of health costs with pre-tax money from health savings accounts.

According to the study, these folks are indeed paying more attention to their cost of care, just as advocates for such plans predicted. On the other hand, they tend to be healthier, whiter, and richer than those who in traditional plans, just as critics predicted. Bottom line: half of those in consumer-directed plans would switch to a traditional plan if they could; about a third of those in traditional plans say they would switch to consumer-directed plans. Snip:

In contrast with other plans that typically require $15 or $20 co-payments for visits to the doctor, the new plans can require consumers to shell out hundreds or thousands of dollars of their own money for medications, physicians' services and hospital care before most coverage kicks in. The plans have high annual deductibles, but their premiums tend to be lower.
....
"It's a cultural shift," said Devon Herrick, a health economist at the National Center for Policy Analysis in Dallas. "When you go to Wal-Mart you don't have to ask about price -- it's right there next to the good or service you are buying. Health care is not there yet, but it's getting that way. This is the early stages. We have the incentives to get people more responsible and asking about price."

Link.

Young man, don't sit up straight

Interesting item in the ChiTrib today about sitting and posture. Turns out that sitting up straight, with your back at a 90-degree angle to the floor, is more likely to lead to back pain than leaning back. Specifically, a 135-degree angle is ideal. In fact, that big-ass recliner in front of the TV would be perfect, if you could get it into your cubicle. Snip:

"Really the best position is what you get in a La-Z-Boy, although that wouldn't work well for someone using a computer," said Dr. Waseem Amir Bashir, who led a study conducted at Woodend Hospital in Aberdeen, Scotland.

Bashir's findings, which confirm what experts in ergonomics have believed, were presented at the McCormick Place meeting of the Radiological Society of North America. His conclusions come from getting a different view of the spine, using a newly designed magnetic resonance imaging machine that allows for a full view of the back while sitting.
....
Assuming any position for a long period is a bad practice, said Judy Lesse, an ergonomics consultant for Herman Miller. "We design our chairs so that people can change positions regularly," she said. "You may find it difficult to lean back while using a computer, but you can lean back while talking on the phone."

Dave Trippany, corporate ergonomist for Steelcase Inc., a Grand Rapids, Mich., maker of office furniture, said that "flexibility is the key. People should move around to increase circulation. Reclining is part of that."

Link.

Anti-inflammatory plant stuff

This morning's WaPo has a gee-whiz article about research into the anti-inflammtory properties of a plant from the ginger family called Afromomum melagueta. In the wild, gorillas have apparently long been savvy to this stuff's benefits, but unfortunately lacked the marketing skills to properly exploit its commercial potential. Thank goodness Avon got ahold of some; it plans to market skin-care products containing Afromomum. Others speculate about its use as a substitute for anti-inflammatory pharmaceuticals like Vioxx and Bextra. Snip:

A clear vial filled with amber fluid rests on scientist Ilya Raskin's desk, glinting in the autumn sunlight streaming through his office window. The container, a small glass bottle with a plain white screw-top, contains a substance Raskin calls 006. "Double-zero-six" is potentially more precious than the rarest topaz.

Raskin is a biochemist at Rutgers University's Biotechnology Center. The golden liquid on his desk may prove to be one of the most powerful anti-inflammatory substances ever discovered. "It contains a derivative of a plant known as grains of paradise, or Aframomum melegueta, a member of the ginger family," said Raskin. The compound works in a similar way to the well-known anti-inflammatory drugs Vioxx, Celebrex and Bextra but, it is hoped, without their side effects, said Raskin and other scientists.

Link.

Stupid brain tricks

As a person whose brain is kinda, well, broken, I sometimes lose sight of what a wacky gizmo the brain is. Frinstance, there's a little article in the NYT about a rare condition called lexical-gustatory synaesthesia, in which the brain tastes words. Snip:

One subject, Dr. Simner said, hates driving, because the road signs flood his mouth with everything from pistachio ice cream to ear wax. And Dr. Simner has yet to figure out any logical pattern. For example, the word “mince” makes one subject taste mincemeat, but so do rhymes like “prince.” Words with a soft “g,” as in “roger” or “edge,” make him taste sausage. But another subject, hearing “castanets,” tastes tuna fish. Another can taste only proper names: John is his cornbread, William his potatoes.

So let's give thanks for brains, even broken brains, for connecting us with the world. Hold the ear wax.

Is this anything? I don't think so.

I've seen a few articles on this particular "story" since Monday or so: the nation's leasing health insurance trade group has come out with a "plan" for covering the millions of Americans who lack health insurance. Snip from a Chicago Trib article:

The organization called on the federal government to spend an additional $300 billion over 10 years to expand public health programs for poor Americans, offer subsidies to working families to buy medical coverage, and support state health reform efforts. But there are no specifics on how the proposals would be financed or provisions for taming rapidly escalating costs.

The first priority should be providing insurance protection to almost all of the nation's children in three years, Ignagni said. Then the focus should turn to programs that will aid adults, including new tax-advantaged accounts for people who purchase insurance on their own.

With the Democrats taking charge of Congress after last week's elections, the industry plan helps set the stage for action on health reform. Democrats have long considered health care a priority and signaled a keen interest in expanding medical coverage.

Is it just me, or is everything in the insurance industry's courageous proposal completely consistent with the industry's interests? It's kinda like the auto industry calling for all Americans to have access to a car.

The articles I've seen characterize the industry's release as a sharp counterpoint to the Harry-and-Louise ads that tanked the Clinton plan a dozen years ago. I could never figure out why it was that the industry opposed the Clinton plan. If I remember right, the plan would have essentially pushed for more employers to offer coverage to their employees, meaning it would have pushed more customers into the waiting arms of the insurance industry.

The only thing that seems not obviously in the industry's interest is the expansion of Medicare and Medicaid. But even there, the industry stands to reap a substantial benefit: more sick people get access to care before they get so sick that they end up in the ER. Right now, the compulsory ER "charity care" is paid for by jacking up the charges to those who have coverage. If you can stop or at least slow down the stampede of poor people through the ER, you can slow down the growth in premiums that's led so many employers (and some employees) to drop their health coverage.

Wake me up when the insurance industry puts out the press release explaining how to pay for the expansion in coverage.

How dry I am

A week and a half into my latest med change, I'm feeling slightly improved but dry as a Mormon barbecue. Since last Friday, I'm taking (for the pain-sleeping-peeing stuff) 40 mg Cymbalta in the morning, then 20 mg amitriptylene, 250 mg Serzone, and 0.8 mg Flomax at night. I think the pain might be a little better: yesterday, I was able to wear a pair of woolly trousers to work with only minimal itching. Sleeping has improved, too: I haven't had the foot-twitching clonus in bed for a few days, and I think I only got up to pee twice last nite. And I actually went two nights without waking up in a puddle.

But it's definitely starting to be the time of year for dry, itchy skin and hangnails, especially after spending some time in the pool. I'm moisturizing my hands twice a day, using only Cetaphil bar soap in the shower, and drinking as much water as I can choke down, but I'm still feeling shriveled. Also, I seem to have regressed back into chronic constipation, so back on the glycolax, I guess. This sucks, because the last time I got the glycolax filled, it was from a different generic manufacturer. The stuff tastes bitter and yucky and never seems to dissolve fully, unlike the last two batches I had. Yuck.

Making a case

Last Friday, I got a visit from a friend. T's not somebody I feel I know well, mostly because he lives elsewhere, but a guy who's a little older and a little smarter than me, the kind of guy I wish I knew more of. Anyway, T came over Friday evening and we had a lovely meal with some really nice wines he brought with him, and a couple neighbors popped in for a glass, and it was really great. I made a squash bisque and roasted a couple chickens and we had a little fancy chocolate tasting after the meal. Nice.

T. spent the night, and we were both up and about at 7:30 or so the next morning, and we got into this kinda long conversation about me and MS. T's a lawyer, too, has a fabulous analytical mind and a very easy-going manner, and he started out with an open-ended question like "So how's your health?" or something like that. I gave him the sort of autopilot answer that I give without thinking, something like, "Oh, not too bad, I guess" or something like that. I don't remember exactly how it went from there, but he just started to ask a few more questions that made it clear that he really wanted to know how things were going.

T wasn't so much interested in any of the history, but really seemed interested in a pretty deep account of where I'm at are now. It's been a long time since I had a conversation like that. I don't have a very large social circle, just a few close friends and assorted medical professionals; these people either know the whole story, because they've participated in it, or they don't, because they haven't asked or because I'm kinda tight-lipped.

Anyway, the theme, I guess, was coping: How do you do it? Why do you do it? What makes some people able to do it, but not others? T's got a pretty close friend with MS (also a lawyer) and he talked about his admiration for those of us who manage to retain some level of control over our situations and his dismay at his inability to understand others who seem unable to cope, particularly a couple of members of his family who've lost or are losing battles with alcoholism.

I don't remember much about what we said, although we went on for an hour or so. But I remember feeling strangely satisfied that I'd stated my case, that I'd been called on to give an account of my experience of my illness--how it feels, and how I live with it--and had been judged worthy. I guess I like to think of myself as a person who doesn't like to feel like he owes anyone. I want to make do for myself, meet life on my terms, but I know that I often feel a contradictory urge to prove that independence. Saturday morning, I had the feeling that I'd made a persuasive argument.

Booze news you can use

Whatever your political leanings, tonight will almost certainly be cause for celebration or lamentation. Champagne glasses will be raised in triumph, and bourbon will be slugged in bitter defeat. According to the NYT, if you're gonna be drinking tonight, you might feel better in the morning if you nix the cheap brandy in favor of some high quality vodka. Snip:

Experts say that the type of alcohol you drink does make a difference, but for various reasons. Among the most important is the amount of congeners (pronounced CON-juh-nurz) — complex organic molecules, like methanol — in a particular drink. Impurities in poorly refined spirits like cheap vodka can also play a role, but congeners, which are common in darker liquors, seem to have the greatest effect.

According to one report in The British Medical Journal, which looked at the effects of different types of alcohol, the drink that produced the most hangover symptoms was brandy, followed by red wine, rum, whiskey, white wine, gin and vodka. Another study showed that bourbon was twice as likely to cause sickness as the same amount of vodka.

I voted this morning and hope to find some way to forget the whole deal until tomorrow morning. As a moderate lib, I'd like to see control of the House shift, but I've got no illusions about what little impact that would have on the issues that matter to me. It just means that we return to being a country where it's hard to change the law, which is how it ought to be.

About time

A week and a half after my last visit, the pain clinic finally called with my new med instructions. Apparently, they'd been playing phone tag with another of my posse of health professionals. I was pretty sure that was the problem, but I resent that nobody saw fit to tell me that. I called them a half a dozen times, but couldn't get a status report until just this morning. In my profession, if I told a client I was going to take a specific course of action, but failed to do so and failed to explain that to the client, I would be subject to professional discipline.

Anyway, the plan is this: 1) stay on 40 mg Cymbalta, but try taking in the morning instead of bedtime; 2) add 10 mg of amitriptyline at bedtime, increasing by 10 mg/week up to 30 mg; and 3) decrease to 300 mg of Serzone now, then drop by 50 mg per week until I get down to 200 mg. This is all to get me better-quality sleep at night (the amitriptyline is supposed to help with bladder stuff) and to ensure that I don't develop serotonin syndrome. If it goes well, then we can talk about increasing the Cymbalta to further reduce the pain.

Initially, I thought, Wait, this plan looks like gives more weight to helping me sleep than it does to actual pain relief. But then I remembered how last nite I got up to pee 8 times and how, when the alarm went off a 6:15, I just about cried. So I think maybe it's just fine if we're focusing on sleep first. It certainly seems at this point like it might be the easier problem to solve.