ArcaMax

Almost 80% of physicians surveyed say that the prior authorization process "often or sometimes" leads their patients to abandon treatment. Prior authorization is a cost-control measure used by health insurance companies that requires patients and their doctors to get approval from the insurance carrier before care or treatment can proceed.

Almost 95% of physicians surveyed by the American Medical Association said that prior authorization sometimes, often or always delays patients trying to access care. Almost 20% of doctors said prior authorization had resulted in a serious adverse event that hospitalized their patients.

Body of Knowledge

Most people have experienced it on occasion: those moments when your eyelid suddenly and involuntarily twitches or wiggles for a couple of seconds. They're typically harmless and the exact cause isn't known, though stress, lack of sleep and caffeine use have been suggested as possible causes.

The reason eyelid twitches are so noticeable is due to the muscle involved -- the orbicularis oculi. This eyelid muscle is the fastest-working muscle in the human body, able to close an eyelid in less than 100 milliseconds and reopen it in about 200 milliseconds. That's roughly equivalent of time it takes the human brain to process a single thought.

So when the orbicularis oculi muscle spasms, it really spasms.

See below if you want to know what to call these twitches.

Get Me That, Stat!

It's only a modest decline, but good news after years of bad: Provisional data from the Centers for Disease Control and Prevention suggests drug overdose deaths dropped slightly from their peak last year. The total is still a whopping 100,000 per year, with a large percentage due to fentanyl overdoses.

The decline in deaths wasn't uniform, dropping across much of the eastern half of the U.S. but increasing in the western half.

The tempering news was that deaths from cocaine and methamphetamine have increased.

Mark Your Calendar

September is awareness month for blood, ovarian, prostate and childhood cancers, food safety and cholesterol, sickle cell disease, sepsis, polycystic ovary syndrome, atrial fibrillation, childhood obesity, head lice and "recovery," which seems needed after a month like this.

Doc Talk

Blepharospasm: An eyelid spasm that causes one or both eyes to close involuntarily. Although benign, they can become chronic and, over time, increase in frequency, making some tasks, such as staring contests, more difficult.

Phobia of the Week

Acerophobia: Fear of sourness

Food for Thought

You won't necessarily find the words "disodium inosinate" on the ingredients label of foods that actually contain disodium inosinate. Sometimes it's just vaguely mentioned as a "natural flavor."

That's because it's obtained from the bacterial fermentation of sugars or extracted from meat or fish, where it is naturally found. Disodium inosinate is used as a flavor enhancer, similar to monosodium glutamate, to provide the umami taste. Unlike MSG, disodium inosinate is not associated with any adverse effects, such as headaches, heart palpitations and nausea.

Best Medicine

Moments before a surgery is to begin, the surgeon says to the patient, "Relax, Jim. It's just a small scalpel incision. No reason to panic."

The patient replies, "Doctor, my name isn't Jim."

The surgeon responds, "I know. I'm Jim."

Observation

"May this tusk root out the lice of the hair and the beard." -- An inscription on a 3,700-year-old lice comb (apparently made from a tusk or bone) unearthed in 2016 at an Israeli archeological site called Lachish, once a Canaanite city. The inscription, written in Sumerian, is the oldest known sentence written in an alphabet.

Medical History

This week in 1978, U.S. scientists announced the production of a genetically engineered human-type insulin by a strain of Escherichia coli bacteria. The work was a joint effort by research teams in California at Genentech Inc. and City of Hope National Medical Center.

Normally, the body produces insulin in the pancreas, programmed by certain genes. The scientists synthesized copies of those genes and inserted them into a weakened lab strain of the intestinal microbe E. coli.

Self-Exam

Q: How many bones are present in the human wrist?

A) 32

B) 8

C) 4

D) 12

Answer: B) 8

Medical Myths

Walking is good exercise, but alone it's not enough to keep you fit as you age. Walking has been shown to lower the risk of heart disease and certain cancers, plus the risk of premature death. But it doesn't address the need to build and retain muscle mass, which begins to progressively decline in your 30s. Experts recommend complementing walks with at least two 20-minute strength-training sessions each week.

Curtain Calls

After watching, apparently enthralled, the act of a (pretend) circus knife-swallower, seaman John Cummings took up the habit. On one occasion, he swallowed four knives, quickly passing three with no ill effects. Later, he swallowed 14 knives, and after some days with abdominal pain, he passed all of them. Finally, he tried 20 knives and a clasp knife case.

After a few days, he had only passed the case. Over the next four years, Cummings endured constant pain before dying in 1809 at the age of 29. An autopsy revealed a knife blade and spring in his intestines and between 30 to 40 fragments of metal, wood and horn in his stomach.

(Note: It is an exaggeration that hydrochloric acid in the stomach can dissolve metal -- at least not quickly -- though some metals corroded faster than others. A 1997 published study using simulated gastric juice found that razor blades immersed in simulated gastric juice weighed 63% of their original weight after 24 hours. Modern disk batteries were acid-resistant for 24 hours before showing signs of corrosion. For pennies, however, there was, uh, no change.)

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