Posts Tagged health
USA health care system “Pareto-inefficient”?
Being a Certified Quality Engineer (CQE) I am well-versed in the Pareto Principle – a term coined by quality guru Joseph Juran for what’s commonly known as the 80-20 rule. When I was the team leader for manufacturing improvement projects, I’d start by categorizing causes for failure and graphing them on an ordered bar chart — most to least, while keeping a running tally on the accumulation in terms of percent. (See this primer on Pareto by the American Society of Quality.) Typically the first 20 percent of causes created 80 percent of the failures – that’s where I first focused the firepower of my quality team.
Today I learned of another concept attributed to the great Italian economist*: Pareto inefficiency. The Concise Encyclopedia of Economics explains that a “Pareto-optimal allocation of resources is achieved when it is not possible to make anyone better off without making someone else worse off.” I found this detailing by The New School which is too much for me to completely digest, but my attention was caught by this heads up:
“An economy can be Pareto-optimal, yet still ‘perfectly disgusting’ by any ethical standards.”
– Harvard Economics Professor Amartya Sen (1970)
So, while I am enticed by the idea that we can make most everyone (80 percent?) better off without making the others (20 percent?) worse off, I remain skeptical. However, having seen what a focused quality improvement team can do with the aid of Pareto charts at a micro level, I remain hopeful that some big strides can be made at the macro level for health care nationwide.
Do mental workouts keep your mind sharp?
Yesterday when I saw a Christmas card in our post-box, I wondered who went right down to the wire with their mailings this year. It was my last card returned for lack of address. I only put the name on the envelope — no postal address. Could this be a sign of my mental decline after age 50? Earlier this month (Dec. 2), I watched NBC’s “Saturday Today” with interest as a fellow only a few years older than me took a test for his brain age. He was horrified to be rated in his ’80’s mentally, but after a session of exercises prescribed by Dr. Gary Small, director of UCLA’s Center on Aging, this guy got down to near the ideal of 20 years of brain age.
The ideas gained by men before they are twenty-five are practically the only ideas they shall have in their lives. — William James (1893)
According to an article by Debbie Geiger of Best of New Orleans, Dr. Small recommends cross-training for the brain, for example by solving visual mazes with your right-brain and completing crossword puzzles with your left. To facilitate mental workouts, you could make use of resources on the internet, such as Happy Neuron, or buy a new computer game by Nintendo called Age: Train Your Brain in Minutes a Day! It includes Sudoku math puzzles and word quizzes, and the software tracks your progress over time. More recently the game-maker released Big Brain Academy (see review by Walter Mossberg of the Chicago Sun-Times). Both of these Nintendo games are based on the theories of Japanese brain researcher Ryuta Kawashima. Ironically, he initially earned the ire of the software publishers by claiming that their computer games stunted brain development.
It seems prudent that, before investing money in software and time to do mental exercises, one should see whether scientific evidence provides any support for such expenditures. This week the Washington Post reported positively on mental exercise based on a randomized controlled trial detailed in the Dec. 20 issue of the Journal of the American Medical Association. It involved several thousand aging adults (over 65 years) who were divided into groups trained for memory, reasoning, and spead processing. Compared to a control group that received no brain training, immediate improvements were seen by most individuals. However, after five years (with some ‘booster training’ along the way), the effect was only significant for the reasoning group.
These results stike me as being somewhat ambiguous over the long haul. For a more balanced view, I recommend reading Mental Exercise and Mental Aging Evaluating the Validity of the “Use It or Lose It” Hypothesis by Timothy A. Salthouse, which appeared in the March 2006 of Perspectives on Psychological Science. This is a very detailed article that thoroughly reviews relevant studies. In the end, the author’s professional opinion is that the benefits of mental exercise hypothesis stem more from optimistic hope than empirical reality. However he suggests that, one should “continue to engage in mentally stimulating activities because even if there is not yet evidence that it has beneficial effects in slowing the rate of age-related decline in cognitive functioning, there is no evidence that it has any harmful effects, the activities are often enjoyable and thus may contribute to a higher quality of life, and engagement in cognitively demanding activities serves as an existence proof — if you can still do it, then you know that you have not yet lost it.” Sounds good to me, but then what do I know (other than what I knew at age 20-25)?
Stress as factor for cardiac arrest felled along with author who did not sweat the small stuff?
I’m a hard-working guy who suffered a heart attack at age 51 despite not smoking, and staying in shape via regular exercise. Although it was hard to overlook the genetic factor of my younger brother preceding me with his own myocardial infarction (as the cardiologists refer to it), many acquaintances figured that both of us probably created our own problem by being too stressed. After reading this morning that Richard Carlson, author of Don’t Sweat the Small Stuff, passed away on Wednesday due to cardiac arrest, I feel less sure than ever that stress creates heart problems. Ironically at this time just before Christmas, Carlson, only 45 years of age, died en route to an a New York city promotional appearance for his new book Don’t Get Scrooged: How to Thrive in a World Full of Obnoxious, Incompetent, Arrogant and Downright Mean-Spirited People.
The American Heat Association in their detailing of Risk Factors and Coronary Heart Disease puts stress near the bottom of the list and speculates that people suffering from this may overeat, start smoking or smoke more than they otherwise would — all more likely to create problems than stress itself. The most stress that I ever experienced was driving into Manhattan for a Broadway play and getting stuck in a traffic jam entering the Lincoln Tunnel. I made the mistake of being ‘Minnesota nice’ by letting someone wedge into line ahead of me. This precipitated widespread honking of horns from irate New Yorkers waiting impatiently all around me. A cursory internet search on stress studies dredged up Exposure to New York City as a Risk Factor for Heart Attack Mortality. It seems that I cannot yet rest my case against stress being a factor for causing heart problems, especially since Carlson was heading for New York when he suffered his cardiac arrest. 🙁
Drinking twice as much reduces heart attack by factor of three?
After suffering a mild heart attack (an oxymoron!) a few years ago, I asked the cardiologist if it’s true that a glass of red wine a day keeps the myocardial infarctions away. He said “yes.” What about white, I wondered. “That works too,” said he. Encouraged by this, I wondered if beer might work too. The answer was affirmative. Next I questioned whether two drinks might be even better. After that got endorsed by the cardiologist, I quit while I was ahead. I’ve enjoyed one glass of beer or wine, and occasionally a second helping, every day since. Life is good!
Today I was heartened to see in the HeartCenterOnline Newsletter that a study by Beth Israel Deaconess Medical Center in Boston indicates that two drinks daily help men avoid heart attack. At first glance at the following detail I thought I ought to have more than two drinks:
“There were 9 heart attacks in a group of 714 men who drank more than two drinks daily, and 34 in a group of 2,252 who drank less than two a day.” Unfortunately, if you do the math and calculate the percents by comparison, this statistic becomes a lot less compelling for those who like their liquor. I am holding the line at one drink every day for sure and two at the most, but only when I want to really live it up.