Facts and ideas from anywhere

DRY JANUARY

William C. Roberts, MD.

Heather E. Ormand, chief executive officer of the Nexus Recovery Center in Dallas, described her ordeal with alcohol.¹ From age 14 until age 32, the thought of not drinking consumed her. She indicated that an alcoholic is often asked, “Why can’t you just have one glass and stop drinking?” She wanted to be able to answer that question so badly for a longtime. Through the years, she often could stop drinking for 5, 10, or 20 days at a time. She tried to convince family members that she could stop drinking and be fine. The problem was that once she picked up even one drink, she couldn’t stop. She went on to say that stopping isn’t necessarily the hardest part of getting sober; that is just the beginning. It’s staying stopped that’s really hard. It requires a level of commitment, honesty, and humility that nothing else in her life has come close to asking of her. Although she was a married mother of two toddlers, she found that getting and staying sober was and is harder than caring for the toddlers. Believing that people suffering with addiction can just stop, make better choices, and move on with their lives is a dream, she indicated. Being dry or abstaining from substances is not the same as being active in recovery or sobriety. Being dry when you are an alcoholic is sheer terror; it is a nightmare. It’s taking away the one tool that sometimes works and replacing it with nothing at all.

For Ms. Ormond, the antidote to that pain was a loving recovery community, therapy, and time. Knowing and hearing that other humans felt and experienced the exact same thing is reassuring for an active alcoholic. She indicated that the bottle took the loneliness away, as well as the stigma of being too weak to stop on her own. She stressed that alcoholics need to reach out for help, sobriety, and recovery. For those who love someone who drinks too much, guide them toward help.

COST OF A C-SECTION

The Wall Street Journal had a piece examining the cost of cesarean sections carried out in Sutter Health’s Memorial Medical Center in Modesto, California, part of a Northern California system with 24 hospitals.² The charges ranged from $6000 to $60,000 and were determined mainly by the insurance plan of the patient. Under a Trump administration rule that took effect in January 2020, nearly all hospitals must make their prices public, a move the industry sued to block. Courts, however, rejected the hospitals’ arguments that their prices should remain under wraps. Health care economists say these rates are major drivers of US medical costs, which are the highest in the world, and they are largely paid by American companies and workers. Other industries sometimes charge different amounts to different customers, but the ranges revealed in the Sutter data show how extreme the variation can be in medical services. These price differentials are unique to the health care and hospital industries. US expenditures on private health insurance increased 50% from 2009 through 2019. Sutter Health revenue in 2019 was around $13 billion. One of my granddaughters recently had a C-section and rather than paying the higher cost using her private insurance, she and her husband paid the smaller price by paying cash. Money tends to lose meaning when it is connected to medicine.

HOSPITAL-AT-HOME CARE

There is talk these days about shifting some hospital services into patients’ homes.³ Startups providing technology and know-how to bring medical services into the home are raising funds from venture capitalists, health insurers, and providers. Two of these supporters are Humana and the Mayo Clinic. Though not a new idea, hospital-at-home care is only beginning to gain attention, thanks in part to new technology for delivering care remotely and some patients’ reluctance to visit hospitals during the pandemic. Medical centers remain best suited for surgery and other complex care, but hospitals are finding that some people with common illnesses, such as heart failure and urinary tract infections, can be effectively managed at home, where patients are more comfortable. Patients often fare better in their homes because they are not exposed to hospital germs and are in a familiar environment where they sleep more soundly and have the support of family.

Hospital-at-home care is not widespread yet, partly because reimbursement has been limited, but it can reduce costs while increasing physical activity compared to typical hospital care. Hospital-at-home care became more accessible to Medicare beneficiaries through a new program enabling hospitals to be reimbursed for home care they provide for patients. That program now includes 48 health systems and 109 hospitals in 29 states. Patients who qualify medically can choose to go home with a kit containing items needed for remote care, such as a tablet and a blood pressure cuff. A physician visits each patient virtually while a nurse is physically in the home daily to help with the care.

The Mayo Clinic initially faced skepticism from some of its physicians when it joined last year with Medically Home to provide hospital-at-home services to patients in Jacksonville, Florida, and Eau Claire, Wisconsin. The resistance apparently disappeared in a few months.

LISTERINE

The original brown liquid was created in St. Louis in 1879 as an antibacterial cleanser for doctors and dentists.⁴ Its inventor, Joseph Lawrence, MD, named his creation after Joseph Lister, the famous English surgeon who brought antiseptics to the operating room. The product sold modestly at first. But, starting in 1920, Listerine’s fortunes skyrocketed, prompted by a single word: halitosis. That grim-sounding bit of Latin means bad breath; Listerine made it infamous with an ad campaign in magazines and newspapers including full-page spreads showing sad-eyed men and women being ostracized from polite society: “They talk about you behind your back.” “Don’t offend others needlessly.” “Are you unpopular with your own children?” Within 7 years of launching its halitosis ads, Listerine increased its annual revenue from $115,000 to $8,000,000, and today it remains the nation’s leading mouthwash brand.

The COVID-19 pandemic has handed the $30 billion fresh-breath industry—mouthwashes, mints, breath strips, and gels—a real challenge. Retail sales in 2020 dropped 20% compared to the previous year. Some Listerine fans got excited in the summer of 2020 when research showed that antiseptic mouthwashes containing alcohol and essential oils—such as menthol, thymol, methyl, and salicylate (the active ingredients in Listerine)—can kill the virus that causes COVID-19 in a Petri dish. Unfortunately, that does not mean that Listerine can help control the disease in people. The virus lurks in the lungs and the throat, not just the mouth. The company claims that Listerine kills germs—up to 99.9% of those in our mouths. A study in India found that rinsing with an antiseptic mouthwash is at least as effective as controlling gum disease by flossing!

Listerine has achieved a level of pop-culture fame that is remarkable for such an unglamorous product. There are videos all over YouTube, Twitter, and TikTok of young people taking the Listerine challenge, showing off how long they can maintain a mouthful of this stuff; usually, that is ≤30 seconds.

READING

Elizabeth Bernstein, writing in The Wall Street Journal, had an excellent piece on reading.⁵ As everyone knows, reading expands our world, provides an escape, offers novelty and excitement, broadens our perspective, helps us empathize with others, improves our social life, distracts us, and helps reduce our mental chatter. Bernstein suggested that reading is a kind of meditation that disconnects us from the chaos around us. The year 2020 saw print books, which make up 80% of the market, increase 8.2% by volume over 2019, and sales of e-books were up 17%. Yet, even as people buy more books, many reports have suggested that readers are having a harder time getting through them. A UK study found that while people were reading more, they were reading more slowly. There are far more distractions now than in the past, and concentrating appears to be a bit more difficult.

Bernstein made the following suggestions for more mindful reading habits. 1) Clear your mind before starting to read. Sit quietly for 5 minutes and let your mind quiet down. 2) Start short. Our brains like completing things, so she suggested choosing an engaging short story, maybe by a favorite author, and allowing yourself to get immersed and finish it. 3) Read something relevant. A topic relevant to your life or current events will more likely hold your attention. 4) Return to a familiar previous read.

She summarized some tips on how to read mindfully: put the phone far away; make reading a habit; pick a favorite spot; read at the same time each day; go inward (introspective books such as memoirs, poetry, and books on mindfulness were particularly popular in 2020); read the way you did as a kid, sprawled out across your bed, on your back, on the floor, under the covers with a flashlight; read first thing in the morning; try listening (consider an audio book and let the narrator do some of the work); put down the book if you are not getting into it; start a new book as soon as you finish the previous one.

RELOCATING TO TEXAS

More than 500,000 people moved to Texas in 2019, the largest number being from California and Florida. About 200,000 new Texans (40%) came from outside the USA.⁶ Some move here, of course, because of its lower cost of living than where they were, a great quality of life, diverse job opportunities, and good weather. A technology consulting firm recently surveyed 150 business executives for their latest quarterly report on industry trends, and one in four said they were considering moving their business locations to somewhere else. Texas was the top state being examined; Florida and Tennessee ranked just behind it on the businesses’ location shopping list.

TEN BASEBALL HALL OF FAMERS GONE IN 10 MONTHS IN 2020

Dale Petroskey, president of the Dallas Regional Chamber, was president of the National Baseball Hall of Fame and Museum from 1999 to 2008.⁷ He wrote a beautiful column in The Dallas Morning News in February 2021 describing the 10 Hall of Famers who died in 2020: Hank Aaron, Don Sutton, Tom Seaver, Whitey Ford, Phil Niekro, Al Kaline, Bob Gibson, Lou Brock, Joe Morgan, and Tommy Lasorda. Five were pitchers, four were batters, and one was a manager.

If Ted Williams had not spent so much time as an Air Force pilot in World War II and in the Korean War, he would almost certainly have challenged Hank Aaron’s spectacular numbers. Aaron hit 715 home runs to pass the record of Babe Ruth on the all-time list, and before he was finished he had hit 755 home runs, a record that lasted >3 decades. Not only did he have the home run record during his lifetime, but he also had the most runs batted in (2297), the most career total bases (6856), the most career extra bases (1477), and the most All-Star game appearances (21); he was #3 on the all-time hit list (3771), behind two non–home run hitters, Pete Rose and Ty Cobb. He also finished with a .305 batting average and stole ≥ 20 bases in 6 seasons. Aaron played 21 of 23 seasons for the Milwaukee and Atlanta Braves. At his election to the Hall of Fame in 1982, he remarked: “I never want them to forget Babe Ruth. I just want them to remember Henry Aaron.”⁸

Lou Brock was proud of the fact that he went to Southern University in his home state of Louisiana on an academic scholarship, not a baseball scholarship! In fact, he was not even recruited to play baseball there. One day while sitting in the stands watching baseball practice, he saw the quality of play and mustarded the nerve to ask the coach if he could try out. Three years later, in 1961, he was in the major leagues with the Chicago Cubs. By the time his career ended in 1979, mostly with the St. Louis Cardinals, he had stolen 938 bases, the all-time record.

William C. Roberts, MD
March 10, 2021