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Everybody knows somebody like this: the self-obsessed, self-congratulatory type with an outsize sense of entitlement and a deluded sense of superiority. He turns every conversation back to himself, prattling on about his own opinions and thoughts, but never deigns to ask about you.

That narcissistic personality can take a toll — and not just on the listeners. It turns out that the more narcissistic a person is, the more likely he (and, yes, it’s especially true of men) is to have health problems like heart disease and hypertension.

Sara Konrath, a psychologist at University of Michigan, studied 106 male and female undergraduate students, measuring their levels of narcissism and the stress hormone cortisol. Previous studies have found that people who score high on the narcissism scale show elevated levels of cortisol when threatened. So Konrath and her colleagues wanted to plumb the cortisol connection more deeply, to see if narcissists have higher levels of the stress hormone overall.

MORE: Narcissists Know They’re Obnoxious, But Love Themselves All the Same

Indeed, that’s what they found. The researchers measured cortisol levels in the students’ saliva and then gave them a 40-item questionnaire to assess their narcissistic tendencies. The test assessed variously adaptive forms of narcissism: some narcissistic qualities can be useful, leading to stronger leadership and authority skills as well as self-confidence, while others are less so because they are more focused on exploitation and entitlement.

Interestingly, Konrath and her team found that people who scored higher on the exploitative aspects of narcissism showed higher levels of cortisol, while those who scored higher on the more positive aspects of narcissism did not. And the trend was more pronounced in men than in women, probably due to the fact that more men tend to be narcissistic.

The consequences of chronically high cortisol levels have been well documented in previous studies. Cortisol, which tends to rise when people feel threatened or anxious, activates the body’s stress response, elevating the heart rate, sharpening the senses and burning a lot of energy to keep the body on alert. Activating this system when it’s needed — if you’re being chased by a saber-toothed cat, for example — is critical for survival. But a constant flow of cortisol can take a toll on the body, stressing the heart and the blood vessels and setting the stage for heart disease.

People who are narcissistic tend to be defensive, becoming aggressive when their superiority is threatened, says Konrath, and that style of coping can elevate cortisol and make the heart more vulnerable to disease.

Biologically, she says, narcissists with negative personality traits looked very similar to people with anxiety disorders. But they differed in one respect that may make them even more susceptible to cortisol’s damaging health effects. “When people have anxiety disorders, they recognize [it] and talk about feeling anxious and under stress,” she says. “For people who are narcissistic, this seems to be happening at a physiological level but for some reason the people aren’t feeling stress, which makes it potentially more toxic because they don’t seek help.”

MORE: Is TV Teaching Kids to Value Fame Above All?

The higher cortisol levels found among the higher-scoring narcissists suggest that they perceived even the task of filling out a questionnaire in the lab to be a potentially threatening situation, and one in which they needed to be on their guard in order to appear superior or in control, compared with the other participants.

Maintaining the narcissistic personality, in other words, is similar to keeping the body under stress, and Konrath says that’s particularly worrisome given the rising rates of narcissism in the U.S. “It makes me wonder what the long term health implications of this will be,” she says.

The findings also suggest that both primary care physicians and mental health professionals need to be more aware of the connection between mind and body, and appreciate that personality can influence our health in potentially serious ways. “People who work with mental health populations should realize that if people show signs of narcissism, then that personality is probably taking a toll on their body,” she says, and those individuals might benefit from some simple stress-relieving therapies.

MORE: Why Are College Students Reporting Record-High Levels of Stress?

It is 50 years since ibuprofen was discovered. It has joined aspirin and paracetamol in the special trinity of medicines that people keep close at hand, even when they’re well. But have we come to rely on it too much?

You might find it in a red packet in the UK, or a blue packet in the US.

Inside, the silver blister packs promise relief from hangover-induced headaches, the ubiquitous bad back and any number of other ailments.

Ibuprofen has gained a special status since its development in a small test lab in a house in Nottingham in 1961.

Since then it has become a bedrock of pain relief and fever treatment all over the world. As an anti-inflammatory it has been taken by sufferers of osteoarthritis and rheumatoid arthritis, as well as generations of injured sportspeople, professional and amateur.

But unlike most drugs that we get on the recommendation of a doctor, ibuprofen is in that trinity – along with paracetamol and aspirin – that we primarily self-medicate with.

50 years of ibuprofen

• Discovered in 1961 by Boots pharmacologist Dr Stewart Adams and colleagues, working in a house in Nottingham
• First clinical trials held in 1966 – launched by Boots as a treatment for rheumatoid arthritis in 1969
• Available over-the-counter in High Street pharmacies in UK since 1983
• There are more than 50 forms of ibuprofen, including syrup, tablets, cream, spray, gel, granules and suppositories
• Available as short-term treatment for acute pain such as headache, dental pain, migraine and period pain
• Also used to treat conditions such as rheumatoid arthritis and osteoarthritis

These drugs leave us as our own doctors. They have escaped the confines of the pharmacist’s shelf and taken up residence in the supermarket, corner shop and all-night garage.

For many people ibuprofen is an essential tool in their bathroom cabinet – as well as featuring in many a handbag and desk drawer around the world.

Stand in an open-plan office and ask loudly for ibuprofen and somebody will have some. For “just in case”, more than likely.

But is this a good thing?

Doctor and medical columnist Thomas Stuttaford says he thinks ibuprofen is a reasonable analgesic and anti-inflammatory – but it has more side effects than people realise.

“Side effects include renal damage. It’s not terribly well tolerated by the over 65s. It can cause gastric bleeding. And NSAIDs [the group of anti-inflammatory drugs that ibuprofen belongs to] contribute to something in the region of 2,000 deaths a year in the UK.”

The risk factors associated with NSAIDs are much discussed but all medicines can potentially cause side effects, and any figures for deaths have to be measured against the vast numbers of people who use ibuprofen without ill-effect. The same calculation has to be made for aspirin.

But some, like Stuttaford, also take issue with the use of ibuprofen as a sort of medical crutch.

He believes that governments have encouraged the use of anti-inflammatories and analgesic drugs like ibuprofen because it cuts down on visits to casualty departments and doctors’ surgeries.

It’s my belief that it would not get an over-the-counter licence today – but neither would aspirin”

“Advice from doctors used to be ‘take two aspirin and call me in the morning’. Now the modern day equivalent is ‘take two ibuprofen and call me in the morning’.”

Dr Stuttaford says he does not think this is terribly useful.

“Pain is nature’s way of telling you something is amiss. I don’t approve of over-the-counter patient-directed painkillers – it’s much better to get a proper assessment of the pain from a doctor.”

Pain management consultant Dr Chris Wells says ibuprofen is a useful drug that helps about a third of people who take it, and reduces their pain by about 50%.

“It is important for a minority of patients with rheumatoid arthritis and osteoarthritis,” he says. “It’s also a good drug for minor acute injuries, sprained ankles, minor burns, and saves people going to the GP [general practitioner].”

But he also has concerns about ibuprofen and its side effects.

“It’s my belief that it would not get an over-the-counter licence today – but neither would aspirin.”

He also thinks the overuse of ibuprofen shows that we have lost the confidence to deal with minor aches and pains in our lives without pain relief.

“It’s become a pill for all symptoms,” he says. “For many people, exercising and weight loss are essential in managing pain, but they are sadly out of fashion.”

Dr Stuttaford says our reliance on drugs like ibuprofen goes hand in hand in the UK with the decline in GP services.

“Although we have a much bigger armoury in dealing with health problems, people no longer have a personal relationship with their GPs. They don’t know their history, they don’t know their mothers and fathers.

“The average allocated time with the doctor is a mere seven minutes. If you’re dealing with an octogenarian they might not be able to get their clothes off for a proper examination in seven minutes.

The tablets have brought relief to millions, but have they helped change our relationship with doctors?

“There’s no time to talk. Prescribing them with ibuprofen is one way of shutting them up.”

The result? “Many people just bypass the doctors and go straight to the chemists instead.”

Ailsa Bosworth, chief executive of the National Rheumatoid Arthritis Society, says people will often go to their GPs in pain, and will be prescribed something like ibuprofen that brings some relief.

But what they really need, she says, is to see a consultant rheumatologist, and the use of anti-inflammatories can delay a doctor in making a diagnosis.

“That doesn’t mean that they don’t play a useful role for some people, and they are important at times, but I sometimes think that doctors don’t spell out the risk-benefit scenario.

“You can be taking NSAIDs like ibuprofen for a long time and suddenly get a massive bleed. They are not totally benign.”

She says anti-inflammatories such as ibuprofen play a role in managing conditions like rheumatoid arthritis, but that role has changed since new drugs treatments have become available.

Ibuprofen has a following among endurance runners and people playing fast-paced sport such as squash, who use it before or after a big race or match. But many believe the practice is, at best, unwise.

Peter Banister, personal trainer at BSAG fitness in London, says he does not recommend its use.

“People who take painkillers before training or before competing in a big race are inhibiting their body’s ability to respond to their environment,” he says.

Ibuprofen has a following among marathon runners

“When you are undertaking strenuous exercise you need to be able to react to pain, not mask it.”

Banister is not keen on using ibuprofen to try to help relieve muscle soreness after exercise either.

“Research shows that use of anti-inflammatories doesn’t actually inhibit muscle soreness and can in fact inhibit muscle growth.”

Research into ibuprofen is ongoing, with possible new uses being discovered. In some studies, low doses of ibuprofen over a long period of time were found to be better than a placebo in preventing Alzheimer’s disease.

Earlier this year, researchers at Harvard medical school announced that people regularly consuming ibuprofen were reported to have a 38% lower risk of developing Parkinson’s disease.

Prof Kim Rainsford, a world authority on ibuprofen, says the beauty of the drug is its chemical simplicity.

“It is handled and metabolised in the body very predictably. It accumulates very well in sites where you need pain relief.

“It’s got a very good safety profile, it’s got wide acceptance because it does control inflammation as well as the painful symptoms.”

Whilst casual overuse of ibuprofen might not be wise, there is no doubting it has provided accessible, effective and well-tolerated pain relief for millions of people around the world.

And it’s for that reason it’s likely to stay in people’s desk drawers and handbags for many years to come.

Patterns: Less Salt Isn’t Always Better for the Heart By Nicholas Bakalar

For years, experts have believed that lowering sodium consumption reduces the risk of heart disease. Now a large new study suggests that it may not be so simple.

The scientists studied an international group of 28,880 men and women over age 55 at high risk for heart disease. They estimated salt intake by testing urine and followed the group for almost five years. The study appears in the Nov. 23 issue of The Journal of the American Medical Association.

The researchers found — unsurprisingly — that high sodium intake significantly increased the risk for heart problems.

But too little sodium was almost as bad as too much. Compared with those who excreted 4 to 6 grams of sodium daily, people who excreted 2 to 3 grams were at 19 percent greater risk for death from a cardiovascular event, and the less they consumed the greater their risk.

Nutritionists recommend a daily intake of 1.5 grams of salt for people with heart problems, a level that in this study increased the risk for cardiovascular death by 37 percent.

“It’s still important to avoid consuming too much salt,” said Andrew Mente, an author of the study and an assistant professor of epidemiology at McMaster University in Hamilton, Ontario. “But people who are consuming moderate amounts may not have to decrease their intake further.”

How many times have you used the toilet today? Judging by the fact that you are awake enough to be reading this blog, I’m assuming the answer is at least once, and probably more. (Maybe you are even reading this while on the toilet, which means you probably have the luxury of using a loo that is clean, private, and relatively comfortable).

For all of you who are fortunate enough to have a toilet in your life, I would like to wish you a happy World Toilet Day.

No, I’m not kidding — Saturday is World Toilet Day. You mean you didn’t get the memo?

Granted, for those of us who are lucky enough to have an abundance of bathrooms in which to “do our business,” it might seem a bit silly to celebrate the toilet. Aren’t there bigger development problems to tackle? Bigger accomplishments to celebrate?

But I want you to think back to the last time you didn’t have a decent toilet when you needed one (maybe your last camping trip, that port-a-potty at the stadium, or that long stretch of road between rest stops). Toilets, or lack thereof, are no laughing matter. Are they?

For those of us who are fortunate enough to live in developed societies, it is easy for us to chuckle at the important role that toilets and proper hygiene play in our lives.

But for those 2.6 billion people — more than a third of the world’s population — who don’t have access to toilets, their absence can lead to sickness and death. Did you know?

• Children living in households with no toilet are twice as likely to get diarrhea as those with a toilet, causing more deaths every year than AIDS, malaria, and measles combined.

World Vision takes toilets and hygiene seriously. Last year, we installed more than 30,000 toilets around the world in homes, schools, and health centers, and trained more than 165,000 in proper hygiene practices — keeping kids and communities safer and healthier.

The following are just a sampling of photos of the toilets built by World Vision around the world. Enjoy.

Cambodia: “World Vision has given (us) a latrine and teaches us how to stay healthy,” says Poeung Sokkhonn, 44, with her daughter Chhern, 14.

Peru: “I have three children under 8 years old, and the lack of sanitary conditions was a huge problem for my family…The latrine that World Vision installed helps prevent my children from diseases, such as diarrhea,” says Arnilla Moya, 28.

South Africa: Life is hard for Itumeleng and her siblings. The children are orphans. Their mother died and their father abandoned them. World Vision recently provided them with a new house and sanitary latrine.

Next time you visit the toilet, remember you are one of the lucky ones and that there are billions of people around the world who don’t have such a luxury. (Photos by Sopheak Kong, World Vision Cambodia; Ester Luis, World Vision Peru; and Olwetu Gwanya, World Vision South Africa)

Join with World Vision in our efforts to expand access to clean, safe water and sanitation systems for communities in need. Make a donation to our Water and Sanitation Fund. Your gift will help us provide interventions like deep wells, piping systems, water storage devices, sanitary latrines, hand-washing stations, and more!

via blog.worldvision.org

Good analysis on the American health care system, and the VHA model in particular.  Also, insight into the unwise ideas of the far right wing politicians, aka, the GOP.  Original article follows:

By PAUL KRUGMAN Published: November 13, 2011

American health care is remarkably diverse. In terms of how care is paid for and delivered, many of us effectively live in Canada, some live in Switzerland, some live in Britain, and some live in the unregulated market of conservative dreams. One result of this diversity is that we have plenty of home-grown evidence about what works and what doesn’t.

Naturally, then, politicians — Republicans in particular — are determined to scrap what works and promote what doesn’t. And that brings me to Mitt Romney’s latest really bad idea, unveiled on Veterans Day: to partially privatize the Veterans Health Administration (V.H.A.).

What Mr. Romney and everyone else should know is that the V.H.A. is a huge policy success story, which offers important lessons for future health reform.

Many people still have an image of veterans’ health care based on the terrible state of the system two decades ago. Under the Clinton administration, however, the V.H.A. was overhauled, and achieved a remarkable combination of rising quality and successful cost control. Multiple surveys have found the V.H.A. providing better care than most Americans receive, even as the agency has held cost increases well below those facing Medicare and private insurers. Furthermore, the V.H.A. has led the way in cost-saving innovation, especially the use of electronic medical records.

What’s behind this success? Crucially, the V.H.A. is an integrated system, which provides health care as well as paying for it. So it’s free from the perverse incentives created when doctors and hospitals profit from expensive tests and procedures, whether or not those procedures actually make medical sense. And because V.H.A. patients are in it for the long term, the agency has a stronger incentive to invest in prevention than private insurers, many of whose customers move on after a few years.

And yes, this is “socialized medicine” — although some private systems, like Kaiser Permanente, share many of the V.H.A.’s virtues. But it works — and suggests what it will take to solve the troubles of U.S. health care more broadly.

Yet Mr. Romney believes that giving veterans vouchers to spend on private insurance would somehow yield better results. Why?

Well, Republicans have a thing about vouchers. Earlier this year Representative Paul Ryan famously introduced a plan to convert Medicare into a voucher system; Mr. Romney’s Medicare proposal follows similar lines. The claim, always, is the one Mr. Romney made last week, that “private sector competition” would lower costs.

But we have a lot of evidence about how private-sector competition in health insurance works, and it’s not favorable. The individual insurance market, which comes closest to the conservative ideal of free competition, has huge administrative costs and has no demonstrated ability to reduce other costs. Medicare Advantage, which allows Medicare beneficiaries to buy private insurance instead of having Medicare pay bills directly, has consistently had higher costs than the traditional program.

And the international evidence accords with U.S. experience. The most efficient health care systems are integrated systems like the V.H.A.; next best are single-payer systems like Medicare; the more privatized the system, the worse it performs.

To be fair to Mr. Romney, he takes a somewhat softer line than others in his party, suggesting that the existing V.H.A. system would remain available and that traditional Medicare would remain an option. In practice, however, partial privatization would almost surely undermine the public side of these programs. For example, one problem with the V.H.A. is that its hospitals are spread too thinly across the nation; this problem would become worse if a substantial number of veterans were encouraged to opt out of the system.

So what lies behind the Republican obsession with privatization and voucherization? Ideology, of course. It’s literally a fundamental article of faith in the G.O.P. that the private sector is always better than the government, and no amount of evidence can shake that credo.

In fact, it’s hard to avoid the sense that Republicans are especially eager to dismantle government programs that act as living demonstrations that their ideology is wrong. Bloated military budgets don’t bother them much — Mr. Romney has pledged to reverse President Obama’s defense cuts, despite the fact that no such cuts have actually taken place. But successful programs like veterans’ health, Social Security and Medicare are in the crosshairs.

Which brings me to a final thought: maybe all this amounts to a case for Rick Perry. Any Republican would, if elected president, set out to undermine precisely those government programs that work best. But Mr. Perry might not remember which programs he was supposed to destroy.

via nytimes.com