Category: health

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Smoke Gamble

Smoking is like a gamble. Your input is your health and money. This is not including those who might rely on you or family relationships that might suffer one way or another. The other link has gambling at its source and smoking goes along with the continuous risk taking or the belief to be able to master the risks involved with both forms of potential addictions. Research has accumulated evidence that in fact both smoking and gambling occur frequently in combination with each other. Taking risks against the odds of suffering losses, maybe only in the medium or longer run perspectives like for health seems acceptable for those people. Society has put rather high taxes on both activities to discourage people and invests in prevention of addictions. However, it does not have substantial effects on people as smoking remains around the same level and gambling (poker online) or betting on sports (Euro 2024) are rising rapidly. Vaping and internet gaming have broadened the spectrum of addictive behaviors mostly for younger persons and young adults. The risks are manifold and increasing in their addictive potential since the smartphone is always in some pocket just like the smoking device. The behavioral turn in the social sciences has been well understood by the industries as well. The stakes for human development are high in this endeavor to offer young people equal opportunities at entry into adulthood.

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Cannabis Alcohol

The use of cannabis and/or alcohol is yet another question where we are used to ask questions in the form of: either the or the other? Over generations we have gotten used to no longer ask for each do you or don’t you. With the controlled liberalization or legalization of cannabis in some Western European states the framing of the question is more like you do the one or the other, particularly for many younger persons.
Decriminalization of both drugs in small quantities is apparently reducing crimes link to drug use and drug dealing. On the other hand, the thresholds for doing drugs are lower than they used to be. In inner cities it is therefore no longer a surprise to find both kinds of drugs with addictive potential next to each other (see image below). We know that it is a slippery road from regular drug use to uncontrolled dependency and personal disaster. For cannabis a study published in the Lancet (Petrilli et al. 2022) added the importance of the potency of tetrahydrocannabinol to the estimate of risks. This is similar to the studies that differentiate the level of alcohol in drinks consumed. The higher the concentration, the higher the risks. A simple proportional relationship prevails in both drugs. The cumulative effects of consuming both together might have quite surprising non-linear effects.
The big issue is the risks of mental health related to these drugs. However, the causal direction is not easy to detect. Drugs induce mental health problems, but also mental health issues lead to drug abuse. This remains quite a puzzle for scientists to disentangle.
Additionally, the link to smoking and addiction to nicotine is a frequently observed corollary. Studying just one single source of health problems and addiction might be too restrictive to learn about the whole set of causal effects and casualties. For the time being we seem to jump from one field of attention to the next one ignoring the multiple interrelated factors at hand.

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Smoking Vaping

Both smoking and vaping are big business. Nicotine is well known for its addictive capacity. Once started, it is very hard to give it up again. For many decades we devote considerable efforts and costs to encourage people to give up on smoking or, better, not to start smoking in the first place. The young are particularly vulnerable as damages persist for a longer time. Progress has been made to reduce passive smoking of children and people in restaurants, at work and public spaces. The relatively recent trend of vaping instead of smoking is considered less harmful, but scientific long-term evaluations, whether these effects are lasting for several years, are still missing.
A repeated cross-section study in England (Tattan-Birch et al. 2024) has revealed that the declining trend of nicotine use has already been reversed among youth due to the rise in vaping. Vaping seems to move from the fashionable niche product to the popular mainstream among youth. The addicts are only cost-sensitive on the margin. The relative prices of smoking and vaping might play a role to put people on different health trajectories. The question is not between either smoking or vaping, but for some it is both, although it should be none of both. The question of smoking yes/no is likely to be framed as either vaping/or smoking.  The re-framing of the question shows the harmful potential in the longer run. We shall have a hard time to convince people and particularly youth not to be tempted by either/or but to focus on their long-term health trajectory and potential. (Image: Extrait from Arnold Böcklin, Self-portrait with death playing the violine 1872, Alte Nationalgalerie Berlin)

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Forecasting floods

As floods as becoming more frequent and more severe forecasting of such events is crucial. The recent example in Bavaria (Germany) of the Danube river (2nd longest in Europe) has demonstrated the role of forecasting to spur adequate behavior of people living in areas at risk of flooding. With the weather forecast announcing lots of rain for a large area the forecasting of floods needs to follow closely these trends. It is not only a question of expectations, but an issue of adaptive expectations for people to adopt appropriate precautions. In retrospect the early forecasts turned out to be fairly accurate in terms of the peak of flooding to be expected in June 2024. The Bavarian “Hochwassernachrichtendienst” (no joke, one word) forecasted on the 2nd of June about 7.50 as the peak to be reached in 2 days in the city of Kelheim. This was beyond the usual 4 warning levels based on an escalation scale. The forecast was beyond the frequent flooding levels established in the last decades. People and emergency services would have to adapt their expectations accordingly. Renewing forecasts is essential to guide people and services in their efforts to deal with emergencies and repair damages as flood levels recede. Management of crises critically depends on forecasting even if they are obviously prone to error margins which should usually be reported as well just like in weather forecasts. Adaptive expectations are key in combination with forecasts to ensure survival.

Hochwassernachrichtendienst Bayern 2024-6
Kelheim on Danube
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Marketing bicycles

The marketing of bicycles has changed considerably over the course of history. Today’s narrative is more about the eco friendly impact of it. Historically the freedom aspect of free movement and emancipation of women was at the forefront. The collection of images in poster formats presented at the DTM in Berlin is impressive. The focus on women on bicycles is quite surprising for this early time around 1900. Few of the companies from the early days have survived until today. Bicycles are still fascinating children and adults today. The experience of a fragile equilibrium, your own strength and weakness in muscle power, cardiac or pulmonary strength is always challenging. It is you who is in control of speed and direction. This should be easy to sell to the masses, and it was and still is. “Bikenomics” is here to stay. Artists had the same impression and created a whole universe of promises for riders of bicycles. The long run health benefits were not even known at the time, but it was unthinkable that humans would spend most hours sitting in offices, cars and on their couches. The biking story needs to be retold to encourage people to take up the emancipating storyline again. Get on your bike again!

DTM Berlin 2024-6
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Bikenomics

There is a whole cluster of enterprises associated with bicycles. Selling a bike is only the first we might think of. Repair works are the most tricky part of bikenomics, a bit like bidenomics. In many cities during spring and summer it is even more difficult to get an appointment for bicycle repairs than for a doctor’s appointment, and that can be hard at times. Shortages of skilled technicians are pervasive in this sector. DIY for do it yourself is the best alternative. With the arrival of e-bikes and the digital connectivity the skill set has been enhanced recently as well. Insurance for bikes, lockers, helmets, airbag system or clothing including spectacles are part of the standard safety and security set of bicycle riders nowadays. Many, many job opportunities there and the willingness to pay for bicycles has steadily increased over the last years.

Berlin has just seen its 48th bicycle demonstration in 2024-6 on roads including 2 motorways with several ten thousands of participants. In a star like fashion multiple tracks met at the city center. The final meeting with stands and information was at the Deutsche Technik Museum with refreshments and repairs. The exhibition of cargo bikes and taxi bikes or “rickshaws” was another highlight. We need to rethink our mobility concepts and try to get the sharing to work more comfortably. For different purposes and activities you need a different bike. Ownership of each is no longer adequate as for example with aging alone your preferences for mobility with bikes also changes. Sharing is caring and this is also part of bikenomics.

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Cars electrified

It is not only cars, but the whole automotive industry that got somehow electrified. The U.S. have imposed a 100% tax on electric cars produced in China recently. Europe is feeling the heat as well (compare Fressoz in Le Monde 31.5.2024). Production of cars is not a for fun activity. It is firmly embedded in our economic system which believes in profit maximization even at high environmental costs. Therefore, the production of cars follows the logic to build cars that generate the highest profits. Bigger cars yield bigger profits and this has been known for decades. Why should we expect our car producers to deviate from this logic. Investors push hard in this direction as well. Small e-cars generate small profits. This can only be economically valid if large numbers are produced. China’s home market has the market size and air pollution levels that make this a viable strategy also for the lower income people. If not sold in the US or Europe, the home market is able to absorb huge amounts of electrified cars. Downsizing of cars needs to happen particularly in inner cities. The implementation of this is not going to be easy and without resistance.

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Competence Gardening

Primary Schools in Berlin have the possibility to participate in the “Gartenarbeitsschule”, the school with learning goal of gardening. It is an interesting option to go out into the real world and deal with nature, sustainability, consumption, climate and many other topics. Voltaire could complement the curriculum in philosophy with his biographical links to gardening. The access to the fields is easy next to one of the central train stations and a larger urban reforestation project as just one example of the 15 overall in Berlin in 2024. (Südkreuz, Südgelände). Hands-on experience of gardening can address multiple forms of problem-solving competencies. Beyond the use of AI, a major advantage is the possibility to train collaborative problem-solving. Beyond the multifactorial approach in determining what to plant, the organization of the implementation and individual contributions towards the realization, all these elements are learning goals. The scope of learning qualifies gardening for learning well beyond primary school as well. It is a nice example of lifelong and lifewide learning even a hundred years after their wider applications in Berlin.

Gardening School, Berlin 2024
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Patient Empowerment

The empowerment of patients is a well-established practice in the treatment of diabetes. Measuring your own blood sugar and adjusting your medication to the self-monitored data is common practice. For patients with high blood pressure this patient empowerment is less prevalent. A medical study carried out in Valencia (Spain) by Martínez-Ibáñez et al. (2024) has tested the effects of such a self-monitoring and self-medication experiment.
The results publishes in (JAMA) gave rise to considerable attention in the profession as the empowerment of patients is one way out of the likely increasing shortage of medical professionals in aging societies. Whereas other studies found that total costs to the medical system might increase, the study in Spain provides evidence of the cost-reduction effect of such an empowerment. 24 months after the beginning of the trial. After the establishment of a “medication based on an individualized prearranged plan used in primary care” the self-administering participants achieved a significant decrease in their blood pressure that lasted until the end of the study after 2 years. The drop-outs of the study seem to follow a random pattern.
The conclusion gives support to the potential of patient empowerment in the widespread treatment of higher blood pressure beyond the regular visits of medical doctors. The monitoring of changes in lifestyle add to this to keep the costs of health care under control in aging societies.

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Camparing Covid-19

In the middle of May 2024 we tend to believe the Covid-19 pandemic is over. However, towards the beginning of the year 2024 in the U.S. we observed at the peak about 2500 deaths per week. In Germany deaths/week amounted to 250. Compared to the overall population size killing is more pervasive in the U.S. than in Germany. The map of the specialized agency “Centers for Disease Control and Prevention” (CDC) in the U.S. shows the coastal regions to be more affected than the center. Population density seems to be still a driver of the spread of infections, illness and deaths. The timeline of deaths due to Covid-19 infections for Germany follows a broadly similar pattern, albeit on a lower level even if roughly accounting for population size (RKI-data). As we tend to forget what the pandemic caused as social and economic disaster in societies, we have to stay alert as the major prevention of Covid-19. Learn to live with the virus around us. This means to keep up our preventive levels of hygiene as well as monitoring of trends.
Many thanks to all those who do the sometimes boring number crunching for us. This includes the medical doctors who bother to do the timely reporting of new infectious diseases on a regular basis.