Hello friends.

Greetings from Montecito.

Where the days have been either too hot or too cold over the past week. And all the nights are cold. When it drops into the mid-50sF here, people dress like they live in the Arctic. Damndest thing I’ve ever seen.

I got emails, comments and poll responses last week about my taking up my belt a notch after ditching UPF.

UPF and My Belt Tightening

Almost all of the comments were of the I-thought-you-ate-a-clean-diet-all-the-time variety.

Well, I don’t always eat a “clean” diet, however that is defined. I eat a low-carb diet almost all the time. I would guess my average daily carb intake is well under 50 grams. On many days, under 20. Now and then I’ll bump it up, but it’s a rare day when it would go over 100 grams of carb.

I eat a fair amount of dairy. MD and I make our own yogurt, which I have a small bowl of almost daily. I eat a jerky and beef sticks of various brands for snacks, if I’m hungry. When we’re in Montecito, we dine out a fair amount at dinner, mainly because our kid and fam here dine out a lot. So we tag along. I usually have a steak and slaw. But I often use various steak sauces and béarnaise sauce. MD and I often eat a charcuterie plate she whips together for lunch.

When I discovered all the heavy cream we eat was adulterated. I quit using anything but the real stuff. Same with the half and half we use to make the yogurt. I discovered the half and half we had been using, even though organic, was not all half and half, but had other crap in it. We switched to the real stuff. Same thing with cottage cheese, which I absolutely hated as a kid, but which I now love. Most supermarket brands are loaded with stuff besides cottage cheese. You can find the unadulterated stuff, but you have to look for it. (The brand we found is called Good Culture and comes in both low fat (nope) and whole milk versions.

MD will whip out a charcuterie tray from time to time for lunch. I always ate it without thinking. After all, it’s only meat and cheese, right. Well, not exactly. Depends on the brands of meats and cheeses. Some are loaded with all kinds of junk, while others are pretty clean in terms of UPF ingredients. You have to be a careful shopper and be willing to pay a bit extra for the good stuff.

I took a look at the ingredients in the various steak sauces I had been using. Same thing. So I abandoned them.

The meat sticks were awful in terms of ingredients other than meat. I took a look at some commercial mayonnaise, and found it to be full of crap. So I quit eating the slaw at the restaurant we haunt. It is made with commercial mayonnaise, which I suspect is loaded with crud as well as ‘vegetable’ oils.

As I discovered, it’s easy to keep the carbs in range and still get a ton of UPF crap.

So, that’s what I did. I just refused to consume anything that had UPF in it. Instead of the meat sticks, I ate sardines and/or tuna salad made with certified mercury-free tuna (which can be had inexpensively from Costco) and avocado mayonnaise made by my friend Mark Sisson’s company.

I can tell you it takes work and a lot of label reading to avoid UPF, but I think it’s worth it. At least based on my results. The only difficult part for me was that I had a half-gallon of Costco vanilla ice cream in our freezer that had been there, unopened, since last time we were here. If I’m going to bolt from my low-carb diet, I usually do it with a small bowl (and I’m talking small) of ice cream. I whipped out the Costco vanilla only to discover that it contained not one, but two gums. So, sadly, it is still untouched. I hate with a whole huge container of it sitting there to go get Häagen-Dazs vanilla, which contains no gums whatsoever. So I’ve been ice-cream free.

Maybe avoiding all those things substantially reduced my caloric intake and allowed me to cinch my belt tighter. It’s a possibility. But I do believe the UPF played a role.

I would suggest anyone interested give it a try. I guarantee you will be surprised at all the junk you find when you start reading labels closely. If you do try it, let me know your results.

For grins I did an online search figuring someone had done a comparison between processed foods from decades ago and the same brands today. I found one that had graphics showing the difference.

Here are a few. You can see the difference. I have no way to check the ingredients listed in the foods from decades ago, so you’ll just have to take the word of the person running the site. But I suspect they are pretty accurate.

And I don’t think these go back 40-50 years. I suspect if we could find the packaging for these same foods from the 1950s/1960s, they would have fewer ingredients than the ones shown below as the old ones.

I can’t remember the last time I had Hershey’s syrup, but I had plenty as a kid.

I ate a ton of these as a kid.

As an adult, I’ve eaten plenty of cheese dip made from Velveeta. I won’t be so keen to eat much of it now.

This is why I avoid store-bought mayonnaise now. Either MD makes it, or we use Mark Sisson’s Primal Kitchen Avo Mayo. I suspect the commercial stuff used in restaurants is even worse than store bought in terms of how much crap it has in it.

This one holds a special place in my heart. To borrow a frequently used phrase of late, I grew up in a middle class household. The truth is, when I first had Campbell’s Cream of Mushroom soup I was part of a lower-middle-class household. I was in 6th grade and had four younger siblings. We all lived in a three bedroom, one bath house. My parents were struggling to make ends meet.

A common lunch for us kids was Campbell’s Cream of Tomato soup along with grilled cheese sandwiches. We always reconstituted the tomato soup with water and not milk.

One day my mother sent me to the store to get some tomato soup (along with, I’m sure, a pack of Kents, her favorite cigarettes). I whizzed down the Campbell’s soup aisle and grabbed a can of what I thought was tomato soup. But what I picked up accidentally was Cream of Mushroom soup. I didn’t notice. Same red and white can and all…

When I got home with it, my mother was pissed, because a) it cost more, and b) she thought none of us kids would eat it.

She was right about the other four, but I absolutely loved it. I consumed every drop. And I asked for it from then on. Sometimes she would buy it for me, but more often than not, she just got the tomato soup.

Whenever I did get the mushroom soup, I would slurp the liquid part of it and save all the little pieces of mushroom till the end. There were so few they barely made a spoonful. But I would savor that spoonful as my last bite. I promised myself that someday I would be rich enough that I could eat all the mushrooms I wanted.

It’s one of the promises to myself I’ve fulfilled. Funny thing is, I now like mushrooms okay, but I could easily live the rest of my life without eating one again. Not so, however, when I was in 6th grade and got my first taste of them.

You can see by these few examples how the food ingredients have changed over the decades. And our bodies have changed along with them, and not for the better.

As I wrote above, I don’t know what contributed to my recent decrease in abdominal girth. Maybe it was because I ate even fewer carbs by avoiding UPF. Who knows? I didn’t really set out to do an n=1 experiment, or I would have carefully logged what I ate. I just wanted to see if avoiding all the UPF would make me feel better. Not that I wasn’t feeling good when I started, I just wanted to see in general what happened when I avoided the UPF.

Along with all the comments I mentioned above, I got a few from readers in Europe. They were a bit confused. They said when they looked at the labels on their cream, they just listed cream. They wrote that they couldn’t find any brands with the stuff I wrote about last week.

Europe has much more stringent laws as to what can be put in food than does the US. Over here, pretty much anything is fair game. All kinds of dyes, emulsifiers, gums, colorizing agents, stabilizers, preservatives, etc., have been deemed GRAS by the FDA.

GRAS stands for Generally Regarded As Safe. And most of the stuff probably is safe in limited doses, which is how it is categorized. GRAS within certain limits. Food manufacturers stay within those limits. Sometimes. (Read here about the shadowy methods used to determine GRAS.) I hope RFK, Jr. does something about it.

But when you eat all kinds of processed foods, each with its own small amount of gums, emulsifiers, etc., the amounts overall add up. And you may well be over the limit at some point. No one gets drunk on a thimble full of whiskey, but consume enough thimblesful, and you’ll ultimately be sloshed. I suspect that’s what happens with the ingredients that make up UPF.

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UPF, Thigh Fat Redux

Last week I wrote about a study in which researchers looked at the degree of thigh muscle infiltration by fat. Here is the graphic from the study once again.

Just to review, this isn’t from a published study, but is instead from a presentation given at a radiology conference. It will doubtless find its way into a journal at some point, but, as of now, it isn’t peer reviewed. It’s simply a presentation of the findings of the group.

These researchers took data from a study on osteoporosis in which scans were taken of the thigh muscles. The subjects who had osteoarthritis were eliminated from the database, and only those without were included in this presentation. Diet questionnaires from these subjects showed that those consuming the most UPF had higher fat to muscle ratios than those who consumed lower amounts of UPF.

This was not a randomized controlled trial. Far from it, in fact. So no causality can be determined. It’s simply an observational study. These researchers looked at UPF and compared its intake with thigh fat marbling. They could just as easily have looked at exercise levels, or red meat intake, or any number of other variables and compared those with the amount of intramuscular thigh fat.

The point I want to make about this is that studies such as this one don’t mean anything. They are simply used to generate hypotheses that can be tested for causality with randomized controlled trials (RCT).

The problem is, however, that RCTs take time and money. How long would it take to do such a study to determine if a high load of UPF in the diet would induce marbling of the thigh muscles? Two weeks? Doubtful. Two months? Maybe, but probably not likely. A year? And who is going to fund such a study? Certainly no one in the UPF business.

It would be expensive to do. Subjects have to be recruited and screened, then randomized to one of two diets with or without UPF. Then they would have to be followed for the duration of the study. If they were inpatients, it would cost a fortune, but intake could be fairly well controlled. If you gave them diets, or even food, yet let them live on their own, the results could be unreliable. People on their own tend not to stick strictly to diets. Especially for months at a time.

Animal studies could be much better controlled and don’t have to last so long. And are much less expensive. But animal studies don’t always correlate with human studies, so you can’t be sure animal studies are applicable.

The point I’m trying to make here is that we can probably never have certainty in these types of studies. Yet people who should know better try to make studies such as the one I wrote about last week and linked to above imply causality.

But that’s exactly what they do.

I received one of my many online medical newsletters a day or two ago in which this very study was featured. Before we get into it, let me remind you that this study was simply a presentation. It has not been published or peer reviewed.

The article titled “Ultra-processed foods weaken muscle, raising osteoarthritis risk” totally and massively over-interprets this study we’ve been discussing.

Here are the bolded points the article makes:

Let’s walk through these three statements.

The first one says that UPF corresponded to intramuscular fat. Corresponded is a weasel word. It means associated with. “Associated” is a weasel word just like “linked” is a weasel word. They imply causality when there may be no causality at all. A lot of umbrellas are correlated to a rainy day. But that doesn’t mean the umbrellas cause the rain.

The first of the statements is true. There is an association between UPF consumption and excess thigh muscle marbling. But it is an association. It may be causal or may not be. From the data we have, we can’t make that determination.

The second statement is also true. People with fatty infiltration (or marbling) tend to have weaker muscles. Weaker muscles can allow damage to the joint.

I experienced this myself. When MD and I moved to Colorado in the late 1990s, we started to ski a lot. I began having trouble with both of my knees, especially the left one. I ended up getting my knees scanned and discovered I had chondromalacia patella in both knees, the left more so than the right. I was instructed to strengthen my quadriceps muscles to help keep my patellas in place.

Which I began to do. And I started walking when I played golf instead of taking a cart. All of those helped, but I completely got rid of it when I started doing my band workouts and taking squats to failure. Maybe the deadlifts helped as well. Whatever, the issue has resolved.

The third statement above is absolutely false. The word “can” is the problematic term. “Correcting one’s diet can reduce fat deposits…” I was on a pretty good diet when I developed chondromalacia. What fixed it was strengthening the muscles. I’m sure my diet high in animal protein helped, but I was doing that when it developed.

This whole article reminds me of Gary Taubes’s most recent article on bad health journalism. In it, he discusses an article in The Atlantic that has the author badmouthing RFK, Jr’s claim about his deep-frying his Thanksgiving turkey in beef tallow. She is disputing the notion that tallow might be a better vehicle than some sort of vegetable oil.

She talks about a video RFK, Jr. made showing how he deep-fried his turkey and said “This is how we cook the MAHA way.” She then goes on to write:

Gary picks up on the line about cardiologists shuddering at the thought of a turkey deep-fried in beef tallow and uses it to launch his set of rules about doing proper scientific, medical, and health (SMH) journalism.

His first rule is

He then goes on to clarify

In other words, they are simply repeating what they’ve heard from people who don’t know anymore than they do. Many professors tell medical students on day one, “Fifty percent of what you’ll learn in medical school will be found to be incorrect in 20-30-40 years from now, we just don’t know which 50 percent that is today.

Based on my experience, I don’t think it is 50 percent. I think it’s less than that. Say, maybe 25 percent, which is still a lot.

This fact was brought home to me in the early days of Covid. Those of you who were with me then may remember my writing that, given what I had learned in medical school about immunology and virology, I couldn’t understand why the powers that be were making the recommendations they were. I bought the most recent text on immunology I could find, read it, and realized that the vast majority of what I had learned in medical school was still considered accurate. Which led me down the road to where I am today in terms of my stances on vaccines, immunology, and all the rest.

A medical education does not encourage critical thinking. It encourages memorizing huge amounts of information over a relatively short time. You don’t have time to think, only time to regurgitate what you’ve memorized.

I don’t know how many of you watched Jay Bhattacharya’s interview I posted last week, but he said the same thing. He learned as an undergrad that he enjoyed research, but there simply wasn’t time in med school for research or deep thinking, because it was all coming so fast and furious. Truly it’s drinking facts through a fire hose.

Once out of med school and in a residency, it doesn’t get any better. It’s a total hierarchy with attending physicians at the top and first year residents at the bottom. You learn from those above you, and, again, there is no room for critical thinking, as in are we on the right track here? You do what you’re told.

Most docs don’t read medical papers in med school. And don’t read many other than those specifically written for their specialty. Most docs don’t know how to differentiate observational studies from RCTs. I had to teach myself. Most of the docs I hobnob with at the various meetings I attend, do know how to read papers. But I don’t think the average doc in practice really does.

They may read a paper on some new technique to do some procedure, but if they are presented with a study like the one above about thigh muscle marbling, I suspect most wouldn’t realize how iffy such a study is.

The vast majority would probably not even read the whole study (such as it is), but might read the summary written by a SMH writer, which is what the linked study above is. And they would come away with the idea that encouraging a patient to avoid UPF might cure their osteoarthritis.

I would say encouraging people to eat less UPF would be a good thing, and I believe it truly would be. But at this point there aren’t any good, solid studies proving as much. I’m taking it on faith.

In his recent article, Gary mentioned a paper by the British epidemiologist Geoffrey Rose that helped clarify my thinking on issues such as this one. Gary sent me Rose’s paper years ago, and I decided to quote from it last week. Then Gary came out quoting him. So I waited till this week, and Gary quoted him again.

I emailed him and said give Rose a break so I can use his paper without seeming to be drafting off you. He replied that he hadn’t intended to use Rose this week, but he (Rose) just ended up inserting himself. I know how that goes.

Rose considered two different ways in which we could prevent disease. One way was to remove anything that was “unnatural” in terms of our evolutionary history, or as he put it, “the conditions to which presumably we are genetically adapted.” The first thing he mentioned in terms of elimination was smoking, which doubtless was not something we evolved to do. Strangely, he also mentioned saturated fat. The paper was written in 1981, a time during which saturated fat was under major attack as a cause of heart disease. Rose, I’m sure, thought the amount of saturated fat the average person ate was too much, so he figured removing it would protect our health. His thoughts on saturated fat are neither here nor there in terms of what he is saying.

Remove anything unnatural. I do’t think anyone would disagree that all the additives in UPF are unnatural. They haven’t been around long enough to qualify as being “the conditions to which presumably we are genetically adapted.” They may well end up being harmless, but they certainly are not a natural part of our dietary heritage.

I would argue that seed oils are also not a part of our dietary heritage, so, according to Rose, they should be limited. Simply as a precaution since we really don’t know for sure what their untoward effects might be. And the average American consumes a significant number of his calories as seed oils these days.

Rose also cautioned that we should be most careful about adding things to our diet that are new and unnatural.

Polyunsaturated fats in industrial quantities are new to us humans. We started eating them back in the 1800s, but nothing close to the amounts in which we eat them today.

I agree with Rose. We should be extremely cautious about adding PUFA and all the emulsifiers, gums, stabilizers, and assorted other crap we find in UPF.

After much research, it may turn out that none of these things are harmful, but I kind of doubt it. But even if it turns out that way, I don’t think any of us will be worse off for avoiding seed oils and UPF in general.

Nighttime Leg Cramps

I don’t know how many of you suffer from leg cramps at night, but it’s a pretty common problem as people age. I suffer it myself.

I think leg cramps are caused by dehydration. I discovered this when I was driving with MD from Tahoe to Santa Barbara. I was having bad cramps in my hands, not my legs. When I had gotten cramps previously, I drank tonic water, which I had read helps. Supposedly the quinine does the job. We stopped so I could get a bottle of tonic water, but none was available. I just got a can of sparkling water instead.

I drank the sparkling water not thinking it would help much, and my cramps disappeared.

I thought, wow, that worked great. Maybe it’s not the quinine; maybe it’s just the water. Next time I get cramps in the night, I figured, I’ll simply drink some water to see if that helps. It wasn’t too long before I had the chance to test it. I did get up and drink some water and the cramps resolved.

I thought that maybe I was dehydrated, so I started reflecting upon what I drank during the day. I would get up and drink a few cups of coffee (Americanos, not regular coffee) and then a decaf or two in the afternoon. At about 5 PM, MD and I would sit down and debrief with a drink. Then we would have dinner, which may or may not have included a bit of wine, and then reading or sometimes TV watching until bedtime.

When I ran all this through my mind, I realized I was probably dehydrated. Both the coffee I drank and the alcohol I consumed were diuretics. They made me pee out more than I was taking in. Other than the cup or two of decaf I drank in the afternoon, I wasn’t drinking anything that wasn’t sucking more fluid out of me than I was putting in.

I think a low-carb diet is dehydrating all on its own. And it doesn’t make you thirsty. When I contemplated all this, I decided I needed to drink more fluids throughout the day. Which I began to do. And my night cramps pretty much went away. Not completely, but they reduced in number and severity considerably.

Then I decided I would drink water before bed. That pretty much got rid of them, but then I had to get up in the middle of the night to get rid of the water. I kind of titrated it until I reached the point at which I would consume enough water—about half a coffee cup, in my case—to prevent cramps and let me sleep through the night.

Having said all this, if you have nocturnal cramps, maybe you can give it a try.

But maybe there are other causes. A new paper just came out showing that taking vitamin K2 prevents nighttime leg cramps. The paper titled “Vitamin K₂ in Managing Nocturnal Leg Cramps: A Randomized Clinical Trial” published in JAMA Internal Medicine describes pretty good results using vitamin K₂ to prevent cramps.

The Abstract starts off with this statement:

I’m sure the authors hadn’t tried just plain old water.

Perhaps there are other causes of nocturnal leg cramping besides dehydration. If so, according to this paper, vitamin K₂ is pretty effective.

It was a pretty simple study. Subjects were screened and randomized into a group of 103, who took the vitamin K₂ and 96, who were on placebo. Each group was instructed to take one capsule (of the vitamin or the placebo) every night with water. The study lasted eight weeks, and at the end it turned out that those on the vitamin K₂ reduced the frequency of their cramps to fewer than one per week whereas those on placebo experienced an average of 3.63 cramps per week. In terms of severity of cramping, those on vitamin K₂ experienced a severity of the cramps they did have to about half the intensity of those on placebo.

So, all in all, a pretty good outcome.

It is a small study. And it was done in China, which always makes me wonder.

But the intervention is harmless, so even if the study can’t be reproduced, you shouldn’t do yourself any harm following the protocol.

The dose of vitamin K₂ used was 180 μg of the MK-7 variety.

If I were advising a patient, I would suggest increasing fluid intake first. Kind of titrate a dose that prevents the cramps, but let’s you sleep all night without having to get up to pee. If that did not work, I would try the vitamin K2. My favorite brand is Thorne, a company with which I have no financial affiliation. Back when we kept supplements in our clinic, we always used Thorne and were never disappointed. At that time, Thorne sold only to healthcare practitioners. When I made inquiries, just about everyone recommended Thorne.

Supplements are not well regulated, so I’m always leery of the dosages. I’m sure many supplements available contain what the label says they contain, but I doubt all of them do. Thorne has a great reputation, so if you do try a different supplement, and it doesn’t work, don’t write it off until you’ve tried the Thorne version.

I found this one on Amazon. It’s got all of the vitamin Ks. You would have to take two per night to get the same dosage of K2 [MK-7] used in the study.

Once again, if you haven’t tried drinking a bit of water before bed, try that first.

At any rate, please, if you do drink water or go for the K₂, let me know how it worked for you.

Coffee: Everyone’s Favorite Drug

As I’m sure I’ve mentioned before, I love coffee. And that’s good because studies just keep coming out showing first one health benefit then another brought about by coffee.

Occasionaly, you will find a study that shows coffee in a bad light, but the vast majority seem to indicate that it does us nothing but good.

I’ve always found it strange that people want to bash coffee. If people worldwide drank some artificially made beverage that had the same effects as coffee, all the health nuts out there would be saying, Look, there is a natural beverage that can do the same for you. It’s natural. It’s organic. It has no chemicals. It’s called coffee.

But since coffee is what everyone drinks, that somehow casts a negative light on it. If it’s that good and everyone is nuts about it, it must be bad. Let’s study it and discover all the terrible things coffee does to a body.

When they do, they almost universally discover that coffee is a health drink.

But more people have the attitude this guy has on a tweet I came across. Interestingly, I found this tweet when I went to Luigi Mangione’s X/Twitter account (which, surprisingly, is still up). He had retweeted it. Maybe his dislike of the beverage is part of his problem.

I don’t understand why so many people want to decry a natural beverage consumed by billions of people that is more likely healthful than harmful.

Most consumable products that could be either minimally harmful or minimally healthful don’t lend themselves to randomized controlled trials simply because it would take too long to come up with a meaningful result. Instead researchers use observational studies, which really can’t prove causality. But these studies are the best we’re going to get.

Back in 2013 there was a meta-analysis of 36 observational studies looking at long-term coffee consumption and risk of cardiovascular disease. A large number of observational studies theoretically shouldn’t be any more accurate than one observational study in terms of proving causality. But when you have a lot of them pointing in the same direction, it makes it a little more persuasive. To me, at least. Though I wouldn’t bet the farm on it.

Just to remind everyone, the reason these studies can’t prove causality is because you don’t know if there is something inherent in certain people driving them to drink coffee that also makes them more prone to heart attacks.

I have no idea if this is true or not, but let’s say more laid back people, who like to sleep in, and wake up to a couple of cups of coffee end up having fewer heart attacks than those go-getter types who don’t have time for coffee. They just want to get to work.

You can’t separate all these characteristics from one another unless you randomize the subjects. Maybe the laid back folks have fewer heart attacks because they’re laid back, not because they drink coffee. It’s impossible to tease all these disparate variables out in an observational study.

If 36 observational studies all stacked up to show that people who drank the most coffee all died young of heart disease, I might consider giving up my coffee. It probably shouldn’t be so, but for me it would be more persuasive than if it showed, for instance, that they lived longer.

This particular meta-analysis shows that the more coffee the subjects drank—to a point—the fewer of them experienced heart attacks.

The conclusion of the authors was

Shown graphically below:

Look at the solid line above. The horizontal dotted line in the middle represents the average risk. Anything below the line means below average risk and anything above means increased risk.

As you can see, the solid line, representing the average of all the subjects, is below the horizontal dotted line until it gets way out to almost ten cups per day. From the top dotted line, you can see that some people were at theoretical risk at six cups per day.

Most of the data I’ve come across fit this same profile for type 2 diabetes as well. I’ve not seen a major study showing any kind of elevated risk for health issues as a function of drinking coffee. Yet this notion persists—as shown in the tweet at the beginning—that coffee is some sort of drug that everyone should be avoiding.

As far as I can tell, the data just isn’t there to make that claim. Even if all the positive results from all the many observational studies out there can’t absolutely prove coffee consumption is a good thing for you health-wise, they certainly haven’t shown it to be harmful. On a worse cases basis, I would say coffee is neutral, but my bias says is provides positive health benefits.

So drink up.

Big Healthcare

This whole Luigi Mangioni shooting incident leaves me wondering. It just all seems too pat. Either this kid is batshit crazy, or something else is afoot. Time will tell, I suppose.

I am not condoning the shooting of UnitedHealthcare CEO Brian Thompson in any way. It is a terrible tragedy for all concerned, But it has shed light on the healthcare situation in the country right now.

And on the way insurance works. Or doesn’t.

Let’s look at insurance first. The problem is all in the fine print. People want to pay VW prices and get Mercedes Benz coverage. The insurance companies in their ads basically imply Mercedes Benz coverage at VW prices. No one ever reads the fine print until something comes up. Then they discover their supposed Mercedes Benz coverage at VW prices turns out to be VW coverage at VW prices. And they’re pissed.

The healthcare industry is consolidating. There are fewer and fewer doctors out there in private practice. More and more have moved into group practices, which are ripe for purchase by large hospital systems. Which is what is happening more and more.

If you’re a doc in private practice, depending on the type of practice, you’ll probably have a nurse and a receptionist. Your overhead won’t be that high. And as long as you cover your overhead and make a living for yourself, you’re doing fine.

Once you become a part of a big healthcare conglomerate, things change. You’ve got someone cracking the whip on you to produce, because you’re now supporting a huge overhead of facilities and highly paid administrators, many of which are making multiples of your salary. And that machine has to be fed.

Because so many more people need to be paid in this system than in the simple private practice system, charges have to be higher. And since most of it is paid by insurance, rates end up going up.

I’ve posted the graphic below a couple of times over the past few years. It tells the tale.

As you can see, the cost of medical care has gone up by a huge amount simply because of all the administrators involved. It’s not the doctors’ salaries that are driving the costs; it is the administrators. And the insurance industry (including government insurance) pays for most of it.

The man who got shot in NY was the head of a huge insurance company, and he was making ~$10M per year. And, according to the first article I read about his murder, he was the 4th highest paid person in the firm. Which means three more people made over $10M per year.

It is the same in big hospital-healthcare complexes. The chief executives make multiple millions of dollars per year. Even those in middle management make a million or so. I doubt that any doctor in one of these situations makes even a million dollars per year.

Not only does this consolidation of healthcare providers into these behemoth outfits make medicine more costly, it also decreases the quality of care.

The US spends more on healthcare than any other country in the world. And yet the longevity of US citizens is declining at a much greater rate than elsewhere. Something is definitely wrong with the system as it operates today.

As I discussed in the sections above, food in the US is adulterated more than in any of the other countries on the chart. If you’re in Europe and you grab a carton of cream off the grocer’s shelf, you’re going to end up with cream. If you do so over here without checking, your more likely to get some cream mixed with milk and a bunch of gums and emulsifiers to make it taste like real cream.

It’s the same with many other foods as well. I don’t want to blame the ill health of Americans totally on the screwed up medical system or on the insurance system. Big Food and Big Pharma are all responsible for a lot of what’s going on.

Drug prices are extremely high. Back in the old days, the expensive part of going to the doctor was going to the doctor. Now it’s the trip to the pharmacy after.

And the insurance industry is footing the bill for the whole thing, including the entire overhead of administrators. It’s no wonder they try to deny, delay, and depose. Especially since a large part of the administrative overhead in these big companies are for administrators to deal with the insurance companies.

I don’t know what’s to be done, because, as it’s going, it’s unsustainable. And I don’t think the heavy hand of the government taking over would make it anything but worse. That’s a behemoth that dwarfs the insurance companies and hospital conglomerates.

I had a conversation a week or so ago with a surgeon friend of mine who just retired. He told me he had been in a discussion with one of the administrators in a local healthcare conglomerate who said the problem is that doctors today are looking for a life-work balance. He was stunned. I was stunned when my friend relayed it to me. If you want a life-work balance job, don’t go into medicine. People don’t get sick or injured on a 9-5 schedule.

What I would guess will happen is that doctors will start to realize they can do a lot better financially in their own practices. They may work harder, but they will make more money and have more satisfaction as they won’t be working for the man.

If this happens, and other docs follow, then over time, things may revert back. It’s hard to tell, though. But what we’ve got now isn’t serving anyone well, other than the huge cadre of administrators in both the giant healthcare outfits and the insurance companies that feed them.

I am hoping RFK, Jr. and Jay Bhattacharya can do something to start to fix this. They’ve got a herculean task before them (assuming, of course, that they get confirmed).
 

All you can do as a potential patient is strive to keep yourself out of the maw of this rolling disaster by eating right and doing everything you can to maintain your health.

Odds and Ends

• Europe’s oldest known bowstrings found in a cave in Spain indicate early humans created archery tools with a high degree of expertise.

• UK Government 'commits' to giving ALL cows in England controversial feed Bovaer by 2030—amid ongoing dairy boycott over 'toxic' additive. What could possibly go wrong?

• A huge hoard of Iron Age and Roman coins dating back to the reign of Emperor Nero were dug up on a building site near Worcester, UK.

• Video news report of a Tiger snake slithering up the leg of a woman driving on the freeway in Australia. I love the warning to tourists by the female announcer at the end.

• A man hid five treasure chests worth more than $2 million across the United States. All you’ve got to do to find one is buy a $45 book of clues and start searching.

• Diet of North American woman from 12,800 years ago was 96% meat. 40% from mammoths, followed by elk, bison, camels and horses, and a negligible contribution from small mammals and plants.

• If you would like to purchase a real, live, free-range bison, here’s how you can do it. No returns, however.

• Latrine diving wouldn’t be my favorite activity, but a lot of interesting info can be found. Nice to know that parasites native to Africa were found in the waste of people living in Belgium 500 years ago. Apparently the little bugs traveled well.

• Bestselling classical violinist of all time Nigel Kennedy experienced partial deafness for about three months after having the third Covid vaccine in 2021.

• Over 200 tiny spoons found across Roman-era Europe hint at previously unknown drug use in Germanic tribes during battles. Snorting stimulants, perhaps?

• Notre Dame Cathedral hosted its first Mass on Sunday since the catastrophic fire of 2019, a moment that transcended religious significance to become a powerful symbol of Paris’ resilience.

• Phone company created an AI 'granny' to beat scammers at their own game. The “elderly lady” blathers on, keeping scammers dealing with her and not with you.

• Believe it or not, professional human scratchers make ~$100 per hour scratching other people’s literal itches. It’s a lot cheaper to just up your intake of omega-3 fats.

• Looks like Hal is here. Google has unveiled a new chip which it claims takes five minutes to solve a problem that would currently take the world's fastest super computers ten septillion—or 10,000,000,000,000,000,000,000,000 years—to complete.

• Despite not speaking Spanish, the Tiger Woods of Scrabble stars wins the Spain Scrabble competition. Same guy won the French one in 2015 by memorizing the French Scrabble dictionary.

• Two rescued tiger cubs were raised together in Russia, then released 120 miles apart. Boris, the male, schlepped the distance in a straight line through the forest to be with Svetlaya, who, six months later gives birth to cubs. (Alternate link if above doesn’t work.)

• Denmark offers largest offshore wind area for auction, but no one bids anything. I think people are finally catching on.

• How would you like to own the oldest inscribed stone tablet of the Ten Commandments in existence. Now is your chance. The artifact dating to the late Roman-Byzantine era goes up for auction in a week.

• Interesting. Seven things you can do to improve the performance of your microwave.

• Archeologists have discovered what they believe to be the tomb of Saint Nicholas, the philanthropic Greek bishop and inspiration behind Christmas icon Santa Claus. Just in time for Christmas.

Newsletter Recommendations

Video of the Week

First, an update to last week’s VOTW. MD and I started watching Landman, and it’s pretty good. The crazy wife and daughter detract—if you watch it, you’ll see what I mean. But Billy Bob is superb.

This weeks video was one I intended to put up a few weeks ago. I can’t remember now what prompted me to want to try to learn the violin as an adult. I’ve always really enjoyed violin music, and, as I recall, I read something about the great Italian violinist Niccolò Paganini. Whatever it was, I started taking lessons. My violin teacher was an older guy who had actually played as a young man in movie orchestra pits during silent films. The films came with a score, and musicians would play in a pit beneath the screen.

He was mad about Fritz Kreisler, and some of it rubbed off on me. Kreisler was born in Vienna in 1875 and rose to fame as both a concert violinist and a composer. Of his compositions, my favorite is “Liebesfreud”, with many others coming in as close seconds.

I badgered my poor teacher to let me move up into the positions just so I could make a stab at “Liebesfreud”. It sounds so smooth and easy, but it’s anything but to a tyro. All kinds of double stops, harmonics, and everything else.

One of my prized possessions is a framed autographed photo of Kreisler that MD and the kids gave me for one of my birthdays. It currently sits in a box in a storage unit, or I would show it to you.

Here is Kreisler himself playing “Liebesfreud”. It fairly drips of Austrian gemütlichkeit. I hope you enjoy it.

Liebesfreud is a violin standard. If you want to see any number of modern violinist playing it, just go to YouTube and search. You can hear how they sound compared to the guy who wrote it.

Time for the poll, so you can grade my performance this week.

That’s about it for this week. Keep in good cheer, and I’ll be back next Thursday.

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This newsletter is for informational and educational purposes only. It is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment and should never be relied upon for specific medical advice.

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