Vaping: A Lot Of Hot Air?

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Vaping: A Lot Of Hot Air?

Yesterday, we asked you for your (health-related) opinions on vaping, and got the above-depicted, below-described, set of responses:

  • A little over a third of respondents said it’s actually more dangerous than smoking
  • A little under a third of respondents said it’s no better nor worse, just different
  • A little over 10% of respondents said it’s marginally less harmful, but still very bad
  • A little over 10% of respondents said it’s a much healthier alternative to smoking

So what does the science say?

Vaping is basically just steam inhalation, plus the active ingredient of your choice (e.g. nicotine, CBD, THC, etc): True or False?

False! There really are a lot of other chemicals in there.

And “chemicals” per se does not necessarily mean evil green glowing substances that a comicbook villain would market, but there are some unpleasantries in there too:

So, the substrate itself can cause irritation, and flavorings (with cinnamaldehyde, the cinnamon flavoring, being one of the worst) can really mess with our body’s inflammatory and oxidative responses.

Vaping can cause “popcorn lung”: True or False?

True and False! Popcorn lung is so-called after it came to attention when workers at a popcorn factory came down with it, due to exposure to diacetyl, a chemical used there.

That chemical was at that time also found in most vapes, but has since been banned in many places, including the US, Canada, the EU and the UK.

Vaping is just as bad as smoking: True or False?

False, per se. In fact, it’s recommended as a means of quitting smoking, by the UK’s famously thrifty NHS, that absolutely does not want people to be sick because that costs money:

NHS | Vaping To Quit Smoking

Of course, the active ingredients (e.g. nicotine, in the assumed case above) will still be the same, mg for mg, as they are for smoking.

Vaping is causing a health crisis amongst “kids nowadays”: True or False?

True—it just happens to be less serious on a case-by-case basis to the risks of smoking.

However, it is worth noting that the perceived harmlessness of vapes is surely a contributing factor in their widespread use amongst young people—decades after actual smoking (thankfully) went out of fashion.

On the other hand, there’s a flipside to this:

Flavored vape restrictions lead to higher cigarette sales

So, it may indeed be the case of “the lesser of two evils”.

Want to know more?

For a more in-depth science-ful exploration than we have room for here…

BMJ | Impact of vaping on respiratory health

Take care!

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  • Without Medicare Part B’s Shield, Patient’s Family Owes $81,000 for a Single Air-Ambulance Flight

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    Without Medicare Part B’s Shield, Patient’s Family Owes $81,000 for a Single Air-Ambulance Flight

    Debra Prichard was a retired factory worker who was careful with her money, including what she spent on medical care, said her daughter, Alicia Wieberg. “She was the kind of person who didn’t go to the doctor for anything.”

    That ended last year, when the rural Tennessee resident suffered a devastating stroke and several aneurysms. She twice was rushed from her local hospital to Vanderbilt University Medical Center in Nashville, 79 miles away, where she was treated by brain specialists. She died Oct. 31 at age 70.

    One of Prichard’s trips to the Nashville hospital was via helicopter ambulance. Wieberg said she had heard such flights could be pricey, but she didn’t realize how extraordinary the charge would be — or how her mother’s skimping on Medicare coverage could leave the family on the hook.

    Then the bill came.

    The Patient: Debra Prichard, who had Medicare Part A insurance before she died.

    Medical Service: An air-ambulance flight to Vanderbilt University Medical Center.

    Service Provider: Med-Trans Corp., a medical transportation service that is part of Global Medical Response, an industry giant backed by private equity investors. The larger company operates in all 50 states and says it has a total of 498 helicopters and airplanes.

    Total Bill: $81,739.40, none of which was covered by insurance.

    What Gives: Sky-high bills from air-ambulance providers have sparked complaints and federal action in recent years.

    For patients with private insurance coverage, the No Surprises Act, which went into effect in 2022, bars air-ambulance companies from billing people more than they would pay if the service were considered “in-network” with their health insurers. For patients with public coverage, such as Medicare or Medicaid, the government sets payment rates at much lower levels than the companies charge.

    But Prichard had opted out of the portion of Medicare that covers ambulance services.

    That meant when the bill arrived less than two weeks after her death, her estate was expected to pay the full air-ambulance fee of nearly $82,000. The main assets are 12 acres of land and her home in Decherd, Tennessee, where she lived for 48 years and raised two children. The bill for a single helicopter ride could eat up roughly a third of the estate’s value, said Wieberg, who is executor.

    The family’s predicament stems from the complicated nature of Medicare coverage.

    Prichard was enrolled only in Medicare Part A, which is free to most Americans 65 or older. That section of the federal insurance program covers inpatient care, and it paid most of her hospital bills, her daughter said.

    But Prichard declined other Medicare coverage, including Part B, which handles such things as doctor visits, outpatient treatment, and ambulance rides. Her daughter suspects she skipped that coverage to avoid the premiums most recipients pay, which currently are about $175 a month.

    Loren Adler, a health economist for the Brookings Institution who studies ambulance bills, estimated the maximum charge that Medicare would have allowed for Prichard’s flight would have been less than $10,000 if she’d signed up for Part B. The patient’s share of that would have been less than $2,000. Her estate might have owed nothing if she’d also purchased supplemental “Medigap” coverage, as many Medicare members do to cover things like coinsurance, he said.

    Nicole Michel, a spokesperson for Global Medical Response, the ambulance provider, agreed with Adler’s estimate that Medicare would have limited the charge for the flight to less than $10,000. But she said the federal program’s payment rates don’t cover the cost of providing air-ambulance services.

    “Our patient advocacy team is actively engaged with Ms. Wieberg’s attorney to determine if there was any other applicable medical coverage on the date of service that we could bill to,” Michel wrote in an email to KFF Health News. “If not, we are fully committed to working with Ms. Wieberg, as we do with all our patients, to find an equitable solution.”

    The Resolution: In mid-February, Wieberg said the company had not offered to reduce the bill.

    Wieberg said she and the attorney handling her mother’s estate both contacted the company, seeking a reduction in the bill. She said she also contacted Medicare officials, filled out a form on the No Surprises Act website, and filed a complaint with Tennessee regulators who oversee ambulance services. She said she was notified Feb. 12 that the company filed a legal claim against the estate for the entire amount.

    Wieberg said other health care providers, including ground ambulance services and the Vanderbilt hospital, wound up waiving several thousand dollars in unpaid fees for services they provided to Prichard that are normally covered by Medicare Part B.

    But as it stands, Prichard’s estate owes about $81,740 to the air-ambulance company.

    More from Bill of the Month

    The Takeaway: People who are eligible for Medicare are encouraged to sign up for Part B, unless they have private health insurance through an employer or spouse.

    “If someone with Medicare finds that they are having difficulty paying the Medicare Part B premiums, there are resources available to help compare Medicare coverage choices and learn about options to help pay for Medicare costs,” Meena Seshamani, director of the federal Center for Medicare, said in an email to KFF Health News.

    She noted that every state offers free counseling to help people navigate Medicare.

    In Tennessee, that counseling is offered by the State Health Insurance Assistance Program. Its director, Lori Galbreath, told KFF Health News she wishes more seniors would discuss their health coverage options with trained counselors like hers.

    “Every Medicare recipient’s experience is different,” she said. “We can look at their different situations and give them an unbiased view of what their next best steps could be.”

    Counselors advise that many people with modest incomes enroll in a Medicare Savings Program, which can cover their Part B premiums. In 2023, Tennessee residents could qualify for such assistance if they made less than $1,660 monthly as a single person or $2,239 as a married couple. Many people also could obtain help with other out-of-pocket expenses, such as copays for medical services.

    Wieberg, who lives in Missouri, has been preparing the family home for sale.

    She said the struggle over her mother’s air-ambulance bill makes her wonder why Medicare is split into pieces, with free coverage for inpatient care under Part A, but premiums for coverage of other crucial services under Part B.

    “Anybody past the age of 70 is likely going to need both,” she said. “And so why make it a decision of what you can afford or not afford, or what you think you’re going to use or not use?”

    Bill of the Month is a crowdsourced investigation by KFF Health News and NPR that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? Tell us about it!

    KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

    Subscribe to KFF Health News’ free Morning Briefing.

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  • Policosanol: A Rival To Statins, Without The Side Effects?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Policosanol (which can be extracted from various sources, but is mostly made from sugar cane extract) is marketed as lipid-lowering agent for improving cholesterol levels, but its research history has not been without controversy:

    2001: it works!

    After a lot of research in the 1990s, it came out of the gate strong in 2001, with:

    ❝Policosanol (5 and 10 mg/day) significantly decreased LDL-cholesterol (17.3% and 26.7%, respectively), total cholesterol (12.9% and 19.5%), as well as the ratios of LDL-cholesterol to high-density lipoprotein (HDL)-cholesterol (17.2% and 26.5%) and total cholesterol to HDL-cholesterol (16.3% and 21.0%) compared with baseline and placebo❞

    This, by the way, is comparable in efficacy to the most powerful statins, but without the adverse side effects.

    Source: Efficacy and tolerability of policosanol in hypercholesterolemic postmenopausal women

    Furthermore, its effects were not limited to postmenopausal women, and additionally, it was found that 20mg/day was sufficient for optimal effects; 40mg worked exactly the same as 20mg:

    Read: Effects of policosanol 20 versus 40 mg/day in the treatment of patients with type II hypercholesterolemia: a 6-month double-blind study

    2006–2010: we do not trust the Cubans!

    After it had been marketed and used in much of the world for some years, extra scrutiny was brought upon it, because the initial studies had been performed by the same lab in Cuba, a commercial lab that had tested them for a private interest (i.e., a company selling the supplement):

    Heart Beat: Policosanol: A sweet nothing for high cholesterol

    And furthermore, US-based labs were unable to replicate the results:

    Policosanols as Nutraceuticals: Fact or Fiction

    The Cuban researchers countered that the composition of policosanol as produced in their lab was different than the composition of the policosanol as produced in the US labs, because of the purity of the ingredients used in the Cuban lab.

    Which, on the face of it, could be true or could just be the claim of a commercial lab with an association with a company selling a product.

    Of course, importing Cuban ingredients to test them in the US was not a reasonably accessible option for the US-based labs, because of the US’s embargo of Cuba. In principle it could be done, but unless there is already a huge clear profit incentive, research scientists are usually on their hands and knees begging for grants already, so getting extra funding for specially-important Cuban ingredients was not going to be likely.

    2012: never mind, it does work after all!

    An American meta-analysis of 4596 patients from 52 eligible studies (from around the world, so many of them not affected by the US’s embargo; some were from within the US using non-Cuban ingredients, though), found:

    ❝policosanol is more effective than plant sterols and stanols for LDL level reduction and more favorably alters the lipid profile, approaching antilipemic drug efficacy❞

    Those last words there, to be clear, mean “yes, the original claim of being on a par with statins is at least more or less true”.

    Source: Meta-Analysis of Natural Therapies for Hyperlipidemia: Plant Sterols and Stanols versus Policosanol

    2018: also yes, the Cuban kind does get those extra-effective results, even when tested outside of Cuba

    A Korean research team verified this; it’s quite straightforward so for brevity we’ll just drop links:

    Mystery resolved!

    Want to try some?

    We don’t sell it, but here for your convenience is an example product on Amazon—it’s not the Cuban kind, because the US’s trade embargo makes it difficult for the US to import even things that are theoretically now exempt from the embargo such as food and medicines. In principle they can now be imported, but in practice, the extra regulations added to Cuban imports make it nearly impossible, especially for small sellers.

    Still, it’s 40mg/tablet policosanol from sugar cane extract, and 3rd party lab tested, so it’s the next best thing 😎

    Enjoy!

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  • There are ‘forever chemicals’ in our drinking water. Should standards change to protect our health?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Today’s news coverage reports potentially unsafe levels of “forever chemicals” detected in drinking water supplies around Australia. These include human-made chemicals: perfluorooctane sulfonate (known as PFOS) and perflurooctanic acid (PFOA). They are classed under the broader category of per- and polyfluoroalkyl substances or PFAS chemicals.

    The contaminants found in our drinking water are the same ones United States authorities warn can cause cancer over a long period of time, with reports warning there is “no safe level of exposure”.

    In April, the US Environmental Protection Agency (USEPA) sent shock waves through the water industry around the world when it announced stricter advice on safe levels of PFOS/PFOA in drinking water. This reduced limits considered safe in supplies to zero and gave the water industry five years to meet legally enforceable limits of 4 parts per trillion.

    So, should the same limits be enforced here in Australia? And how worried should we be that the drinking in many parts of Australia would fail the new US standards?

    What are the health risks?

    Medical knowledge about the human health effects of PFOS/PFOA is still emerging. An important factor is the bioaccumulation of these chemicals in different organs in the body over time.

    Increased exposure of people to these chemicals has been associated with several adverse health effects. These include higher cholesterol, lower birth weights, modified immune responses, kidney and testicular cancer.

    It has been very difficult to accurately track and measure effects of different levels of PFAS exposure on people. People may be exposed to PFAS chemicals in their everyday life through waterproofing of clothes, non-stick cookware coatings or through food and drinking water. PFAS can also be in pesticides, paints and cosmetics.

    The International Agency for Research on Cancer (on behalf of the World Health Organization) regards PFOA as being carcinogenic to humans and PFOS as possibly carcinogenic to humans.

    child at water fountain outdoors
    Is our drinking water safe? What about long-term risks? Volodymyr TVERDOKHLIB/Shutterstock

    Our guidelines

    Australian drinking water supplies are assessed against national water quality standards. These Australian Drinking Water Guidelines are continuously reviewed by industry and health experts that scan the international literature and update them accordingly.

    All city and town water supplies across Australia are subject to a wide range of physical and chemical water tests. The results are compared to Australian water guidelines.

    Some tests relate to human health considerations, such as levels of lead or bacteria. Others relate to “aesthetic” considerations, such as the appearance or taste of water. Most water authorities across Australia make water quality information and compliance with Australian guidelines freely available.

    What about Australian PFOS and PFOA standards?

    These chemicals can enter our drinking water system from many potential sources, such as via their use in fire-fighting foams or pesticides.

    According to the Australian Drinking Water Guidelines, PFOS should not exceed 0.07 micrograms per litre in drinking water. And PFOA should not exceed 0.56 micrograms per litre. One microgram is equivalent to one part per billion.

    The concentration of these chemicals in water is incredibly small. And much of the advice on their concentration is provided in different units. Sometimes in micrograms or nannograms. The USEPA uses parts per trillion.

    In parts per trillion (ppt) the Australian Guidelines for PFOS is 70 ppt and PFOA is 560 ppt. The USEPA’s new maximum contaminant levels (enforceable levels) are 4 ppt for both PFOS and also PFOA. Previous news reports have pointed out Australian guidelines for these chemicals in drinking water are up to 140 times higher than the USEPA permits.

    Yikes! That seems like a lot

    Today’s news report cites PFOS and PFOA water tests done at many different water supplies across Australia. Some water samples did not detect either chemicals. But most did, with the highest PFOS concentration 15.1–15.6 parts per trillion from Glenunga, South Australia. The highest PFOA concentration was reported from a small water supply in western Sydney, where it was detected at 5.17–9.66 parts per trillion.

    Australia and the US are not alone. This is an enormous global problem.

    One of the obvious challenges for the Australian water industry is that current water treatment processes may not be effective at removing PFOS or PFOA. The Australian Drinking Water Guidelines provide this advice:

    Standard water treatment technologies including coagulation followed by physical separation, aeration, chemical oxidation, UV irradiation, and disinfection have little or no effect on PFOS or PFOA concentrations.

    Filtering with activated carbon and reverse osmosis may remove many PFAS chemicals. But no treatment systems appear to be completely effective at their removal.

    Removing these contaminants might be particularly difficult for small regional water supplies already struggling to maintain their water infrastructure. The NSW Auditor General criticised the planning for, and funding of, town water infrastructure in regional NSW back in 2020.

    Where to from here?

    The Australian water industry likely has little choice but to follow the US lead and address PFOS/PFAS contamination in drinking water. Along with lower thresholds, the US committed US$1 billion to water infrastructure to improve detection and water treatment. They will also now require:

    Public water systems must monitor for these PFAS and have three years to complete initial monitoring (by 2027) […]

    As today’s report notes, it is very difficult to find any recent data on PFOS and PFOA in Australian drinking water supplies. Australian regulators should also require ongoing and widespread monitoring of our major city and regional water supplies for these “forever chemicals”.

    The bottom line for drinking tap water is to keep watching this space. Buying bottled water might not be effective (2021 US research detected PFAS in 39 out of 100 bottled waters). The USEPA suggests people can reduce PFAS exposure with measures including avoiding fish from contaminated waters and considering home filtration systems.

    Correction: this article previously listed the maximum Australian Drinking Water Guidelines PFOA level as 0.056 micrograms per litre. The figure has been updated to show the correct level of 0.56 micrograms per litre.

    Ian A. Wright, Associate Professor in Environmental Science, Western Sydney University

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • Lucid Dreaming – by Stephen LaBerge Ph.D.

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    For any unfamiliar: lucid dreaming means being aware that one is dreaming, while dreaming, and exercising a degree of control over the dream. Superficially, this is fun. But if one really wants to go deeper into it, it can be a lot more:

    Dr. Stephen LaBerge takes a science-based approach to lucid dreaming, and in this work provides not only step-by-step instructions of several ways of inducing lucid dreaming, but also, opens the reader’s mind to things that can be done there beyond the merely recreational:

    In lucid dreams, he argues and illustrates, it’s possible to talk to parts of one’s own subconscious (Inception, anyone? Yes, this book came first) and get quite an amount of self-therapy done. And that hobby you wish you had more time to practice? The possibilities just became limitless. And who wouldn’t want that?

    Grab Your Bedtime Reading From Amazon Now!

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  • Get Ahead (Healthwise) This Winter

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Tomorrow will be December the first.

    A month later, it’ll be January the first, and very many people will be quite briefly making a concerted effort to get healthier.

    So, let’s get a head start, so that we can hit January already in great health!

    December’s traps to plan around

    In North America at least, common calendar-specific health problems associated with December are:

    • Infectious diseases (seasonal flu and similar unpleasantries)
    • Inactivity (seasonal weather)
    • Slower metabolism (seasonal eating and drinking, plus seasonal weather)
    • Alcohol (seasonal drinking)
    • Stress (seasonal burdens)

    So, let’s plan around those!

    But first, sleep

    Nothing will go well if we are not well-rested. There are six dimensions of sleep, but the ones that matter the most are regularity and duration, so plan for those and the rest should fall into place:

    Calculate (And Enjoy) The Perfect Night’s Sleep

    Skip those viruses

    If you’re doing the rest of what we advise, your immune system will probably be in good shape, unless you have some chronic disease that means you are immunocompromised, in which case the next things will be extra important:

    • Avoid enclosed spaces with lots of people where possible
    • Ventilation is your friend (as is air filtration)
    • Masks don’t protect against everything, but they do protect against a lot
    • Wash your hands more often than you think is necessary (invest in luxurious soap, to make it a more pleasant experience, then you’re more likely to do it often!)
    • Breathe through your nose, not your mouth (nostril hairs attract floating particles by static charge, and then dispose of intruders via mucus)

    See also: The Pathogens That Came In From The Cold

    Plan your movement

    But, realistically. Let’s face it, unless you already have such a habit, you’re not going to be hitting the gym at 6am every day, or be out pounding pavement.

    The weather often makes us more reluctant to exercise, so if that sound like you, plan something low-key but sustainable that will set you in good stead ready for the new year. Here are two approaches; you can do both if you like, but picking at least one is a good idea:

    1. Commit to just a few minutes of high-intensity exercise each day. If you don’t have equipment, then bodyweight squats are a great option.
    2. Commit to gentle exercises each day—pick some stretches and mobility drills you like, and focus on getting supple for the new year.

    See also: How To Keep On Keeping On, When Motivation Isn’t High ← this isn’t a motivational pep talk; it’s tricks and hacks to make life easier while still getting good results!

    Fuel in the tank

    It’s fine if you eat more in winter. We even evolved to put on a few pounds around this time of year. However, to avoid sabotaging your health, it’s good to do things mindfully. Pick one main dietary consideration to focus on, for example “anti-inflammatory” or “antidiabetic” or “nutrient-dense”.

    Those focused ways of eating will, by the way, have a huge amount of overlap. But by picking one specific factor to focus on, it simplifies food choices at a time of year when supermarkets are deliberately overwhelming us with choices.

    If you’re having a hard time picking just one thing to focus on, then we recommend:

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    About that festive spirit…

    Alcohol consumption goes up around this time of year, partly for social reasons, partly for “it’s cold and the marketing says alcohol warms us up” reasons, and partly for stress-related reasons. We’re sure you know it sabotages your health, so choose your path:

    How To Reduce Or Quit Alcohol, or

    How To Reduce The Harm Of Festive Drinking (Without Abstaining)

    Relax and unwind, often

    There’s a lot going on in December: consumerism is running high, everyone wants to sell you something, finances can be stressful, social/familial obligations can be challenging sometimes too, and Seasonal Affective Disorder is at its worst.

    Make sure to regularly take some time out to take care of yourself, and make sure you’re doing the things you want to do or really have to do, not just things you feel you’re expected to do.

    Different people can have very different challenges at this time of year, so it’s hard to give a “one size fits all” solution here (and we don’t have the room to cover every possible thing today). You know your life best, so think what you’re most likely to want/need for you this month, and make sure you get it.

    At the very least, most of us will benefit from taking a few minutes to consciously relax, and often, so something that is almost always a good idea for that is:

    No-Frills, Evidence Based Mindfulness

    …but if you’re feeling in a more playful mood, consider:

    Meditation Games You’ll Actually Enjoy!

    Take care!

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  • How Emotions Are Made – by Dr. Lisa Feldman Barrett

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    We’ve previously reviewed Dr. Barrett’s (also good) book Seven And A Half Lessons About The Brain, and this one is very different, and of more practical use:

    The main thrust of the book is: the bioessentialist model of emotions is flawed; there is also no Platonic perfect form of any given emotion, and in fact emotions are constructed by the brain as a learned adaptive response.

    She argues this from the dual vectors of on the one hand hard sciences of affective neuroscience and clinical psychology, and on the other hand sociology and anthropology.

    In the category of criticism: Dr. Barrett, a very well-known and well-respected cognitive neuroscientist, is not an expert on sociology and anthropology, and some of her claims there are verifiably false.

    However, most of the book is given over the psychophysiology, which is entirely her thing, and she explains it clearly and simply while backing everything up with mountains of data.

    The usefulness of this book is chiefly: if we understand that emotions are not innate and are instead constructed adaptive (and sometimes maladaptive) neurological responses to stimuli and associations, we can set about rewiring things a little in accord with what’s actually more beneficial to us. The book also outlines how.

    Bottom line: if you’d like to be able to not merely manage emotions as they are, but also prune and/or grow them from the stem up, then this book provides a robustly scientific approach for doing that.

    Click here to check out How Emotions Are Made, and get more discerning about yours!

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