Showing posts with label health. Show all posts
Showing posts with label health. Show all posts

Saturday, September 11, 2010

Reconsider Healthcare

While on my bicycle ride across the country, I picked up a book by Patrick Lynch called Omega. This book was remarkably well written, and communicated in the clearest possible way the danger of antibiotic abuse. Using antibiotic measures can result in microorganisms developing genetic resistance, potentially making them more menacing. In fact there are known strains of such dangerous organisms, like MRSA aka Methicillin-resistant Staphylococcus aureus, which is named for the fact that it is resistant to antibiotics. MRSA is found most frequently in hospitals and other medical care facilities, perhaps not coincidentally the places where the most extreme antibiotic measures are undertaken. There is no question regarding the effectiveness and necessity of a sterile environment for medical practice, but it seems very clear that the tradition of doing so in one large building is not the best way to achieve said sterile environment, and thus not the best way to conduct medical procedure. There is further evidence in the grim fact that babies born by Cesarean section are more likely to have their skin be populated by the hospital flora in the absence of vaginal flora, which in many cases means MRSA and other scary bugs; MRSA is known to live on human skin and in the nose without necessarily infecting the carrier. If you are sensitive to graphic medical imagery, I'd recommend not looking at pictures of the effects of MRSA.

The really unfortunate thing is that C-sections are still increasingly popular in the USAs medical-industrial complex despite growing activism (documentary: The Business of Being Born, available on Netflix), whereas the rest of the world has continued the ancient tradition of home birth with a midwife.

The most obvious solution is that healthcare be undertaken in a physically distributed fashion by way of house calls. What else might help?

Sunday, August 15, 2010

Rise of the Velomobile

The velomobile will be the next great technology to reach ubiquity. 

(Assuming that everybody behaves in a perfectly rational manner, which is not a safe assumption, unfortunately)

Near the beginning of August the web was abuzz with news that obesity incidence in the US has continued to increase; more recently, it was suggested that obese people visit general practitioners more frequently than smokers and generally unfit folks. Obesity is bad, this is not news--with the distributed costs of public health care, obesity is even worse. Another bit that isn't news is that a moderate, sudden, and sustained escalation of petroleum prices, perhaps as a consequence of finite/dwindling supply, would likely lead to cataclysmic economic destabilization because of our profound reliance upon it--a point practically self evident in the most rudimentary economic perspective. Of course for whatever reason many more people have petroleum centric anxiety manifested as fear of global warming, for which the more dire consequences won't happen until a fair while after we've already run out of gas if we keep increasing our consumption.

But for a culture in which the automobile was supplanted by the velomobile, these problems amongst many others would be made irrelevant.

What is a velomobile? It's a pedalcar, resembling a grown-up soapbox racer with bicycle pedals. This is a velomobile:



The typical modern velomobile is little more than tricycle recumbent with a fairing, but these two things together make for something of an advanced vehicle. Here's what it looks like in the cockpit of a good DIY velomobile that was constructed for under $1500 (full flickr here):



Recumbents are increasingly popular as they can provide more comfort than the usual bicycle and also utilize the mechanical advantage from having lower back support while pedaling. The fairing adds the benefit of aerodynamics, a good thing as air is the principle force that slows a cyclist. But the fairing does more than that: by enclosing the tricycle, it is suddenly a vehicle equipped to ride in inclement weather; perhaps even more important, what was a bike now strikes the casual bystander as a car. Unfortunately the fairing adds weight... and with intuition it becomes clear that with the minor addition of a small electric motor, this vehicle is the most sensible form of transportation ever devised.

On flat terrain with no wind, an average person can sustain 25 MPH in a velomobile without much difficulty. With an electric motor I'd expect one would be able to sustain 25 MPH while going up a decent hill.

There are many exciting things about velomobiles--by my figuring they potentially represent the cheapest, safest, cleanest, healthiest, and most sustainable form of transportation ever conceived--but the most exciting thing about it all is that like bicycles there's already an international legal precedent for their use on public infrastructure. In the US a velomobile is classified as a moped, as long as it has pedals and doesn't exceed 20 MPH (varies by state). Because of this a velomobile can be piloted on public roads with all the rights of a cyclist, which tend to be more generous than the rights of motorists, no registration or insurance necessary. Newer velomobile designs incorporate headlamps, turn signals, and brake lights; with an electric motor you could drive with city traffic as though you were one of the internal combustion monstrosities. The biggest problem with velomobiles is that they haven't caught on yet, and as part of that, nobody has been able to produce one on a large scale for a price within reason.

This is an incredible custom velomobile, replete with water-filled airbag suspension (full flickr here):


This velomobile is somewhat commercially available, total price >$6000 (retail site here, worklog here):



With the widespread adoption of velomobiles our country could reap the benefits of increased general health with vastly reduced vehicle related expenditure, and thus an increase in overall prosperity. Perhaps even more important, we'd reduce our exposure to calamity by decreasing our extreme dependence on a steady (and foreign) supply of petroleum at a steady (and low, and further subsidized) price. Not that I think adoption should be limited to US.

Wednesday, April 21, 2010

The Secret to Weight Loss

This is a "common misconceptions" post that I've been meaning to do for a long time, and thanks to a recent article in The New York Times I finally have a good reason. More on that later.

Everybody knows weight loss is a big deal, the fact is obvious from the astounding range of products/services with weighty promises (lose 30 pounds in 30 days!!!); the advertisements assault us constantly, from every possible angle. Given that the majority of US Americans are considered overweight in a culture with highest regards only for the exact opposite build, it's really no surprise that weight loss is big business. The real surprise is just how successful such ventures are when practically all of them make explicitly outrageous claims and just as many (if not more) are wholly ineffective. The truth is that with few exceptions commercial weight loss products are simply fraudulent--they are designed to take your money, not to help you lose weight.

I know the secret to losing weight, and I'm willing to share it... for free! It is very simple, and not simple in the subtly very complicated way, just simple. Ready?

How to lose weight:  Eat less.

 It's a matter of physics. Imagine an extreme case where a person doesn't eat or drink anything; by the very laws of nature and obvious from elementary intuition, it is impossible for that person to gain weight. This would be just like setting a scale in a sealed room: it would be very silly to think that the scale might at any point suddenly measure any more weight than it has all along. Humans are magnificently, extraordinarily, incomprehensibly complex systems, but that doesn't exempt us from the laws of physics. Unless more stuff is added to a body, that body will either maintain or lose weight. In case it isn't obvious, let me remind you that abstaining from all consumption for longer than a little while is a bad idea--remember, the rule is to eat less, not to eat nothing.

Let's explore the physics in slightly more detail. The main reason we eat is to supply our body with energy; our bodies need fuel to keep the magic alive, just like a car needs gas to move. Clearly it would be a bad setup if the energy we consume couldn't be stored, like a car without a gas tank we wouldn't get very far. There are a variety of ways the human body can store energy, but the presently relevant one is best known as fat. Call me crazy, but next time you see that extra bit of flab, try being grateful--if it weren't for that "unsightly" bit of excess, a few missed meals would result in death. I don't know about you, but I'd rather have a less than optimal social image than be dead.

So fat is stored energy, but what's this energy? Is there any way to quantify it so that its consumption might be regulated? In fact, yes, there is! The energy in food is also known as Calories, which is actually a kilocalorie or 1,000 calories. A calorie is a unit of energy, just like an hour is a unit of time. If you eat 2,000 Calories in a day and only use half of them, the rest will be stored, with some portion of them being stored as fat, it's as simple as that! If you are gaining weight and it's not because you're building muscle mass, you are eating more energy than you're using. Here's the Eureka moment!

How to lose weight (revised): Eat fewer calories than you use.

But wait, what about fatty foods, exercise, and metabolism, don't these play a major role in weight loss? Lets look at each of them.

Fatty Foods
One of the strongest diet related misconceptions around is that eating foods with excess fat, saturated, unsaturated, or otherwise will lead to increased body fat. This isn't true, food fat doesn't automatically turn into body fat. Perhaps this misconception arose because lipid nutrients and adipose tissue are both known colloquially as fat, but the notion that consumed lipids will transform into adipose tissue is as silly as the notion that eating brain will make a person smarter. Anybody can eat pure fat every day and lose weight, because the amount of fat in a food doesn't matter for weight management, what matters is the amount of Calories in the food and how much food (ergo how many Calories) is consumed. It's true that fat, with 9 Calories per gram, has a higher energy density than protein and carbohydrates, which have 4 Calories per gram, but for the purposes of weight loss this is moot--all Calories in a food, regardless of the source, are accounted for by the "Calories" figure on every nutritional label. Predictably there's a fair degree of complexity in how effectively food energy is captured, but the given number of Calories represents the maximum; if you closely regulate energy intake, you will realize there are no magical foods that cause body fat. Often, however, energy intake is far from regulated, far even from monitored, and it is very easy to underestimate how many Calories are eaten in a day. One case deserves special mention: high-fructose corn syrup (HFCS), the modern sweetener du jour, has been shown in a recent Princeton study to lead to more weight gain in mice than equal amounts of cane sugar. The theory I've heard is that HFCS is far more easily digested than cane sugar, and since digestion requires energy, HFCS results in more energy than an equal amount of sugar.

Exercise
When people think weight loss, they usually think exercise. It's always a point of contention when I say it, but exercise does very little to hasten weight loss. The reason is that the body burns a lot of energy no matter what its doing; for most people exercise causes only a marginal increase in energy consumption from the already high baseline. Remember the NYTimes article I mentioned? Here's a quote from it:
“In general, exercise by itself is pretty useless for weight loss,” says Eric Ravussin, a professor at the Pennington Biomedical Research Center in Baton Rouge, La., and an expert on weight loss.
The exception here is athletes, whom require many more calories than everybody else. This is because athletes have bodies that are especially efficient in utilizing energy--in other words, they have a higher basal metabolic rate. For those of us who aren't professionally physically fit, the connection between exercise and weight loss isn't anywhere near as clear cut. For more information on this topic I recommend reading the aforementioned NYTimes article: "Weighing the Evidence on Exercise." Beyond weight loss, keep in mind that frequent aerobic exercise is universally acknowledged as a critical component in the maintenance of cardiovascular health.

Metabolism
One of my pet-peeves, if you can call it that, is when people disseminate false information. We live in an age when almost the full knowledge of Earth is accessible on demand, so the reasoning goes that it's time we stop defaulting to wild speculation and just google it. Of course I have nothing wrong with wild speculation, my displeasure arises when the speculation is presented as fact. I'm bringing this up because it's relevant to the topic at hand, metabolism. Everybody has heard the word, it's used all the time, especially in regard to weight management, but what does it mean? What is metabolism? For all the mention it gets, I'd think everyone would be familiar with what exactly was being referred to. If you visit the Wikipedia page for metabolism, you might find that the subject is rather complicated; the summary refers to cellular respiration, metabolic pathways, and the carboxylic acids that are part of the citric acid cycle. That doesn't sound like weight loss! Metabolism is something of a shotgun term that refers to the chemistry of life. The basal metabolic rate is a bit more specific, as it refers to the amount of energy an organism expends while at rest and in a post-absorptive state. Since basal metabolic rate is roughly energy expenditure, it must be able to indicate how many Calories are needed to manage weight, and indeed it does. Interestingly enough, metabolic rate is strongly correlated with lean muscle mass and the same figure has been arrived at for all people: 16 Calories per pound of lean mass per day. This means an estimate for how many Calories you need each day can be found by multiplying your lean mass by 16. This also indicates what has been shown in other studies as well: the best known way to increase the basal metabolic rate is by increasing lean muscle mass.

Just one final note: losing more than a pound or two a week is neither healthy nor permanent.

Saturday, August 15, 2009

A Radical Proposal

What if you could decrease the US's oil consumption (and the foreign dependence requisite therein), cut greenhouse gas emissions, increase general public health, reduce obesity substantially, and preempt cardiovascular deterioration in one stone's throw? It isn't difficult to imagine how it could be done, they're all related problems.

In the USA:
Percent of all energy consumption that is used for transportation: 29
Percentage of that energy used that comes from oil: 95
Percent of all trips that are 3 miles or fewer: 50
Percent of those that are driven: 72
Percent that are by bicycle: less than 2
Percent of all trips that consist of driving 3 miles or fewer: 36 
Percent of bicycle trips that are 3 miles or fewer: 85
Estimated average speed of a moderately fit cyclist: 12 mph
Time for this cyclist to cover 3 miles: 15 minutes
Estimated time for a lawful driver (regardless of physical fitness): 15 minutes
Estimated gasoline used by the car to cover 3 miles: 0.1215 gallons
Amount of energy this represents: 15,800,000 joules
Estimated energy expended by the cyclist: 135,000 joules
Estimated additional food calories the cyclist burned: 32
Estimated total food calories the driver burned: 29
Amount of food calories the car burned: 3,775
Food calories in a gallon of gasoline:  31,070
Example daily Caloric intake of an ultra-endurance athlete: 6,000
sustained horsepower of Lance Armstrong: 0.67
sustained horsepower of an average male: 0.20

In Amory's video below, it is mentioned that less than 1% of the energy consumed in moving a vehicle is moving the driver - obviously, too, the car weighs an awful lot more than you do and weight costs energy to move. So we are wasting 99% of our highly condensed energy to move a hulking steel shell a couple of miles. Cars are great vehicles for moderate distances, 30 miles and up at least, but they're too wasteful for anything less--just the same as how you wouldn't taxi an airplane to travel a few miles.

But wait, weren't we supposed to be talking about health? Where does health fit in? Right here.

Bicycles. Yes, they've been around for ages, all the laws regarding their use are (internationally) in place, they're cheap, familiar enough in culture to not be mocked (ahem, Segway), and just about every business has some kind of object a bicycle can be locked to, usually closer than the handicapped parking space. The bicycle is a legitimate form of transportation; having ridden a bicycle the ~3,600 miles that span the US this is a statement in which I have authority to represent. A healthy human being can sustain an average of 15 miles per hour for one hour without much problem. The result is that anything within a few miles of where you are is a short bike ride away. For me, and I'm nowhere near as in shape as I was, riding my bike 3 miles takes about the same time as in a car. When closer, the bike is definitely faster in most cases, and a whole lot more pleasant. Of course, the more you ride a bike the more fit you become, and so forth. If everyone were to abandon their cars for short distances, the streets would be flooded with cyclists. You wouldn't need to worry as much about being hit by a car because there wouldn't be near as many cars, and many of the people who were driving would realize what it would be like to be a cyclist and would drive more defensively. Bicycle collisions aren't much of a worry, nothing like auto collisions which are the 4th greatest cause of death in the US--cars are, to people, a disaster; the human brain is not built to process the number of things at the speed required for driving, as much is clear in the amount of accidents that happen every day. Add on top of this our increasing distraction by the fast pace of modern life (drivers on cell phones, grrr) and that a four thousand pound vehicle (such as an average SUV) moving at 35 mph has tremendous kinetic energy, about 11% of a stick of dynamite: kinetic energy is 1/2 * mass * velocity squared, which ends up as 222,088 Joules. A stick of dynamite has around 2.1 million Joules of energy, so the percent of dynamite's energy the vehicle has is 10.6%. The result is clear: people just shouldn't be allowed to drive, we aren't capable of doing so safely. I love driving a lot, but there is no question here, no way to justify allowing people to drive. The way to make a vehicle inherently safer is to reduce its energy, which means lighter and slower; bicycles are singularly wonderful in that they represent one of the lightest forms of transportation conceivable, however even they are not perfect, as in the wrong hands they can be tricked into traveling at dangerous speeds ;)

Pushing cars off the road and people into the streets with motivation/education for physical fitness is, very unfortunately, not enough. We need to truly revolutionize our understanding of existence--not a new same-as-usual car with an astonishingly expensive marketing campaign that uses the word "green" a lot. In this small domain of personal, local transportation we already have the technology, we just need to use it!

The craziest thing about the low utilization of bicycles is that self-powered transportation would be an overwhelmingly positive thing for the majority of people. It comes down to health, wealth, and happiness.

Wealth is obvious, bicycles are a lot cheaper than cars, even absurdly expensive bicycles. 17% of the average USAmerican yearly income goes to transportation, which is the second largest spending category after housing. Furthermore cycling naturally supports the very local economy, which the cyclist necessarily participates in and at least indirectly benefits from. The savings can even be realized directly with participation in the Bicycle Benefits program, with presently almost a hundred local, conscientious businesses (some of my favorite) offering incentives such as 10% off purchases.

A widely accepted goal for life is to live a long and healthy life. Healthier lifestyles would substantially reduce the majority of deaths, including their often extensive associated medical care/cost, by the biggest killers (followed by the chance any person will die from it):

1. Heart disease, 1 in 5
2. Cancer, 1 in 7
3. Stroke, 1 in 24
4. Motor vehicle accident, 1 in 84
5. Suicide, 1 in 119

I included suicide because there is evidence that shows exercise effective in mediating the symptoms of depression. There is no reason I know of to imagine that an active society will have significantly reduced cancer rates (except for the decrease in environmental pollutants), as the many causes of cancer aren't so well understood. For the next greatest causes of death some arguments could be made for the effectiveness of cycling in prevention, though they get weaker: number 6, falling, could be diminished by increased muscular fitness of elderly folks and increased spatial coordination for (tragically) clumsy people; number 7, firearm assault, could be decreased by the increase in social interaction that is inevitable when you aren't enclosed in a glass and metal box and by increasing the wealth of immediate neighbors through the support of local economy. Number 8, pedestrian accidents, would clearly decrease with the amount of cars on the road and number 9, drowning, could also decrease with increased general fitness. Of course each of these causes have instances in which the fantasized bicycle culture won't help, but there is little question that increased mean health of the population ultralight human powered vehicles would have an incredible impact on healthcare expenses. There is no other way to say it but that bicycling is a miraculous thing that a (growing) few take advantage of. Riding a bike leaves the air cleaner, your self happier and your body healthier, where's the downside? You can't say safety because cars aren't safer, car accidents kill way more people than bicycle accidents. There is no downside, ride your bike.