Access to Health Services


The US doesn’t provide equal access to health services.

That’s not up for debate. The Centers for Medicare and Medicaid Services has created a set of interactive charts showing who has access and who doesn’t.

The example below is for home health services. Basically, nursing homes/rehab facilities are expensive. The average cost of nursing home care is $9,200 per month. That’s  more than many families can afford. That’s especially true for seniors, as Medicare only covers the first 100 days of nursing home care. The rest is the responsibility of the patient.

The viable alternative to nursing home care is home care, but families sometimes require assistance from trained professionals in providing this care. At $3,600 per month, that’s a lot less than a nursing home, although still not cheap.

Unfortunately, a skilled facility isn’t always available.

The map shows the average number of home health care providers per county.

  • Certain states are well provisioned: Arizona, California, Connecticut, Florida, Illinois, Massachusetts, Michigan, Nevada,, Ohio, Oklahoma, Texas and Utah.
  • Certain states aren’t: Arkansas, Iowa, Kentucky, Mississippi Montana, North Dakota, South Dakota, West Virginia and Wyoming.


When we look in detail at the better served states, we see that services are primarily in urban areas. Smaller towns and rural areas are poorly served. The examples of Illinois and Texas are shown below. In Illinois, services are concentrated around Chicago and the St. Louis suburbs. In Texas, the concentrations are around Dallas, Austin and Houston. West Texas is relatively poorly served.



(Sorry about the chart titles: that’s a problem with the jpeg download from the CMS site. The titles are supposed to read “Home Health — Average number of providers per county”)

Why don’t voters hold their politicians accountable for the lack of services?

For that matter, since Mississippi and West Virginia are at the rock bottom on almost every measure of quality of life, why does anyone live there?



Opiod Deaths and State Law


There were 71,000 fatal drug overdoses in the US in 2014. Roughly 2/3 of these (47,000 deaths) involved opiods, rather than heroin, cocaine or other substances. To put that in perspective, there were 13,472 murders in the US in that year.(2) Yes, opiod addiction is a big deal.

Opiod overdose requires immediate treatment. Those overdosing are usually not alone, but companions may be afraid to call 911 for fear of arrest and prosecution. Some states, primarily in the Northeast, have passed “Good Samaritan” laws exempting callers from prosecution, but the level of protection provided by these laws varies from state to state. Vermont provides expansive protection. Ohio has limited protection, excludes those on parole from being Good Samaritans, and provides loopholes that can enable other prosecutorial action.

Here’s another drug war we can lose.

Ad hoc, fragmented, uncoordinated state laws accomplish nothing expect filling for-profit prisons and increasing taxes. Punishment for addiction makes little sense. Rehabilitation is nonexistent.


  1. Steven H. Linder, MD; Kathryn K. Hodge, MD; Evan M. Baker, PharmD; Lisa C. Huang, MLS, “Opioid Overdoses: Prosecution Risk and the Need for Naloxone,” Medscape, 26 July 2017.


ACA: Equality and Justice for All


Every ACA repeal bill offered by the GOP this year has been a horror show, designed to cut taxes for the affluent while raising costs and reducing access for everyone else. The backstory of the healthcare debate has been to free up government funds to enable tax cuts primarily for the wealthy.  It’s not good health policy and it’s not good economic policy. It’s greed, nothing more.

If you believe in the concept of fairness, if you believe that the Declaration of Independence isn’t just a scrap of paper, or if you believe that the Preamble to the Constitution is meaningful, then you have two new heroes this week.

We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.

These are rights for everyone, not just the more fortunate.

So let me introduce to you the two major risk takers of the Senate, Lisa Murkowski (Alaska) and Susan Collins (Maine). Senator McCain could kill the bill because these two stood firmly against it. It’s called placing citizens and Country above party and donors.


(Source: Huffington Post)

Full disclosure: There are parts of the GOP bills that would have helped me. However, I’m not willing to place my own interests ahead of what I know to be true and just. Rich or poor, we are all fellow travelers to the grave. Or as the country song says, “never seen a hearse with a luggage rack.”

Blue Light Special (aka Sleep, What’s That?)


For older American shoppers, the “blue light special” had a special meaning years ago.StarryNight_by_Van_Gogh

For people who need sleep, it has a special meaning now.

According to researchers at the University of Houston, the blue light from computer and LED TV screens disrupts sleep patterns.

Blue light is a major component of sunlight. However, it is also emitted by LED screens. It suppresses the production of melatonin, the chemical that prepares the human body for sleep. Basically, the blue light from the device tricks the body into thinking it’s still daylight.

In an experiment, when younger adults (17 to 42 years of age) wore special blue spectrum blocking glasses to bed, they

  • Showed a 58% increase in melatonin levels
  • Fell asleep faster
  • Reported better quality of sleep
  • Slept 24 minutes longer

Why does this matter?

  • Up to 40% of Americans have reported some disruption to their daytime activities due to loss of sleep.
  • Impacts include
    • There’s loss of focus at home and friction with family.
    • Loss of productivity at work or school.
    • Risk of suicidal behavior.
  • Then there’s the all-night binging at computer games. This may play a key role in understanding that behavior.

Sleep matters.


  1. Lisa A. Ostrin, Kaleb S. Abbott, Hope M. Queener. Attenuation of short wavelengths alters sleep and the ipRGC pupil response. Ophthalmic and Physiological Optics, 2017; 37 (4): 440 DOI: 10.1111/opo.12385
  2. University of Houston. “Artificial light from digital devices lessens sleep quality: Melatonin skyrockets when blue light is blocked.” ScienceDaily. ScienceDaily, 28 July 2017. <>.
  3. Dan Douglas, “All-night gaming binges: why do we do it, and what does it do to us?” Gamesradar, June 2017.
  4. Donovan Vincent, “16-hour video game binges almost ruined Calgary teen’s life,” The Toronto Star, 5 March 2017.

Restoring Brain Function


I don’t usually write about early or animal-phase research, but this is potentially quite important for those dealing with dementia, related illnesses, and brain injury.

The protein amyloid beta is believed to be the major cause of Alzheimer’s disease. This protein basically clogs cells and causes neurotransmitters in cells to become hyperactive, generating noise that interferes with thinking and memory.

That leaves three interesting questions:

  • What triggers the production of this protein?
  • Is there a way to shut production of the protein down?
  • What happens if we do?

A team of researchers at the University of Munich (Germany) have identified one such substance, of a category known as BACE inhibitors, that is effective in reducing the amount of amyloid beta in brain cells. Tested in mice, with the inhibitor included in their food for eight weeks, the result when beyond what the researchers expected:

As expected, the mice had less amyloid beta in their brain after this period, since its production was inhibited. However, the effect of the substance was much more far-reaching: the animals’ brain functions actually normalized. There were fewer hyperactive nerve cells, and the slow-wave brain patterns once again resembled those in healthy mice. A key finding for the scientists was the observation that the animals’ memory also improved.
(1 is the original journal article; 2 is the report in Science Daily for non-technical readers.)

Basically, functioning was restored to a level comparable to healthy animals who had never had the disease.

These researchers are planning a human clinical trial.

What makes this a really big deal is that amyloid beta is also a factor in traumatic brain injury (TBI). This presents a possible and quick route to restoration of brain function for both dementia and TBI victims. It is not a “cure” for either, but for the victim and their family, the potential is life-changing.

It’s amazing what you can find buried in a list of breaking scientific news.


  1. A. D. Keskin, M. Kekuš, H. Adelsberger, U. Neumann, D. R. Shimshek, B. Song, B. Zott, T. Peng, H. Förstl, M. Staufenbiel, I. Nelken, B. Sakmann, A. Konnerth, and M. A. Busche. BACE inhibition-dependent repair of Alzheimer’s pathophysiology. Proceedings of the National Academy of Sciences, 2017 DOI: 10.1073/pnas.1708106114
  2. Technical University of Munich (TUM). “Dementia: BACE inhibitor improves brain function: BACE inhibitor successfully tested in Alzheimer’s animal model.” ScienceDaily. ScienceDaily, 28 July 2017. <>
  3. . Amyloid imaging with carbon 11-labeled Pittsburgh compound B for traumatic brain injury. JAMA Neurol. 2014 Jan;71(1):23-31. PubMed.
  4. ALZFORUM, “Imaging Reveals Amyloid Up To a Year After Traumatic Brain Injury,” 16 November 2013.
  5. VE Johnson et. al., “Traumatic brain injury and amyloid-β pathology: a link to Alzheimer’s disease?” Nat Rev Neurosci. 2010 May;11(5):361-70. doi: 10.1038/nrn2808.
  6. Rebekah C. Mannix and Michael J. Whalen, “Traumatic Brain Injury, Microglia, and Beta Amyloid,” International Journal of Alzheimer’s Disease, Volume 2012 (2012), Article ID 608732, 5 pages.

The Groupthink Epidemic


Groupthink, a term coined by social psychologist Irving Janis (1972), occurs when a group makes faulty decisions because group pressures lead to a deterioration of “mental efficiency, reality testing, and moral judgment”.  Groups affected by groupthink ignore alternatives and tend to take irrational actions that dehumanize other groups.  A group is especially vulnerable to groupthink when its members are similar in background, when the group is insulated from outside opinions, and when there are no clear rules fGroupThink-300x141or decision making. (1)

Simply, this is how companies, governments, investors and families and individuals drive themselves over cliffs:

  • Bad mergers
  • Bad proposed laws or invasions
  • Investment fads
  • Poor decisions about marriage, divorce of having kids
  • Suicide bombers

just to name a few examples.

The process is pretty simple.  You surround yourself with people who share your opinions and use that agreement to reinforce your beliefs regardless of any contradictory information. Then you make important decisions based on those beliefs. Then you just have to wait for the crash.

No one is immune from groupthink. In fact, human nature tends to encourage it. Most people are conflict-adverse. They don’t like tension. They don’t like disagreement. So they gravitate to people who share like opinions and don’t say anything if they disagree.

Companies make merger decisions based in part on groupthink, which helps to explain why 90% of them fail. Spend a lot of money to buy a company, then sell it cheap when the merger fails. Great for shareholder value.  Examples:

  • 2008 Arby’s acquisition of Wendy’s. That merger lasted 3 years.
  • Also in 2008, Bank of America’s purchase of Countrywide financial. “The bank paid just $2.5 billion for Countrywide, a deal that ended up costing the bank more than $40 billion.”(2)
  • The combination of K-Mart and Sears. Yep, that’s worked.

Politicians and generals make bad decisions on a regular basis.

  • How about the 2003 invasion of Iraq, looking for phantom weapons of mass destruction. Despite the evidence, some people still believe they were real, instead of the imagining of disgruntled Iraqi emigres who wanted the US to toss Sadam.
  • What about the current debacle over healthcare reform? Clearly a group in the Trump administration felt that Congress would submissively obey their demands.

The fiberoptic cable investment bubble of the late 1990s is an example of groupthink. It was mathematically impossible for demand to double every year, but during the bubble, no one thought about it.

Marriages can begin or end influenced by groupthink. In this case, it’s called peer pressure, but that may not be as good a term. Being surrounded by people who think a marriage or divorce should happen increases the odds that it will happen.

Suicide bombers? How does anyone with any intelligence convince themselves that there are 46 virgins waiting to greet them in an afterlife? By surrounding themselves with people who share the fantasy and drawing strength of conviction of peers. To some extent, that’s how every religion and political movement works.

How do you avoid groupthink?

  1. Recognize that smart people will have different points of view on virtually any important issue.
  2. Surround yourself with smart people, not “yes people”.
  3. Listen to differing points of view. Encourage debate. Understand the values that are competing in any decision.
  4. Avoid labels that antagonize. They inhibit open discussion.
  5. Find data that both support and contradict. Don’t ignore data that disagree. Instead, figure out how it makes sense and how it changes the decisions you need to make.
  6. Read Kuhn’s “Structure of Scientific Revolutions.” This thin book should be required reading for anyone with a brain.

Above all, remember, humans don’t do perfect. If you think something is perfect, you’re missing something important. If you think you have all the answers, you’re wrong. Unless you’re a god, of course.


  2. Huffington Post, “9 Mergers that Epically Failed,” 23 February 2013.
  3. “5 Odd Things that Raise Your Chances of Divorce,” Newser, 2 June 2015.