This story from Pro Publica describes how Intuit, the maker of tax-preparation software, has successfully fought efforts to simplify tax-filing (and reduce costs) for tens of millions of Americans. For shame.

And it illustrates a broader point, unfortunately all too common: even when the best solution to a problem is to do less, economic forces invariably will offer a “do more, spend more money” solution, and use their dollars to promote it. Even if your unshod legs could walk or run pain-free down the street, someone will find a way to sell you padded shoes, someone else will give you painkillers for your shin splints and runner’s knee, then the doctor and physical therapist will jump into the fray, now maybe you need treatment for your kidneys, trashed by those NSAIDs, possibly a surgery, and so on.

I don’t have a quick fix, but honesty and transparency are a great start. And, of course, thinking for yourself before each and every purchase. Beware the assumptions that advertising shoehorns into our subconscious.

Kudos to Pro Publica and NPR for their investigation.

From The Wall Street Journal [paywall - search Google News for "Hepatitis C Drug Derailed by Deal"] yesterday: “Sometimes drugs die not because they don’t work or are unsafe, but because they don’t make business sense.”

The article is an indictment of the medical-pharmaceutical-industrial complex: with revenues so large, and profit so often unaligned with patient outcomes … patients often lose, because the bottom line does not give way.

Where to point the finger of blame? Without a profit motive, who could afford to risk the billions of dollars necessary to bring a new drug to market? And at the same time, what evidence do we have that these billion-dollar projects are improving our health as a society? Not much.

And yes, I have my own horse in the race: I’m claiming that the book you can buy for the price of a Bloody Mary at the St. Regis will save you $6000 in footwear costs, not to mention pain, suffering, ill-health, and untold medical bills. (And, in the interest of full disclosure, you don’t need the book – just take off your shoes. That’s free)

But it’s my word, and the word of a handful of similarly heterodox barefooters, against the advertising and prestige of a multi-billion-dollar shoe industry, a multi-billion-dollar healthcare industry, and a multi-billion dollar drug (painkiller) industry, all of whom make their boat payments off of injured runners, not healthy ones. If running injuries ceased by a decree from Up There, a lot of high-powered MBAs, MDs and PhDs would be out of work. “Managed chronic disease” – that’s what they require to keep the lights on.

So what’s the solution? How can corporate incentives be aligned with good health? How can customers (in my case runners) make better rational decisions for their own long-term benefit? Will Obamacare encourage systems thinking, to optimize long-term outcomes for society? How to balance economics with human (ir)rationality?

The discussion continues …

I get lots of questions about stepping on splinters. That’s no surprise.

In a given day, most shoe wearers don’t step on a splinter, so “not stepping on a splinter” is the expected condition, and any deviation seems significant, noteworthy, scary. (And, truth be told, I do get a splinter in my foot, probably two or three times a year. I can’t remember the last time it happened … which probably means I’m due. I’ve been picking up a lot of trash lately – the kids and rummies are out in force.)

What I don’t get, that most shod runners do “expect,” is any of: smelly feet, banged-up toenails, plantar fasciitis, shin splints, and IT Band Syndrome. I also expect to keep running until the day I keel over. I do not expect to ever be “too old to run.” If you’ve read Born to Run, you know that we have evolved to run after our food – to stop running is to die.

And yet, this idea of being “too old to run” has entrenched itself in our modern collective consciousness. So when shod runners suffer shin splints, back pain, or ITBS (as I did), rather than look for a remedy, they believe that their time has come- because that’s what they expected. The promise of injury-free barefoot running might sound nice, and a few of the truly motivated might give it a try, but for most … being permanently injured matches their prior expectation, so they feel fine about abandoning their true love and moving on to biking, swimming, or outright couch-potatohood.

How sad to be limited from achieving our potential, not from any physical constraint, but from false expectations.

I just finished reading Dan Ariely’s wonderful The Honest Truth About Dishonesty. Another great read – another book I wish I had written. I’m developing a serious man crush on that guy.

Anyway, Dan (I’ve decided we’re on a first name basis since he took the last spot in a grad program for which I was waitlisted – back in ’92) describes a series of behavioral experiments he ran, and concludes

we may not know exactly why we do what we do, choose what we choose, or feel what we feel. But the obscurity of our real motivations doesn’t stop us from creating perfectly logical-sounding reasons for our actions, decisions, and feelings.

This really struck a chord, as I’ve completely failed in my attempt to use logic and reason to convince my many injured running friends to try going bare. (And that a certain famous American bicyclist doped.) It never works – just royally pisses them off.

I’m no longer sure I should be trying to “change” anyone’s mind – trying to “save” them. Perhaps all I can do is set an example, and those who have reached a certain point of inspiration (or desperation) may decide to follow that example. We’re more Troi than Data, all of us.

Dan suggests (in an email – yes, I have a message from Dan Ariely!) that behavior change may result from “endorsement from authority.” Authority, I assume, means anyone whose example you want to follow. Yes, some day, Lindsay Lohan or Justin Bieber might do more for the cause of healthy bare feet than my book, Jason’s, and Ken Bob’s combined. Cross your fingers!

Just how much do you think your running shoes are costing you? Besides your good health, I mean.

Runner’s World estimates that runners go through 3.1 pairs of running shoes each year.

How much does a pair of these shoes cost? For the sake of simplicity, let’s call it $100, which is actually pretty conservative – the toe shoes are $80-90, before tax, and most beefier shoes are more. Much more, in some cases. And of course, shoe prices keep going up and up, but we’ll ignore that for now.

And how many more years do you plan to keep running? Let’s call it 40. (Though I realize that running injuries will unfortunately stop many of you before the 40-year mark, but I did say “plan.”)

How about an interest rate? Does 4% sound good to you? I’m pretty confident that 4% is more than your bank is paying, so to be conservative, I’ll pick that.

Now let’s geek out for an instant. What I want to do is calculate the “present value” of all the money you will be spending on running shoes over the next 40 years, using the assumptions above: 3.1 shoes/year, $100/shoe, 40 years, and a 4% interest rate in your savings account.

Let me plug those numbers into my trusty HP 12C Financial Calculator.  Running … running (yes, it says “running”!) … and it spits out … $6135.76. That’s right. The money you can expect to spend on running shoes over your lifetime is the same as $6000 in your hands right now. (Only getting 2% interest? You think shoe prices will go up? That only makes it much worse. For you, I mean – not for the shoe companies.) And this is even before I count up the cost of all those pesky orthotics and doctor’s visits and MRIs and crutches and eventually a big leather couch and wall-sized plasma TV because you’re too injured to run.

Just Say No.

Always Recycle!

The almost universal response when people hear about my barefoot running is “oh, do you mean in those toe shoes?”

No. No, I do not wear toe shoes, and I’m not recommending them.

But how to convey this diplomatically? First I had to practice stifling my frustration, but fortunately years of meditation have worked their magic. I’m serene, like a Red Sox fan with the Yankees ahead by two at the bottom of the eighth.

Over time, I’ve tried different responses; lately it’s been something like this: “Do you have an extra 90 bucks? Great. Why don’t you buy three copies of my book, one for yourself and two for your running friends, and then you’ll be running injury-free and still have 45 bucks left over. Everyone finishes ahead!” [Except for Nike and their podiatrist buddies.]

Seriously. I don’t object to minimalist shoes per se. But they’re a terrible transitional device, providing a false sense of security to someone coming off a lifetime on crutches. Your feet need to rehab, and rehab requires that they feel the ground and learn to move with it – gradually. Once you’ve learned to move (barefoot) with good form, which will take at least several months, if you happen to move to Minnesota to become a Garrison Keillor groupie, then by all means invest in a pair of running mocassins.

Take it easy. Give your body time. Make haste slowly.

As winter (meaning rain) finally reaches the Bay Area, almost all of my running these past few weeks has been on the 1K trail by my house, past the library, the new gym, and right along the Caltrain killing tracks. There’s something so wonderful about the sensation of running on wet earth, feeling the dampness and occasionally the mud squeezing between my toes at soggy spots along the way. Even the dogs seem to be having more fun – the other morning I saw a dog bound up a tree in its exuberance. No firemen necessary.

Yes, muddy trail running can get slippery, but then I remind myself of Dr. Romanov’s demonstration that running forward is all about form, not the surface. Use the hamstrings to lift the feet. Let the knees hinge - don’t drive forward with them. Be like a satellite, “falling ahead” before you “fall down.”

The disadvantage of mud running? I really do need to remember to deposit some socks by the front door as I leave – my own little “mud room.” It’s the only time these days my colorful sock collection of the past decade gets any use – I hope they don’t mind a little dirt.

This week we learned that US marathon record holder Ryan Hall has been suffering from plantar fasciitis for the past four months. He’s dealing with it by taking lots of Aleve (Naproxen), an NSAID effective in reducing inflammation and pain, and in large doses associated with a range of serious side effects, including kidney and liver damage. The danger of kidney damage is magnified during dehydration – such as might occur during high intensity running.

I’m often asked how fast I run (8K PR: 33:49, Marathon PR 3:40), the question accompanied by an implication that I’m not really fast enough to give advice to others. What the running “elite” either cannot or do not want to understand about their eliteness, exemplified by but not limited to Ryan Hall’s “I run on Aleve” example, is that running fast has little to do with running healthy. In fact, elite-level running, just like elite biking, football and baseball, is often the opposite of healthy.

I wish Ryan, who buys his spinach at my neighborhood Trader Joe’s, a speedy recovery before the London Olympics. And I wish he’d stop running while on NSAIDs. It’s not good for him, and it’s not a good example for the next generation of young running Americans who look up to him.

(Obligatory barefoot running plug: I had PF when I ran in shoes, but not since turning bare.)

“How long was your transition to running barefoot?” must be one of my top-5 questions, right behind “do you wear those toe shoes?” and “what about splinters?”

If I don’t answer the transition question with a specific number of months, weeks, and days, it’s only partly because I don’t have records of my transition; mostly it’s because your legs and experience are different from mine, and your transition will be different too. When I say, again and again, “listen to your body,” I don’t mean it in some woo woo Marin hippie way. I really mean – run only till it hurts, then stop.

If the ubiquity of padding and of NSAIDs means that we no longer can feel when our body hurts, then that’s a problem that needs to be fixed. Sensations from your nerve endings are real electrical stimulation, scientifically measurable – this is not vortex healing. Learn to listen to those nerve endings, and then pace your workouts to match the feedback from your body, not according to a schedule set by some dude who’s never even met you.

And yes, expect to allow at least six barefoot months, very likely a year, until you regain your previous shod running mileage. In the scheme of a healthy lifetime, isn’t that worth it?

I like my dentist, Dr. J. Compared to his predecessor (who, bizarrely, was dating my neighbor, but I digress) Dr. J has vastly better bedside manner, and my teeth have generally prospered under his care.

For a while, though, my gums weren’t doing so well, and as we now know, gum health may be related to heart health, so he had me come in for cleanings at twice the normal frequency – every three months.

Then something changed – I discovered oil pulling. I began to swish sesame oil around my mouth for ten minutes each day, and over a single three-month period, and continuing for a year now, my gum health has turned around completely – no more pockets, inflammation or bleeding. The change happened before the very eyes of Dr. J and his hygienist, A. Just this morning I was given the green light to return to a six-month schedule.

Here’s the thing. Given this big turnaround in the state of my gums, wouldn’t you expect a dental pro to be slightly curious as to the cause? On each of my last several visits I’ve mentioned my oil pulling regimen – which coincides exactly with my gum improvement, but Dr. J isn’t at all interested. He listens politely, but the next time has no memory – is just as surprised to see me doing better. Oil pulling wasn’t taught in dentistry school, so apparently it merits no attention or investigation.

I think you can see where I’m going with this: podiatric religion. A few podiatrists seem to be strongly emotionally invested in the war against bare feet. Fine. But what about the rest? With the growing anecdotal and increasingly scientific evidence demonstrating the health benefits of keeping our feet bare, how can so many intelligent, trained professionals turn a collective blind eye? How can it be that so many physicians whose heart is in the right place … are so unable or afraid to look up from the script they received in their long-ago training? When the theoretical box is falling apart at the seams, does the standard of care not require looking outside that box – as a duty to the patient?