Fair Use Notice

FAIR USE NOTICE

A BEAR MARKET ECONOMICS BLOG

OCCUPY MADNESS AND DYSFUNCTION

This site may contain copyrighted material the use of which has not always been specifically authorized by the copyright owner. We are making such material available in an effort to advance understanding of environmental, political, human rights, economic, democracy, scientific, and social justice issues, etc. we believe this constitutes a ‘fair use’ of any such copyrighted material as provided for in section 107 of the US Copyright Law.

In accordance with Title 17 U.S.C. Section 107, the material on this site is distributed without profit to those who have expressed a prior interest in receiving the included information for research and educational purposes. For more information go to: http://www.law.cornell.edu/uscode/17/107.shtml

If you wish to use copyrighted material from this site for purposes of your own that go beyond ‘fair use’, you must obtain permission from the copyright owner.

FAIR USE NOTICE FAIR USE NOTICE: This page may contain copyrighted material the use of which has not been specifically authorized by the copyright owner. This website distributes this material without profit to those who have expressed a prior interest in receiving the included information for scientific, research and educational purposes. We believe this constitutes a fair use of any such copyrighted material as provided for in 17 U.S.C § 107.

Read more at: http://www.etupdates.com/fair-use-notice/#.UpzWQRL3l5M | ET. Updates
FAIR USE NOTICE FAIR USE NOTICE: This page may contain copyrighted material the use of which has not been specifically authorized by the copyright owner. This website distributes this material without profit to those who have expressed a prior interest in receiving the included information for scientific, research and educational purposes. We believe this constitutes a fair use of any such copyrighted material as provided for in 17 U.S.C § 107.

Read more at: http://www.etupdates.com/fair-use-notice/#.UpzWQRL3l5M | ET. Updates

All Blogs licensed under Creative Commons Attribution 3.0

Saturday, August 10, 2013

Hypochondriacs Cost Our Healthcare Industry Billions




Personal Health  


Hypochondria is a debilitating condition that extends far beyond a harmless obsession with imaginary illness.

 
 
 
Photo Credit: Dormstormer


 
 
“What’s the matter?” “I have a headache,” “Maybe it’s a tumor?” “It’s not a tumor!”  In pop culture, we like to poke fun at individuals who fuss over every little ailment with numerous TV characters based on those who possess hypochondriac personas. However, for the sufferer, living each day in constant fear of contracting a serious life-threatening illness is no laughing matter.

Hypochondriasis, as it was previously known in the medical field, is a serious mental condition that places a major physical, emotional and financial strain not only on the sufferer, but also on relationships, family members and the entire health care industry.  To date, there has not been significant medical research dedicated to understanding the condition and many doctors are unsure about how to manage patients who exhibit symptoms.  A working definition was only formulated in the last few decades by the American Psychiatric Association (APA), which defined the disorder as, “the fear or belief of serious illness that persists six months or more despite physician reassurance."

More recently in May 2013, the condition was re-termed Illness Anxiety Disorder by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) of the APA in an effort to shift the focus away from the symptoms of the condition and instead toward the abnormal behavior and feelings evoked by the symptoms. This made it clear that this is primarily a mental disorder where people worry excessively and unnecessarily about medical problems.

In the absence of concrete medical studies it is uncertain how many people actually suffer from illness anxiety disorder, but according to Brian Fallon, professor of clinical psychiatry at Columbia University and co-author of Phantom Illness: Recognizing, Understanding and Overcoming Hypochondria, at least 25 percent of patient visits to doctors are believed to have no identifiable medical cause.  Moreover, approximately 12 percent of the population suffers from some form of a fear of illness.

“A factor that contributes to illness anxiety disorder is a person’s genetic makeup," Fallon told AlterNet. "If you have genes in your family aiding obsessional anxiety, it is likely you will suffer from obsessional anxiety. It is also true that if you grew up as a child where a parent was quite ill or suddenly afflicted with serious illness then this can create a channeled fear that you will develop a disease and also adds to a lack of trust in the world. Others can develop the disorder after losing a loved one to a serious illness or as a secondary illness to depression or anxiety disorder."

Sometimes, the condition is so extreme that individuals can actually experience physical symptoms created through the mind. Such worry wreaks havoc on the immune system causing a lack of sleep and severe anxiety which can lead to further physiological conditions.  As Arthur Barsky of Harvard Medical School and author of Worried Sick: Our Troubled Quest for Wellness told  WebMD, the illness then becomes part of the hypochondriac’s identity and as a result, the individual’s work, family and relationships begin to suffer.

“Contrary to what some skeptics think, hypochondriacs are not pretending or just trying to get attention.  They're absolutely not fakers or malingerers […] They really feel the distress they're talking about. It's just that their feelings don't have an obvious medical basis,” Barsky said.

So how does one differentiate between a hypochondriac and a person merely concerned about their health? According to Benjamin Liptzin, chair of the department of psychiatry at Baystate Medical Center in Springfield, the primary distinction lies in the extent to which a person believes he or she has a serious illness. As he explained to AlterNet:
“A certain amount of concern about one’s health is a good thing.  This gets us to visit the doctor, to watch our diet, to exercise, take medication – healthy normal people should be concerned about their health. What distinguishes people with the disorder is that it is excessive – these people are not reassured by good news from the doctor or when test results come back negative. They are just convinced there is something their doctor is missing." 
Fallon agrees.

“Hypochondriacs live in constant or intermittent fear that they might be dying or afflicted with a serious illness whereas people who are generally concerned about their health are conscious about their wellbeing rather than live in incessant apprehension of a threat to their health or contracting a serious illness,” he said.

This inability to accept negative test results at face value or a doctor’s assurances leads to a rampant abuse of the healthcare system whereby hypochondriacs spend large amounts of money on numerous and unnecessary medical appointments and procedures like blood tests and MRIs even after results indicate they do not have an illness.

A study by Barsky found that those with unexplained physical symptoms with no medical basis accounted for 16 percent of all medical costs, with the annual cost of hypochondria in the billions of dollars. Fallon believes this to be an accurate figure in light of the ease and freedom with which patients in the US can visit multiple doctors at any given time, at the expense of the insurance companies which beart the costs.

The disorder places a major strain on the doctor-patient relationship as doctors struggle with having to determine to what extent they should investigate a physical medical complaint in the absence of any substantial symptoms. This often results in a doctor ordering excessive medical tests not out of necessity, but merely to ease a patient’s state of mind.

Such measures serve as a double-edged sword whereby exploring phantom illnesses only heighten the insecurities of the hypochondriac patient who already believes he/she has some rare disease. Many doctors feel pressured to succumb to a patient’s irrational demands to avoid a malpractice action based on misdiagnosis.

Physician Rahul Parikh describes the lack of faith between doctor and patient in his article, “The real reason hypochondriacs drive doctors crazy." He wrote:
“Today’s medical system encourages the approach of hurrying difficult patients out the door. Doctors, unlike lawyers or consultants, don’t bill for their hours. Most of us get reimbursed by insurance companies for tests, and procedures, and prescriptions, often regardless of whether they’re necessary. A hypochondriac on our schedule is a time and money sink. The ugly truth is that modern medicine doesn’t reward those physicians, like primary care doctors, whose main work is to listen to and think deeply about patients and their ailments, whether they are physical or psychological." 
It doesn’t help that we live in a society of medical paranoia where self-help books are encouraged and when we turn on the TV we are confronted with public health messages stressing the benefits of early detection in the absence of symptoms.  Even 30-second drug advertisements manage to provide every possible life-threatening side-effect of taking medication.

The plight of the hypochondriac is amplified by the Internet. Historically, those interested in investigating their physical symptoms had to trek to a library to borrow a book in order to research an illness.  Today, one only needs to Google a symptom of an illness and instantaneously thousands of serious medical conditions appear, often displaying a worst-case diagnosis that happens to match the seeker’s problem.

As Fallon explains, “cyber-chondria” is the addiction to researching medical conditions online whereby the more access a person has to learn about an illness, the more the person thinks he/she has it. He said:
“There is a tremendous temptation for people with illness anxiety to type in their symptoms on the Internet to see if they can find a diagnosis to explain their symptoms.  The problem with that is that the web is filled with information which is both accurate and inaccurate, as well as other patients trying to give people advice and warnings against horrible doctors. This only causes people to feel worse. My recommendation is that if you have a pre-existing illness anxiety, stay away from the Internet!” 
So how should a doctor proceed when treating a patient who is exhibiting hypochondriac traits? Liptzin says that when a doctor is faced with a person suffering from an obvious illness anxiety disorder, it is better not to submit to patient pressure.

“Doctors should only do what is necessary and if they are confident that they have ruled out a series of illnesses, they should explain that to the patient and say, Let’s see how you do over the next six months,” he said.
Fallon believes the key for doctors is to differentiate between illness and obsessional anxiety disorders.

“It is hard for doctors at an initial consultation to diagnose hypochondriasis because of the limited amount of time they have with their patients," he said. "However, if a patient returns after medical tests come back negative, and the doctor has the opportunity to get to know the patient, it is important for the doctor to show compassion and kindness and explain carefully that the cause of the problem may be an underlying anxiety disorder and encourage treatment for anxiety or depression."

Whether such measures by physicians actually curb erratic patient behavior is debatable, considering that many patients who are unhappy with a diagnosis are likely to continue doctor shopping in search of a validation of their illness. Fallon acknowledges that those who believe they are hypochondriacs can take matters into their own hands to help alleviate the problem.

“People suffering from illness anxiety disorder can do things to help themselves by reducing the focus on physical symptoms and enhancing interpersonal physical relationships," he said. "Psychotherapy has also proven effective by concentrating on positive behavioral strategies. If the illness anxiety is severe, it is important to see a mental health professional or at the very least learn about the disorder."

Liptzin believes that while attending clinics with group sessions for those who suffer from the illness may be helpful, it can have the opposite effect.
“Sometimes these clinical sessions only reinforce the disorder as sufferers end up supporting each other’s irrational thought patterns," he said. "There is not much evidence that medication helps either.  Rather, any type of relaxation technique or meditation or mindfulness is recommended to help reduce the anxiety of the person. What you really need to do is to take your mind off the symptoms and anything that is upsetting you."

People who believe they may be suffering from illness anxiety disorder can take the Whitley Index Test, which has been developed to help identify hypochondriacs. The Mayo Clinic recommends sticking with one doctor, no self-checks or self-diagnosis and attending group therapy sessions. In severe cases, medications like Prozac can be prescribed to treat anxiety disorders with mixed results of success.

It is important to remember that even hypochondriacs do get sick at times. Therefore, it is important to always listen to your body and seek medical assistance when it comes to general health concerns.

Sunday, August 4, 2013

Science deniers just don’t think: All hail the scientific method

SALON



Science deniers just don’t think: All hail the scientific method

The scientific method's the best way for people to get smarter, precisely because theories get revised and improved




 
Science deniers just don't think: All hail the scientific method
Excerpted from "You Are Now Less Dumb"


Back when Shakespeare said you were the paragon of animals, both noble in reason and infinite in faculties, he did so during a time when physicians believed the body was filled with black bile, yellow bile, phlegm, and blood, and all sickness and health depended on the interaction of those fluids. Lethargic and lazy? Well, that’s because you are full of phlegm. Feeling sick? Maybe you’ve got too much blood and should go see a barber to get drained. Yes, the creator of some of the greatest works of the English language believed you could cure a fever with a knife.

It’s easy to laugh at the very wrong things that people once believed, but try not to feel too superior. My friend Susannah Gregg was living in South Korea and working there as an English teacher when she first learned about fan death, a common belief among people in that country that oscillating desk fans are among the most deadly inventions known to man. She was stepping out for a beer with a friend when he noticed, to his horror, she had left her fan running with her pet rabbit still inside her house. Her friend, a twenty-eight-year-old college graduate, refused to leave until she turned off the fan. He explained to her that everyone knows you can’t leave a fan running inside a room with the windows shut. That would mean certain death. It was shocking to him that she was unaware of something so simple and potentially life-threatening. Susannah thought he was kidding. It took several conversations to convince him it wasn’t true and that in her country, in most countries, no one believed such a thing. She successfully avoided absorbing the common belief not because she was smarter than her friend but because she had already done the experiments necessary to disprove the myth. She had slept in a house with a fan running many times and lived to tell about it. Since then, she has asked many friends and coworkers there about fans, and the response has been mixed. Some people think it is silly, and some think fan death is real. In 2013, despite the debunking power of a few Google searches, the belief that you shouldn’t fall asleep or spend too much time in a room with a running electric fan is so pervasive in South Korea that Susannah told me you can’t buy one within their borders without a safety device that turns it off after a set amount of time. The common belief is so deep and strong that fan manufacturers must include a safety switch to soothe the irrational fears of most consumers.

Your ancestors may not have had the toolset you do when it came to avoiding mental stumbling blocks or your immense cultural inheritance, but their minds worked in much the same way. The people who thought the world rested on the back of a great tortoise or who thought dancing would make it rain — they had the same brain as you; that is to say, they had the same blueprint in their DNA for making brains. So a baby born into their world was about the same as one born into yours. Evolution is so slow that not enough has changed in the way brains are made to tell much of a difference between you and a person from ten thousand years ago. That means that from gods in burning chariots to elves making cookies in trees, people long ago believed in all sorts of silly things thanks to the same faulty reasoning you deal with today. They, too, were fueled by a desire to make sense of reality and to answer the age-old question: “What, exactly, is happening here?” Instead of letting that question hang in the air, your distant relatives tended to go ahead and answer it, and they kept answering it over and over again, with newer yet equally dumb ideas because of one of the most profoundly difficult obstacles humans have faced since we started chipping away at flint to make heads for spears. This malfunction of the mind is called the common belief fallacy.

In Latin, it is argumentum ad populum, or “appeal to the people,” which should clue you in that this is something your species has worried about for a long time. The fallacy works like this: If most people believe something is true, you are more likely to believe it is true the first time you hear about it. You then pass along that mistaken belief, and on and on it goes.

Being a social creature, the first thing you do in a new job, new school, new country, or any other novel situation is ask people who are familiar with the environment to help you get acquainted with the best way to do things, the best places to eat, the hand gestures that might get you beheaded, etc. The problem, of course, is that your info is now based on opinions that are based on things such as conformity and emotions and norms and popularity, and if you’ve spent any time in a high school, on a dance floor, or at a rave, you know that what is popular is not always what is good or true. It isn’t exactly something we’ve overcome, but at least we now have a strategy for dealing with it.

Before we had a method for examining reality, the truth was a slippery fish, which is why your ancestors were so dumb. So dumb, in fact, that for a very long time people got smarter in a slow, meandering, and unreliable sort of way until human beings finally invented and adopted a tool with which to dig their way out of the giant hole of stupid into which they kept falling. The hole here is a metaphor for self-delusion. Your great-great-great-grandparents didn’t really keep falling into giant holes, at least not in numbers large enough to justify a book on the topic.

The tool here is also a metaphor. I’m talking about the scientific method. Your ancestors invented the scientific method because the common belief fallacy renders your default strategies for making sense of the world generally awful and prone to error. Why do bees like flowers? What causes snow? Where do babies come from? Every explanation in every tribe, city, and nation was as good as the next, even if it was completely made up. Even worse, once an explanation was woven into a culture, it would often become the official explanation for many lifetimes. “What is thunder?” a child might have asked. “Oh, that’s the giant snow crab in the sky falling off his bed,” a shaman would have explained, and that would have been good enough for everyone until they all had their own kids and eventually died of dysentery. That hamster wheel of limited knowledge kept spinning until the scientific method caught on. Even then, there was a long way to go and lots of cobwebs to be cleared from common sense.

Scholars used to believe that life just sort of happened sometimes. Learned people going all the way back to Aristotle truly believed that if you left meat outside long enough it would spontaneously generate new life in the form of maggots and flies. The same people thought that if you piled up dirty rags and left them alone for a while they would magically turn into mice. Seriously. The idea started to fade in 1668 when a physician named Francesco Redi tested the hypothesis by placing meat and eggs in both sealed and unsealed containers and then checked back to see which ones contained life. The sealed containers didn’t spontaneously generate flies, and thus the concept began to die. Other thinkers contested his discoveries at first, and it took Louis Pasteur’s great fame and his own experiments to put the idea away forever some two centuries later.

People learned that science, as a tool, as a lens to create an upside-down way of looking at the world, made life better. Your natural tendency is to start from a conclusion and work backward to confirm your assumptions, but the scientific method drives down the wrong side of the road and tries to disconfirm your assumptions. A couple of centuries back people began to catch on to the fact that looking for disconfirming evidence was a better way to conduct research than proceeding from common belief. They saw that eliminating suspicions caused the outline of the truth to emerge. Once your forefathers and foremothers realized that this approach generated results, in a few generations your species went from burning witches and drinking mercury to mapping the human genome and playing golf on the moon.

The twisting path to becoming less dumb has led to many stops and starts, yet humans persist. Sure, scientists are just people, prone to the same delusions as anyone else, but the enterprise, the process, slowly but surely grinds away human weakness. It is a self-correcting system that is always closer to the truth today than it was yesterday.

The people who came before you invented science because your natural way of understanding and explaining what you experience is terrible. When you believe in something, you rarely seek out evidence to the contrary to see how it matches up with your assumptions. That’s the source of urban legends, folklore, superstitions, and all the rest. Skepticism is not your strong suit. In the background, while you crochet and golf and browse cat videos, people using science are fighting against your stupidity. No other human enterprise is fighting as hard, or at least not fighting and winning.

When you have zero evidence, every assumption is basically equal. You prefer to see causes rather than effects, signals in the noise, patterns in the randomness. You prefer easy-to-understand stories, and thus turn everything in life into a narrative so that complicated problems become easy. Scientists work to remove the narrative, to boil it away, leaving behind only the raw facts. Those data sit there naked and exposed so they can be reflected upon and rearranged by each new visitor.

Scientists will speculate, and they will argue, but the data they extract from observation will not budge. They may not even make sense for a hundred years or more, but thanks to the scientific method, the stories, full of biases and fallacies, will crash against the facts and recede into history.

This excerpt is a shortened chapter from the book “You Are Now Less Dumb.” Reprinted by arrangement with Gotham Books, a member of Penguin Group (USA) LLC, A Penguin Random House Company. Copyright © David McRaney, 2013.