"Whenever I go into a restaurant, I order both a chicken and an egg to see which comes first"

Thursday, December 13, 2012

Why We Need Hypochondriacs

I once knew a man who opened all doors with his elbow.  Because of exaggerated hypochondria, he avoided touching anything with his hands.  He always wore specially-made jackets with a rough, gathering material on the sleeves to get a better grip on doorknobs and he became as adept as a Thalidomide adult using his chest, stomach, and shoulder to negotiate his way through an environment meant for handed people.

He carried a supply of Purell liquid and wipes with him wherever he went, and in the off chance that his hands touched any contaminating surface, he was quick with the sanitizing gel.  He developed his own behavior modification program to stop touching his eyes and nose with his hands, something the normal person does a thousand times a day. During the initial boot camp phase, he wore sterilized mittens, and then when he found that he was still rubbing his eyes and brushing his nose (the mittens completely stopped nose-picking), he resorted to an abrasive compound which he sprayed on the mittens.  Whenever he inadvertently touched his face, the compound (used in dog training), made his skin burn.

Handshaking was his ultimate problem.  Americans don’t shake hands like other cultures do.  We wave a general goodbye after a party while a Frenchman will go around the room and shake everyone’s hand.  Not that long ago in the US it was considered impolite for a man to extend his hand to a woman, and the proper etiquette was to wait for her offer.  All of which narrowed the range of hand-to-hand infection. Yet, my acquaintance couldn’t avoid what, regardless of mores, had always been a staple of American social commerce. He tried a lot of evasive measures and finally decided upon a slight bow (Japanese) combined with a Namaste (Indian). Most people in our increasingly multi-cultural society respectfully assumed that he preferred this greeting because of religious reasons and although thinking him a bid odd, never thought too much of it.

Of course his hypochondria got worse and worse.  He rightly assumed that if the doorknobs, faucets, refrigerator doors, gearshifts, and elevator rails were crawling with bacteria, what must the air be like? He began to wear surgical masks whenever he went outside; and again, although people thought him a bit off, they assumed that, like the Japanese you see in Tokyo photographs, he was keeping his infection from them, not the other way around.  He boiled and triple-filtered his water, became more and more solitary, and eventually began to see things that weren’t there.  Shortly thereafter he was committed to the State mental hospital.  When a neighbor had not seen him for over two weeks, she called the police who found him huddled in a corner, wrapped in gauze from head to toe.

The other branch of hypochondriacs features people who always assume the worst – that every mole is melanoma, every cough lung cancer, every loose bowel movement colon cancer or AIDS.  This type of hypochondria can be as crippling as the doorknob phobia variety.  I knew a woman once who was always on edge and in a state of hyper-alert paranoia about her health.  She was sure that she could sense any slight change in her body temperature, was finely attuned to every erratic gurgling in her stomach, twinge of her sciatic nerve; every micro-variation in the tone and timber of her voice (cancer of the larynx).  Every new floater that appeared before her myopic eyes was the onset of blindness, the tiniest mini-itch or –burn after urinating was the preamble to fulminating drug-resistant E.Coli infection.

She got every penny’s worth of her health insurance as she pestered specialist after specialist for appointments to check out some phantom illness.  I was friends with one of her doctors who broke the rules of confidentiality and told me how nuts this woman was and how he had instructed his staff to tell her that the next available appointment was six months off.   I never tracked her progress, and was quite happy not to hear of her multiple suspicions; but I assumed that pharmacology saved the day.  There are now psycho-active drugs for every possible quirk.

Phillip Ball writes in BBC News Online (12.13.12) that hypochondriacs actually serve a useful purpose:

Hypochondriacs might be good for everyone’s health, to judge from a study that’s just been published. The paper describes a computer model of the uptake of vaccinations by a population, and shows that just a few individuals whose fear of the disease prompts them to take a vaccine can trigger others to do the same. As a result the population as a whole is more likely to reach a critical mass of vaccinated people, in other words reach “herd immunity”.

This is of course offset by the growing numbers of people who think that vaccines are government tools for keeping us docile and in line; or that government is hiding the real truth about the correlation between vaccination and autism, mental irritation, palsies, and idiocy.  I once heard an otherwise intelligent journalist tell me about how fluoridation was devised by the Nazis to kill Jews (Mengele apparently knew how to formulate the levels of fluoride in the water to disable only Jews) and then modified and adapted by the Soviets to produce a kind of political torpor in individuals who ingested it, and predisposing them to Communism.

In any case, bravo for the health worriers whom I see lined up at CVS an hour before the first flu shot is given each year.  These are not the ones who pay attention to the new science which suggests that the flu shot doesn’t work that well, particularly in the elderly who need it most (See my blog post Are Flu Shots A Scam? http://www.uncleguidosfacts.com/2012/12/are-flu-shots-scam.html); but since the shots work at least a little bit, this obsessiveness about protection is, I suppose, a good thing.

I remember a few years back when the media blew up the threat of Avian Influenza. This was Armageddon to be sure, they shouted, but there was one possible salvation – Tamiflu, an anti-viral formulation that could either prevent or mitigate the effects of bird flu.  While most people were calm and reasonable about the threat, studying reports from Hong Kong and Bangkok which showed people living and sleeping with the chickens they would sell the next day, thus facilitating the spread of the disease; and encouraged by the reports of the mass slaughter of poultry and the engines of the WHO and CDC in full steam ahead mode, the worriers found every way to get Tamiflu.  Physicians were pressured, cajoled, and enticed to give Tamiflu injections.  In cities like Washington where K Street Lobbyists lunch with the top surgeons at GW or Georgetown Hospitals, all stops were pulled.  Trips were planned to Spain and Portugal where rumors of large inventories promised easy non-prescription access.  It was a crazy time, and any social scientist or epidemiologist trying to track user trends was in for sleepless nights.

There is another advantage to tracking hypochondriacs – they love to talk about their phantom and real ailments; and now in the age of social media, reports of every cough, hack, liver spot, or digestive ill are spewed throughout Facebook and Twitter.  Thanks to ‘big data’ and the total lack of user privacy, tweets and posts can be read, sifted, and organized by sophisticated software programs; and CDC who purchases this information can tell where illness might break out. If a lot of FB ‘friends’ in Missoula are banging on about their dry coughs, this might be a sign of the onset of seasonal flu and CDC can alert health providers to be ready.  Of course the software has to be sophisticated enough to tell the real coughers from the hypochondriacs, but such ‘sentiment’ software is already available.  Car dealers now can, with enough key strokes from a potential consumer, determine whether he is a serious customer for a new Porsche or just another delayed adolescent getting off on images of the new Carrera.

The public health value of hypochondriacs is not limited to vaccinations; nor should the phenomenon be restricted to medical issues:

The same should apply to other behaviors: a few committed individuals who always practice safe sex might limit the spread of sexually transmitted diseases, and perhaps even non-medically-related behaviors such as responsible energy use and recycling could be propagated this way – not just among individuals but, say, businesses too. That could be an empowering message: one all too often hears the lament that individuals can’t make much difference to the world, but the power of social feedback implies that you might have more influence than you think.

I had a friend who had become paranoid about HIV/AIDS early in the epidemic when gay advocates had successfully turned what was a relatively isolated infection into “Everyone’s Disease”.  This was a brilliant political move, for it assured that gays would not be singled out or discriminated against.  Epidemiologically speaking, it was crazy.  I interviewed a former head of the CDC who was appalled that for the first time in epidemiological history, HIV/AIDS was not treated as an epidemic, but a political issue.

Be that as it may, my friend bought into the ‘Everyone’ argument and would have used a condom with a compliant nun.  He bought the thickest, most durable condoms available.  He said he had to use his imagination more than most men during sex because he couldn’t feel anything, but avoiding infection was worth it.  He even doubled up on his condoms when having sex with someone he thought of higher risk.  The point is, he was so obsessed about getting AIDS that he – like every other hypochondriac – talked endlessly about the risk out there and the importance of protection.  Most men and women these days are pretty good about using condoms, but have their lapses.  Too much to drink, Ecstasy, romantic love, “just-this-once”, are all common and understandable reasons for delinquency.  Not my friend.  There is no such thing as safe sex without a condom.  Period.

The point is, he converted a lot of sexual libertines, and got them to be more faithful in using protection.

There is a problem here.  Most hypochondriacs - and especially true believers in other fields such as environmentalism – are bloody bores. I have suffered through more than my share of doomsday scenarios from committed ‘progressive’ environmentalists who are convinced that because of global warming, the seas will soon be lapping at inland shores, corn will be growing in the Arctic, and violent tempests will rage in a Biblical cataclysm.  Every tapping of shale oil or gas will produce methane clouds thick and extensive enough to wipe out entire cities.  Neo-Peaceniks trumpet the coming Nuclear Winter. The threat of nuclear holocaust never went away, they say, it just went underground for a few years after 1989, but is back with a vengeance.

This is a great country, one huge tent of the sane and the crazy, the wacko and the convent-conservative, Doomsday-sayers and sexual profligates, conspiracy theorists and moldy academics; and there is plenty of room for hypochondriacs of any and all stripes.  I just don’t have a lot of patience for them. 

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