Mike Kueber's Blog

May 15, 2015

My kidney

Filed under: Biography,Medical,Philosophy — Mike Kueber @ 5:50 pm
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A couple of weeks ago, NY Times columnist David Brooks proposed that his readers write their personal eulogy and submit it to him for a project he is working. He thinks that the process of writing a eulogy may cause participants to recognize what is meaningful to their lives and to shift away from things that are unimportant.  It might also prompt participants to get after things they have been putting off.

As I started writing my eulogy, I was immediately prompted by something I had been putting off for months – namely, donating a kidney.

I’ve heard of thousands of people dying each year or living a debilitating life because they couldn’t receive a kidney transplant.  Then last year, I read an article in the Express-News about a donor who started a chain of transplants by agreeing to give her kidney to a stranger, who in-turn had a relative who would donate a kidney to another stranger.  The first donor, called the altruistic donor, triggered a chain of 17 relative-friend donations.

That sounded amazing.  Why shouldn’t I become an altruistic donor by donating my kidney, especially since medical advances made the donation relatively safe and pain free?

I’ve casually mentioned this possibility to friends and family, and my M.D. son later informed me that he did some research that indicated my life expectancy would not be shortened because of the donation.

That was comforting, but due to my dawdling retirement lifestyle, I didn’t make a lot of progress toward getting this done, other than a few phone calls, until I started working on my eulogy.  My eulogy made me realize that a kidney transplant would be one of those meaningful things that I wanted to include in my eulogy.

So I went back to work on this project and made contact with a local hospital in town that specializes in transplants.  The process is underway.

In an amazing coincidence, two days after getting in contact with the hospital, I started reading a new book called The Most Good You Can Do by Peter Singer.  In the book, which describes becoming an effective altruist, donating a kidney is listed as the gold standard of altruists.

My patron saint, Ayn Rand, is probably turning over in her grave.


October 30, 2014

Go Public – marketing government services

Filed under: Education,Medical — Mike Kueber @ 12:33 am
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Last month, there was an article in the Express-News describing a multi-district program – Go Public – to better market the public schools in San Antonio.  My initial reaction was that our financially strapped schools should be spending money on teaching students, not on marketing. Indeed, the article even reported that a school board trustee was similarly minded:

  • Until last month, Schertz-Cibolo-Universal City ISD was one of the few traditional districts with students in Bexar County that hadn’t joined Go Public. Its board voted 4-3 to participate after a lengthy debate that included Trustee George Ricks asking how the district was going to benefit from its $15,000 contribution and questioning its appropriateness as a public expenditure. “Are we trying to steal students away from private schools?” he asked.

But another board member had a different opinion:

  • The district should promote itself, board member Gary Inmon argued. “If you don’t get the positive word out, the negative word sticks, which really does hurt the entire system,” he said.

Although marketing seems wasteful to us Pollyannaish idealists, the practical person must accept that marketing is needed for government programs to compete successfully against private options. E.g., the post office, military employment.

I think there is a difference, though, when I see marketing of welfare programs, like food stamps. Yes, the SNAP program should be readily accessible and the use of food stamps should not be demeaning, but I don’t think government should be spending money encouraging people to avail themselves of welfare benefits they are entitled to. As JFK said, “Ask not what your country can do for you; ask what you can do for your country.”

How does this apply to the marketing of Healthcare.gov?  ObamaCare seems to be a hybrid.  Much of it is designed to improve the health-insurance industry for everyone, but as a practical matter, most of the coverage for those previously uninsured is merely an expansion of welfare – Medicaid.  I don’t think the voters want to see a lot of ObamaCare marketing.

October 10, 2014

Happy Drugs and yoga

Filed under: Fitness,Medical — Mike Kueber @ 11:57 pm
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I recently blogged about the possibility that yoga, like good sex, causes the human body to produce drugs that cause immense happiness. The science behind this hypothesis is explored in a popular book and an interesting scientific article in Psychology Today, both published in 2012:

  • Book – Meet Your Happy Chemicals by Loretta Graziano Breuning
  • Article – The Neurochemicals of Happiness by Christopher Bergland

Breuning’s book focuses on four chemicals:

  1. Dopamine – the joy of finding what you want, which motivates you to keep seeking rewards.
  2. Endorphin – the oblivion that masks pain, which motivates you to ignore physical pain.
  3. Oxytocin – the safety of social bonds, which motivates you to build social alliances.
  4. Serotonin – the security of social dominance, which motivates you to get respect from others.

Bergland’s article addresses seven neurochemicals, including Breuning’s four:

  1. Endocannabinoids – “the Bliss Molecule”
  2. Dopamine – “the Reward Molecule”
  3. Oxytocin – “the Bonding Molecule”
  4. Endorphin – “the Pain-Killing Molecule”
  5. GABA – “the Anti-Anxiety Molecule”
  6. Serotonin – “the Confidence Molecule”
  7. Adrenaline – “the Energy Molecule”

Both Breuning and Bergland approach this subject from the perspective that humans (and other mammals) are programmed so that they feel happy when engaging in activities that are conducive to their survival. To create this feeling of happiness (and encourage this behavior), the body produces various chemicals during those physical activities.

Unfortunately, as life has become more sedentary, the chemicals aren’t being produced as much, with a deleterious effect on happiness. The authors suggest that certain physical activities can reverse this trend. Because Bergland’s background is as a self-described world-class endurance athlete, his focus is primarily on how these neurochemicals can be produced by athletics:

Endocannabinoid: sustained running produces a runner’s high.

Dopamine: the high resulting from setting a goal and achieving it.

Oxytocin: skin-to-skin contact, lovemaking, affection and intimacy.

Endorphin: strenuous physical exertion, sexual intercourse, and orgasm.

GABA: yoga is much better than reading a book.

Serotonin: actions that increase self-esteem and reduce insecurity.

Adrenalin: distress and fearful situations.

Based on these findings, yoga could easily be helpful in producing endocannabinoid, dopamine, endorphin, serotonin, and especially GABA. And there is a subsequent study in Psychology Today reporting that yoga helps produce oxytocin.  That leaves only adrenalin unaffected by yoga, and, personally, I am willing to avoid the high produced by escaping a fearful situation.  No parachuting for me.

The connection between yoga and oxytocin is the most interesting to me.  Breuning describes the function of oxytocin as follows:

  • When you have a good feeling about someone, oxytocin causes it. When you feel you can trust a person, or you enjoy their trust in you, oxytocin is flowing. The feeling of belonging, and of safety in numbers, is oxytocin too.  Social trust improves survival prospects, and it feels good. The brain motivates you to build social bonds by rewarding them with a good feeling, and thus promotes survival.

The social component of yoga is undeniable.  I have commented to several friends that I select classes to attend primarily on knowing which of my classmates are attending which classes.  We visit some before class and often afterwards.  And during class, there is a ubiquitous reference to sharing your energy with those around you, especially when the practice gets physically demanding.

Breuning says, “Touch triggers oxytocin,” and although our Lifetime Fitness classes don’t often involve touching, earlier this year I attended a special practice conducted by a master teacher from Minnesota, and preached lots of touching.  First he placed our mats only a couple of inches apart and then twice had us introduce ourselves to our mat mates (the second time was to demonstrate how often an introduction is forgotten within minutes).  Later in the practice, we held our mates arms and feet to help with balancing poses.  And finally, after we were all sweated up, he had us give our mat mates a big hug.  That is touching, big time.

I suspect the master teacher’s routine hasn’t been adopted in SA because many of my classmates aren’t ready for that level of familiarity.  In lieu of that, for the past few weeks I have been taking baby steps in that direction by shaking hands with those on adjoining mats immediately after practice and thanking them for a great practice and sharing their energy.  I believe that is oxytocin talking.

And after one especially demanding practice a couple of months ago, I mentioned to my two mat mates that the practice felt like a religious experience.  That, too, was the oxytocin talking.  And that’s a good thing.

May 7, 2014

Pricing of prescription drugs

Filed under: Medical — Mike Kueber @ 6:57 pm

I’ve often wondered how prescription drugs are priced.  In a typical context, prices are based on supply and demand.  But because of patents, the supply of drugs in many instances is absolutely controlled by the drug inventor.  So if the drug is of the live-saving variety, what is to stop the drug company from charging and the insurance company from being forced to pay exorbitant prices?

An article this week in the SA Express-News reported on a situation that exemplifies this troubling situation.    The maker of a drug that often cures life-threatening hepatitis C charges $84,000 for a 12-month treatment.  According to the article:

  • The industry has set the price at a point which I can’t see how it would be affordable for any health insurance or any system to take this on 100 percent,” said Dr. Rena Fox, a professor of medicine at the University of California at San Francisco who researches hepatitis C in veterans.
  • “Gilead also wants to recoup the $11-plus billion it spent developing the technology.”

I don’t understand how an insurance company can deny coverage for a drug just because it is expensive.  The insurance policies that I am familiar with always provided that they would cover all reasonable, necessary treatment, so there probably is an argument that this treatment is not reasonable, although that would be a tough argument in a life-threatening situation.

Regarding the drug company wanting to recoup its $11 billion development cost, I don’t understand how that would affect pricing.  A company is motivated to charge as much as the market will bear, and the development costs would have no effect on that.  Why not charge $185,000 for the treatment?

When I searched the internet for some information on this matter, I learned that my understanding was pretty the consensus view, with the key being how much private and government insurance would pay:

  • As simple as that explanation is, the calculations behind the price are complicated. They factor in how many people will buy a drug, how many of those people are likely to be privately insured, how many are likely to have Medicare or Medicaid, how many will have no insurance at all, for how long will a given patient be on the drug (on average), how much it costs to make the drug (yes, this does matter), and even what’s at stake (is the drug treating a life-or-death condition, or is it treating something more mild?).”

The problem with more government involvement to fix this problem is that such involvement would probably make matters worse.  But I’m hoping someone comes up with a better system that produces reasonable pricing without stifling innovation.

March 6, 2014

Organ donation

Filed under: Medical — Mike Kueber @ 1:23 am

Last night during my friend’s weekly Boys Night Out party, the wide-ranging conversation drifted onto organ donation.  I mentioned to the boys a recent article in the Express-News about “nondirected” kidney donation whereby one anonymous donor could start of chain of 10-15 donations that would not otherwise occur.  I also told the boys that when I blogged about this subject I couldn’t think of a solid reason why I shouldn’t volunteer to be a donor.  After a few minutes of hemming and hawing, they couldn’t think of a good reason either.  But they still weren’t going to volunteer.

insurance payment of $10,000 that could be applied toward burial and other expenses.  This program would encourage people to donate without crossing the line into organ selling.

When I find out who is elected my state rep later this year, I plan to discuss this idea with him, provided I survive my kidney donation.

February 1, 2014

Nondirected kidney donors

Filed under: Medical,Philosophy — Mike Kueber @ 11:22 pm
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An article in the Express-News today discussed a chain of 10 kidney transplants that is started by a single “nondirected” donor.    Apparently, most transplants occur when one family member donates to another family member.  If there is no family match, the ill person usually needs to wait for a kidney from a cadaver.

The article describes an alternative way to create a multitude of kidney transplants.  If one individual will agree to provide a kidney to an anonymous recipient, the hospital will give the kidney to a recipient who has a family member willing to give a kidney to another recipient.  Although this type of chain theoretically could go on indefinitely, it is always broken when there is no potential matching set of donors-recipients available.  The record chain length for the San Antonio hospital is 16 donors, but the recent story involved 10 donors.

Because the subject interested me, I did some on-line research and learned about a similar program at Johns-Hopkins Hospital.  The program website provided an interesting comment from a nondirected donor:

  • Becoming a living kidney donor is a serious decision, with some risks, but many rewards. I couldn’t get past the idea that the slim chance that this surgery might affect my quality of life was more than offset by the knowledge that my kidney might mean all the difference to some child who would have no life at all if I backed away.

According to the SA Express-News article, there are 98,000 people currently waiting on such a kidney.  According to the National Kidney Foundation, 5,000 people die each year because they couldn’t get a kidney:

  • Last year, 16,812 kidney transplants took place in the U.S. Of these, 11,043 kidney transplants came from deceased donors and 5,769 came from living donors.  Of the living donors, only 165 were unrelated anonymous donors.

With this number of people needing help, I wonder why there aren’t more nondirected donors. I wonder why I’m not one.

I’m going to ponder this.

November 8, 2013

Mental-health insurance and ObamaCare

Filed under: Insurance,Issues,Medical,Politics — Mike Kueber @ 8:11 pm
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Yesterday, an article in the New York Times proclaimed that recent ObamaCare regulations have completed “a generation-long effort to require insurers to cover care for mental health and addiction just like physical illnesses.”  Although most Americans were probably unaware of this effort, I was aware of it because I remember learning many years ago at a previous employer about the generous mental-health coverage that was required in all employer-provided health insurance (ERISA).

At that time, the federal government had already interjected itself into micro-managing the contents of ERISA-based health insurance.  ObamaCare extends that micro-management into individually-purchased health insurance.

Back then, when I heard about this mandatory coverage (I believe Senator Al Gore was a big proponent), I was opposed for both personal and economic reasons.  The personal reason was that I knew someone who had been going to a therapist almost her entire life, and this treatment didn’t seem necessary.  Instead, it seemed she enjoyed having someone she could talk to.  The economic reason was that people who wouldn’t consider obtaining mental-health treatment shouldn’t be required to contribute to the insurance pool to pay for such treatment.  Ditto – maternity coverage.

America is not ready for socialism (from each according to their ability, to each according to their needs).

November 5, 2013

Putting a face on abortion

Filed under: Culture,Issues,Law/justice,Medical,Politics — Mike Kueber @ 6:53 pm
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Abortion is almost always discussed in the abstract because almost no one is willing to be the face of abortion.  Even the most ardent advocate of abortion rights will express her personal opposition to aborting a fetus of hers.  That all changed today in the Express-News when an Austin woman complained loudly that her scheduled abortion had been cancelled at the last minute because of Texas’s new anti-abortion law had shut-down her abortion clinic.

According to the article, which was accompanied by a large close-up photograph, the seven-weeks’ pregnant Marni Evans was devastated:

  • This was my decision to make, but I am still pregnant today because that decision was taken away from me.”

The article went on to report, “(Marni) will use frequent-flier miles she had saved for their honeymoon to travel to Seattle this week to have the abortion, rather than try to start over with a new ultrasound and attempt to get an appointment at another Texas clinic.”

Aside from Evans’ willingness to publicize her planned abortion, the thing I found most surprising was Evans’ comment that she and her fiancé cannot afford health insurance, much less care for a child.  Both her insurance status and her ability to care for a child seem irrelevant to the article, but even conceding their relevance, they are highly dubious and the reporter should have insisted that Evans elaborate.  According to Evans’ website:

  • I believe in the power of continuous personal and professional development.  Trained as an architect, Marni Jade Evans, LEED AP BD + C, is a sustainability educator, consultant and mentor as founder of the Austin, TX based office.
  • With thirteen years of professional sustainability experience, Marni possesses a deep passion for transformation of the development industry, after a spiritual awakening led her to question conventional process and unsustainable patterns in the way we design and build today.
  • Her spark has ignited individuals and organizations to pursue deep green solutions – be it career transitions into sustainability or pursuit of the Living Building Challenge.

Does that sound like a person who cannot afford health insurance or care for a child?

October 24, 2013

ObamaCare – temporary glitch or systemic failure

Filed under: Economics,Issues,Medical,Politics — Mike Kueber @ 1:41 pm
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There has been much talk the past few days about the problems associated with the federal government’s ObamaCare exchanges.  This publicity suggests that public radio’s David Martin Davies was correct last week when he suggested that the TEA Party was shooting itself in the foot with its shut-down of the federal government.  According to Davis, the shut-down was distracting the public from ObamaCare’s embarrassing crash.  Now, with the shut-down over, there is no bigger story in America than the ObamaCare exchanges.

The initial debate seemed to have conservatives arguing in a knee-jerk fashion that the implementation failure was only an example of all that was wrong with ObamaCare, while the liberals countered that the problems with on-line implementation had nothing to do with the substance of the law.  Eventually, though, the debate has gravitated toward the real issue, which was the title of a pro-con op-ed piece in today’s SAEN:

On the side of temporary glitch is NY Times columnist Paul Krugman.  On the side of systemic failure is Washington Post columnist Michael Gerson.  Both Krugman’s and Gerson’s columns tend toward picking straw man arguments and then debunking them.  Near the end of Gerson’s column, however, he makes a broader point that resonates with me.  He refers to Friedrich Hayek’s point about a fundamental flaw of central planning, which is the inability to consider all of the relevant information.  By contrast, the free market has the marvelous ability to do just that.

And that is why ObamaCare needs to go away.

October 13, 2013

The lost night

Filed under: Culture,Medical — Mike Kueber @ 2:28 am
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There is an Academy Award-winning movie titled The Lost Weekend.  In the 1945 movie, an alcoholic writer goes on a binge that results in a foggy memory of a weekend.  That sounds like to a more recent movie titled The Hangover, but without the alcoholic component.  While visiting Aneta last week, I had a similar experience.

On one of my first days in North Dakota, I went golfing in McVille with two old friends.  After playing nine holes, we decided to have a beer at a McVille bar before returning to Aneta.  One thing led to another, and after four rounds of light beer, we finally headed back to Aneta.  We were planning to have a beer in Aneta’s bar, but I suggested the weather was so nice that we should drink instead on a friend’s patio.  While my two friends drank beer, I took some spiced rum and diet coke from my car’s trunk.  Soon another friend and the wife of one of my friends joined us for this Happy Hour party.  I remember having one 12-oz. diet coke with two shots (my standard mix), and then starting on another around 6 pm, and that is the last thing I remember of that night.  The next thing I remember, I was waking in the driver’s seat of my car at 5:30 am.

What the hell happened?  According to my friends, we had a really good time with a lively conversation.  Then my friend’s wife made me a drink, and unbeknownst to me, filled my glass half full of spiced rum before adding some diet coke.  When another friend expressed concern that the drink was too strong, she responded that I would let her know if that were the case.

Well, apparently, I didn’t complain and proceeded to consume most of the drink.  My friends decided there was a problem later when I fell over walking behind their garage to take a leak.  Wisely, they decided I shouldn’t drive home, but after driving about a mile toward the family farm, I persuaded them to let me sleep it off in my car.  That worked fine for us, but his neighbor reported that she was surprised at 2 am when she took her dog outside and saw a man taking a leak alongside my car.

According to Wikipedia, this phenomenon is called a blackout:

  • Blackouts are commonly associated with the consumption of large amounts of alcohol; however, surveys of drinkers experiencing blackouts have indicated that they are not directly related to the amount of alcohol consumed. Respondents reported they frequently recalled having “drank as much or more without memory loss,” compared to instances of blacking out.  Subsequent research has indicated that blackouts are most likely caused by a rapid increase in a person’s blood-alcohol concentration.

The rapid increase in BAC appears to be what happened.  I always drink at a moderate pace and never drink shots, and because I’ve never blacked out before, or even fallen down while drinking, I plan to consider this incident to be an aberration.

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