Category Archives: Health

Retirement, and the destruction of our financial system.

140530_retirementThe number of people over 65 is set to double within 25 years. By 2035 Japan will have 69 old people for every 100 of working age (up from 43 in 2010), and Germany 66. In China the dependency rate will double from 15 to 36. By 2050 China will have 440 million pensioners or more than the projected population of the US!

Most countries have the PAYG system whereby the workers pay for those in retirement. When the scheme was initiated there were about 7 workers to pay for one retiree. In Europe there are now almost 4 people of working age to pay for each person over 65. They are now paying far more than when the scheme was introduced. Increasing the payments further is politically impossible. But by 2050 the number of workers to pay for one pensioner will be halved to about 2. The system is obviously unsustainable.

Unless the retirement age is changed there will be relative fewer and fewer workers to pay for more and more of the retired.  Not only will there be more retirees but they will live longer and pensions will have to be paid for increasing longer periods. Already in Germany, retirement for a female lasts 20 years. It has been estimated that 20% of those living today will reach 100; Thus having a retirement lasting 40 years!   Financing pensions with the present scheme will then be impossible.

Under the UN`s assumption that a working life ends at 65 and with no increase in productivity, ageing populations could cut growth rates by between one third and one half over the coming years (Economist 411(8884): 18). This is probably an over- optimistic view.

Not only is there no increase in productivity growth, but there is a growth decrease from 2.2% in 1971-2007 to only 0.3% per year since 2008!

All these factors help to explain why the UK has unfunded pension obligations of a staggering £4.7 Trillion (with a GDP of £1.5 Trillion). This amounts to £180,000 per person (Office of Nat. Statistics.). The National Debt would be increased 5 times if the unfunded pension obligations were added. The UK Government has pension liabilities of over 300% of GDP. In Poland and France they are over 350% of GDP (FT 23rd Aug. 2016).

While these figures can be questioned, it has been estimated that if the US pension liabilities were to be added to the US National Debt, the debt would be increased 7 times!    Federal unfunded liabilities alone exceed $127 Trillion or $1.1million per taxpayer (Forbes, Jan. 2014). US pension liabilities have increased 6 times over the last 10 years, (Harvard Kennedy School; “Unfunded Public Pensions in the US”).

The FTSE 100 global companies with pension schemes had a net pension deficit of 290 Billion Euros in 2011 or nearly double the amount of 170 Billion Euros in 2010. (A pension deficit of 170 Billion Euros is more than the Greek bailout package).

An example of the enormous burden of pensions schemes on individual companies can be illustrated by the BT Group (UK). The pension liabilities are estimated at £47 Billion and the company has a market capitalization of only £35.5 Billion. The Pension Fund is 1.5 times larger than the size of the company!   The UK `s 6,000 schemes had an aggregate deficit of close to £300 billion (FT Aug.12th 2016 p.8). IBM has pension obligations of a staggering $99.7 Billion, (Fortune Nov. 2014).

There is a bright spot. Britain`s Pension Protection Fund to protect workers pensions had a surplus of £3.6 Billion. The American Pension Benefit Guaranty Corporation on the other hand, had liabilities of $164 Billion with total assets of only $87.7 billion; a record deficit of $76.3 billion. Congress has provided a levy of £27 per employee per year. This is $270 million, which is woefully inadequate to cover a liability of $52 Billion. (Economist, April 9th 2016, p.62). The severity of the problem has not been realized.

The idea of pumping more money into the economy or “quantitive easing” with historically low interest rates to revive the economy, has resulted in global debt increasing to $200 Trillion; far outpacing growth. (This amount is greater than the world debt before the financial crisis (McKinsey Survey)). The extreme low rates of interest have resulted in a massive increase in pension fund liabilities. The liabilities of pension funds in the US are now double their assets.  (They had a surplus 30 years previously)!

There is fear that some states, cities and pension funds may have to declare bankruptcy, due to pension liabilities. The City of Detroit was declared bankrupt with half of the debt being pension debt.

While some figures may be questioned the fact remains that retirement is massively bleeding the world economy, by reducing the relative size of the working force, (thereby reducing productivity), through ever increasing massive pension demands on the state, cities, companies and pension funds (thereby reducing investment). It is no accident that the economy stagnates.

The figures are enormous. They are frightening (G. Magnus) and are increasing by a huge amount every minute, as more and more people become older and older. The figures have been ignored because the pension debt and liabilities are not on the balance sheets. But they have the potential of causing a world financial crisis with our children and grand children living in poverty.

Unless the present retirement system is completely overhauled, and the elderly incorporated into the working force, making a contribution to society, the world will face a human disaster.

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Cancer and Exercise.

English: Nutrigenomics: bring disease, cancer,...

English: Nutrigenomics: bring disease, cancer, diet and genetics together (Photo credit: Wikipedia)

Recent press articles in the UK have trumpeted the alarming fact that “Half of the UK population will get cancer in their lifetime,” but if one reads further through the reports there was also another eye-opening claim:  “Exercise is so effective in the prevention and rehabilitation of cancer, that if it were a drug; it would be a wonder drug.”

Why am I not surprised? In my mind, these findings lead me to imagine a situation in which it is suddenly realized that that food (even in minute portions) is now the new wonder drug to cure  famine!

The tragic reality is that the vast majority of the population suffers from exercise hunger or acute chronic exercise deficiency. Inactivity is now the 4th preventable cause of death. Based on a survey of 153,000 people, only 5% of UK adults meet the minimum physical activity recommendations. (NHS Sport & Exercise Medicine Sept. 2011) and only 3% do not smoke, have normal weight, eat 5 fruits and/or vegetables per day and exercised sufficiently. (Ach. Intern. Med. 165:854, 2005). On the other hand, regular exercisers are up to 50% less likely to be affected by serious illness, including cancer. (NHS Sport & Exercise Medicine Sept. 2011).

45% of the US population has at least one chronic disease (including cancer). By 2025, it is estimated that the proportion will increase to 49%, or about half the population! Behavioural risk factors for chronic disease include physical inactivity, an unhealthy diet and smoking. (WHO).

In spite of the fact that the intimate details of the preventive and curative aspects of exercise are not widely known, efforts are being made to develop special training regimes and specialized coaches for specific medical conditions. The ACSM/ACS (USA) offers courses for a “Certified Cancer Exercise Trainer”, with requirements that include a Bachelor’s Degree. (American College of Sport Medicine).  In principle, this is a development I welcome, though much more research is necessary.

I am, however worried that, it is readily forgotten that exercise must be combined with diet in order to achieve the desired results. Diet should be tailored and timed to the training regime. Certain dietary components that were present in the mid-Victorian diet contain enzymes that induce cancer cell arrest. (J.R.S.M. 101(9):454 2008). These components and avoidance of the carcinogens present in many modern foods should be incorporated. I’m convinced that reduced energy expenditure or lack of exercise and the increased consumption of processed and less nutritious foods are the main causes of the dramatic continuing increase in chronic disease.

A specified training regime, for cancer patients, administered by a certified cancer exercise trainer together with a diet, tailored to the exercise regime as well as being anti-carcinogenic seems a valid prescription.  Sadly, the recommendation is often just a short walk.

Perhaps the cancer patients are often so weak that even a 30 min. walk is very demanding or the knowledge of exercise and it’s inter-relationship with nutrition is sparse. Either way, both are disturbing.

Causes of Knee Osteoarthritis.

Knee

Knee (Photo credit: mariandy_gizfel)

I have talked about the extraordinary and disturbing number of knee joints that are being replaced by artificial joints. There are 600,000 knee replacements every year in the US at a yearly cost of $9 Billion. They have doubled over the last decade. (OECD iLibrary 2011). They are expected to double again in the UK over the next 2 decades! (Lancet 380:1768 2012).

Age is a factor. 70% of those 65+ show radiological evidence of osteoarthritis in at least one knee or hip joint. (J. Orthop. Res. 7:15 2012)

But one of the major causative factors is obesity. 69% of knee operations may be attributed to obesity in Croatia (Ljec. Vjesn. 131:22 2009). If all overweight and obese people were to reduce weight by only 5Kg., or until their  BMI was within the normal range, 24% of OA knee surgical cases could be avoided.! (Int. J. Obes. Relat. Metab. Disord. 25(5):622 2001). Some surgeons do not operate until the patient has reduced his BMI. A BMI of 40 is considered inoperable!

Another major cause of osteoarthritis of the knee, which is rarely discussed, is inactivity. The synovial fluid of the joints is viscous and cannot function unless the joint is put under pressure. 40% of men with knee osteoarthritis are couch potatoes (Northwestern Univ. News Aug. 2011). Lower extremity muscle weakness is a risk factor for knee osteoarthritis (Arthrit. & Rheum. 41(11):1951 1998). Low muscle strength is strongly associated with knee pain, (Ann. Rheum. Dis. 57:588 1998) and muscle weakness may be an im portant factor in the pathogenesis of osteoarthritis. (Rheum. Dis. Clin. N. Am. 25(2):283 1999).  Such patients require not only rehabilitation after the operation  but “prehabilitation”, to increase necessary muscle strength,  before the operation!

Age-standardised disability-adjusted life year...

Age-standardised disability-adjusted life year (DALY) rates from Osteoarthritis by country (per 100,000 inhabitants). (Photo credit: Wikipedia)

Man is the most destructive animal that has ever existed on the planet and efforts are being made to protect animal and plant species. However there seems little effort to protect the human species from the man made destruction of human health.

We are already at a point where we have to be treated to give us sufficient minimal health in order that we can be treated.

Fluoridation of Drinking Water in Switzerland

English: Putting toothpaste on a toothbrush. T...

English: Putting toothpaste on a toothbrush. The toothpaste is Crest Pro-Health Clean Cinnamon, 0.454% stannous fluoride, 0.16% w/v fluoride ion. Deutsch: Zahnpasta auf eine Zahnbürste auftragen. Русский: Выдавливание зубной пасты из тюбика на зубную щётку (Photo credit: Wikipedia)

I was in general practice as a dental practitioner from 1954 to 1984 and during this period witnessed the enormous and dramatic gains in oral health. Before the Second World War, it was very rare for anyone over 40 to have any teeth left. Everyone over 40 was toothless. Dentists were having to pull the remaining teeth and make full dentures. My best friend, in England, lost all his upper teeth before the age of 20, which was not unusual.

In some countries, even after the war, young women would have healthy teeth removed and full dentures made, as these were inevitable, in order to save their future husbands dental expenses, and thus be more attractive! Today dentists are filling few teeth and are now in the cosmetic business, working in “Smile Clinics”, with patients having beautiful teeth, well into old age.

There are no federal laws forbidding the practice fluoridation of drinking water Switzerland, however it is impossible to fluorinate the public drinking water.  The reason for this is that the water supply in Switzerland is extremely diverse, from lakes, rivers and especially springs and is not centralized.

As an older dentist I feel that fluoride was mainly responsible for the rapid and dramatic advance in oral health. As water fluoridation was not feasible in Switzerland, fluoride was added to salt as well as to milk.

English: Photo of mild dental fluorosis, or ev...

English: Photo of mild dental fluorosis, or evidence of trauma to deciduous teeth while permanent teeth were still forming. (Subject never had braces, which can be another cause for white dots or rings in the center of the teeth.) The condition appears here as white spots on both central incisors (front teeth) and upper left canine tooth, and less noticeably in the upper left lateral incisor. (Photo credit: Wikipedia)

Pregnant mothers and young children were given fluoride pills. Systemic fluoride was considered most important as the fluoride is thus incorporated into the developing tooth enamel making it more resistant to tooth decay rather than fluoridation of the tooth surface.

Dental clinics for school children were set up. Dental hygienists visited schools and gave toothbrush instruction with fluoridated toothpaste, rinsing instruction with fluoridated mouth washes and distributed fluoride pills. In addition dentists gave regular fluoride treatment. Inspite of the considerable amount of fluoride given in various forms to the public, in my 30 years of practice I never saw a case of dental fluorosis, mottled enamel or skeletal fluorosis or any condition that would suggest that the fluoride given was detrimental to health. Academic support was given by the University of Zurich which became well known for its preventive research. In fact the systematic, statistical research on the effects of the preventive measures in Switzerland received international acclaim in the field of caries prevention.

Today, fluoridated salt and non-fluoridated salt are available, fluoride is no longer added to the milk and pregnant mothers and children are no longer pressurized into taking fluoride pills.  Although Switzerland did not, in contrast to it’s neighbors have fluorinated drinking water, the population was certainly subjected to far more fluoride than any of the surrounding countries. The amount of fluoride could be huge as it was uncontrolled.  At the same time research showed that dental health in Switzerland increased dramatically and was superior to that of the surrounding countries.

To summarise; my practice experience has led me to believe that fluoride administered in the recommended dosage does not have a negative effect on health and that fluoride, together with other factors was responsible for the dramatic advances in dental heath.

Jumper’s and Runner’s Knee

English: Medial view of the knee showing anato...

English: Medial view of the knee showing anatomical features. (Photo credit: Wikipedia)

In my one of my previous blogs the content referred to the dramatic increase knee replacements, mainly due to osteoarthritis, which creates a huge burden on health systems.

The causes are multifactorial, which include previous injury, obesity and possibly genetic influences. (Dr. Sofat, RFS Newsletter 46:4 2013).

Age is also a factor with the majority of people over 60 showing evidence of osteoarthritis in at least one joint. At over 65 (a shocking) 70% of hips or knees show radiological evidence of osteoarthritis! (J. Orthop. Res. 7:15 2012)

But the increased number of knee replacements cannot be explained by population growth and obesity epidemic alone. The recent increase is likely to be related to the growing prevalence of sport-related knee injuries. (J. Bone Joint Surg. Am. 94(3):201 2012)

Injury:   An injury in younger years can lead to osteoarthritis in later years. Kneeling for long periods can cause injury. Housemaid’s Knee (Bursitis), (swelling in front of the kneecap) or Clergyman’s Knee, (swelling below the kneecap), seem to be relatively harmless (Mailonline May 2013).

Jumper’s Knee:  Jumping causes sudden pressure to the knee joint of 9-11 times body weight.  20% of jumping athletes have Jumper’s Knee (Performance, June 2009). In volleyball the prevalence of jumper’s knee is high, up to 40-50%!  Symptoms increase slowly and are often unreported especially as athletes with tendon pain perform substantially better in jump tests compared to asymptomatic controls!  “Jumper’s Knee Paradox”. (B.J.S.M. 47(8):503 2012)

Runner’s Knee: Whereas in jumper’s knee, high stresses on the knee are the main causative factor, runner’s knee is caused by repeated micro-trauma. (Angelfire March 2002).    25-65% of runners suffer from runner’s knee. There is a significant increase with increasing duration per week, but training pace has no impact on the incidence of chronic knee lesions. (Eur. J. Radiol. 58:286 2006).  In Singapore up to 50% of runners have runner’s knee (HealthXchange).  However, long distance running per se does not increase the risk of osteoarthritis. (J. Am. Osteopath. Ass. 106(6):342 2006).

English: Jogging at Cranny Good for your healt...

English: Jogging at Cranny Good for your health, but sore on the joints. (Photo credit: Wikipedia)

Jogging is excellent and popular exercise, but decades of jogging especially after 50 can cause problems. Not only overuse, but muscular imbalance can be a source of injury. (Walk Jog Run May 2012).  Cross training has been seen to be beneficial as prevention of injury.   Barefoot running reduces joint movement and work done at the knee and may provide potential benefits for the management of knee pain and injury. (Br. J. Sports Med. 47:387 2013)

It is unfortunate that sport related knee injuries are too often ignored, thus compounding the damage.  While the percentage of jumpers and runners that develop jumper’s knee or runner’s knee are disturbing and sport related knee injuries are on the increase, early injuries, although important, are nevertheless not the major cause of knee osteoarthritis in later life.

Contrary To General Opinion

University of Birmingham Medical School, England.

University of Birmingham Medical School, England. (Photo credit: Wikipedia)

Professor Janet Lord made an interesting presentation at the first AgeWell Conference at the University of Birmingham 2010, entitled “How to maintain a healthy immune system in old age”.

She was quoted as saying that, “the immune system declines with age”. However I have experienced exactly the contrary.

I am very nearly 94 and have experienced a dramatic improvement in my immune system during the last 3 years. Previously I suffered a cold just once a year- usually in November. During the last 3 years I have not had a cold nor suffered any complaints, or illnesses whatsoever.  I no longer have a doctor.

Contrary to general opinion I believe that high intensity training and muscle building in old age are essential factors for successful aging.

High Intensity Resistance Training

3-d model of IGF-1

3-d model of IGF-1 (Photo credit: Wikipedia)

Although there seems to be considerable research on the benefits of mild aerobic exercises in this regard, there are suggestions that vigorous aerobic activity (A.J.H. P 26(6):333 2012),  high intensity training and diet ( J. Alzheimer’s Disease 28(1):137 2012),  or resistance training (Arch. Intern. Med. 172(8):666 2012) are beneficial.

Also insulin-like growth factor (IGF-1), hormones and second messengers encourage neurogenesis, synaptogenesis and angiogenesis in the brain, which improve brain health. (Klinik Psikofarmakoloji Bulteni suppl. 2 21:91 2011). However, increased production of IGF-1 and hormones, such as testosterone, occur as a result of or hypertrophy training and not with aerobic or endurance training.

In addition, multi-tasking  and neuromuscular training have been shown to be beneficial for cognitive functioning.