Health Care Summit

I was able to watch most of the summit yesterday.  To no one's surprise, it was fairly boring and most people talked past their opponents.  I do believe, if anyone was listening, the R's did get to present an image of agreeing there's a problem, being serious about it, and having credible solutions.  Now the D's can't claim the opposite of this anymore - at least without shame.  But here really is one of the better presentations, for those who missed it.

Paul Ryan from Wisconsin:

Corn Oil and Cancer: Reality Strikes Again

The benefits of corn oil keep rolling in. In a new study by Stephen Freedland's group at Duke, feeding mice a diet rich in butter and lard didn't promote the growth of transplanted human prostate cancer cells any more than a low-fat diet (1).

Why do we care? Because other studies, including one from the same investigators, show that corn oil and other industrial seed oils strongly promote prostate cancer cell growth and increase mortality in similar models (2, 3).

From the discussion section:

Current results combined with our prior results suggest that lowering the fat content of a primarily saturated fat diet offers little survival benefit in an intact or castrated LAPC-4 xenograft model. In contrast to the findings when omega-6 fats are used, these results raise the possibility that fat type may be as important as fat amount or perhaps even more important.

The authors seem somewhat surprised and pained by the result. Kudos for publishing it. However, there's nothing to be surprised about. There's a large body of evidence implicating excess omega-6 fat in a number of cancer models. Reducing omega-6 to below 4% of calories has a dramatic effect on cancer incidence and progression*. In fact, there have even been several experiments showing that butter and other animal fats promote cancer growth to a lesser degree than margarine and omega-6-rich seed oils. I discussed that here.

I do have one gripe with the study. They refer to the diet as "saturated fat based". That's inaccurate terminology. I see it constantly in the diet-health literature. If it were coconut oil, then maybe I could excuse it, because coconut fat is 93% saturated. But this diet was made of lard and butter, the combination of which is probably about half saturated. The term "animal fat" or "low-omega-6 fat" would have been more accurate. At least they listed the diet composition. Many studies don't even bother, leaving it to the reader to decide what they mean by "saturated fat".


* The average American eats 7-8% omega-6 by calories. This means it will be difficult to see a relationship between omega-6 intake and cancer (or heart disease, or most things) in observational studies in the US or other industrial nations, because we virtually all eat more than 4% of calories as omega-6. Until the 20th century, omega-6 intake was below 4%, and usually closer to 2%, in most traditional societies. That's where it remains in contemporary traditional societies unaffected by industrial food habits, such as Kitava. Our current omega-6 intake is outside the evolutionary norm.

Taking AAIM

David B. Nash, MD, MBA
Editorial
Pharmacy and Therapeutics
February 2010 • Vol. 35 No. 2

Taking AAIM

Imagine that you have the chance to address nearly all of the professionals in organized academic internal medicine in one place. I had such an opportunity when I was invited to deliver a plenary luncheon address during Internal Medicine Week in Philadelphia last October.

Internal Medicine Week represents the federation called the Alliance for Academic Internal Medicine (AAIM). Its constituent groups include the Association of Professors of Medicine, the Association of Program Directors in Internal Medicine, the Association of Specialty Professors, Clerkship Directors in Internal Medicine, and Administrators of Internal Medicine.

Ostensibly, I was asked to speak about the impact of health care reformon training programs in internalmedicine. AAIM represents the single largest annual gathering of these teachers from around the country. Graduates of these programs will become P&T members of the future. Here is the gist of my talk:

My job today is a tough one—namely, to address this question: what is the impact of health care reform on academic departments of medicine and their affiliated training programs?1

There are many smart people in the audience today, and I'm confident that all of you read the newspaper and watch television news. So, regardless of the specific legislative outcomes from our leaders inWashington, what, then, are the key themes that are emerging, and how should we respond?

First, some caveats. I do not have a crystal ball that is any clearer than yours.
I do not have the recipe for the “secret sauce” of health care reform, nor am I
directly connected with any of the specific individuals who are involved in writing reform legislation.

It's for precisely these reasons that I have an opportunity to analyze what is going on inside the Beltway and to interpret these possible changes with regard to the curriculum for academic departments of medicine. Writing in JAMA, two major leaders, Dr. Edward Miller, Faculty Dean and President of Johns Hopkins Healthcare, and Dr. Paul Ramsey, President of the University of Washington Health System, have declared that academic medicine has one overarching goal—to improve the health of the population.2 I will use this as my jumping-off point.

I will describe what I call the four pillars of reformand then outline five themes that will enable us to operationalize these pillars. I will end with three critical challenges to academic medicine.

What are the four pillars? They are to create value in the system, insure everyone, change the pernicious payment system, and coordinate care.

We must create value because we currently spend more than any nation on earth, nearly $7,000 per person per year, including children, and we do not score in the top 30 of any recognized worldwide measures of societal well-being.

In accordance with the Judaic concept oftikkun olam, “to heal the world,” we now strive to insure everyone. This is the only way that we will we be able to achieve an equitable distribution of resources and afford the changes ahead.

We must change the payment system and move away from piecework. Currently, there are more than 16,000 CPT [Current Procedural Terminology] codes and none for coordinating care. Only through coordinating care will we make [health care] truly patient-centric.

How, then, might we operationalize these pillars? I believe that there are five critical themes that will enable us to make this dream a reality.

The first is to link the payment system to quality. Of course, the Centers for Medicare andMedicaid Services (CMS) is already moving rapidly in this direction with the advent, in October 2008, of a list of nonpayment events. This list has expanded in 2009, and now there are nearly two dozen nonpayment events. From a training program perspective, this means we must move from so-called eminencebased care to evidence-based care. We must promote a culture of critical self-evaluation based on measurement and reflection. Dr. David Asch and his colleagues, writing in JAMA, have been able to rank obstetrics/gynecology residency programs based on maternal outcomes.3 I believe that a comparable model will move to internal medicine training programs.

The second theme is to encourage coordination and teamwork. These soft concepts, often ridiculed by our most senior leaders, are critical. How much formal training have our interns, residents, and fellows received in the area of teamwork? I believe many physicians falsely contend that teamwork cannot even be taught.We must be role models for the behavior that we seek. We must give away what we want most.

We must focus on [disease] prevention and wellness. How might this fit into the educational continuum?Wemust provide special experiences for trainees to follow chronically ill individuals throughout their training experience. We must promote a longitudinal and population-based view of health and wellness. Next, we must practice the tenets of disease management with our own employees in the temples of technology where most of us work.

We must promote comparative effectiveness research (CER). The way to do this is to study the Institute of Medicine's (IOM's) June 2009 list of top 100 priorities for CER. I believe that many aspects of this list would make wonderful house officer research projects that could be led by teams of interdisciplinary faculty members. The IOM CER list ought to be the basis for a robust trainee research agenda.

Finally, we must implement quality improvement tools and assume organizational responsibility for the patient safety agenda. We are faced with an epidemic of medical errors whereby hospital errors constitute the fourth leading cause of death in the U.S. In our training programs, we must make rectifying this our top priority. We could do that by embracing “crew resource management.” Let's conduct a regular morning report based on the review of what went wrong last night.

We must promote the scholarship of quality. For example, the entire December 2009 issue of Academic Medicine is devoted solely to this topic.

What, then, are the three challenges that lie ahead? The first and most difficult challenge is our training culture. The messages of co-operation, teamwork, communication, quality improvement, safety, and evidence-based practice are all major threats to the status quo. There are insufficiently trained faculty members to help us change the extant culture.

The second major challenge is to create a cadre of physician leaders for the future. Wendy Levinson and colleagues, writing in JAMA, noted that there might be a new career pathway for clinicians in quality improvement.4 We must embrace this new thinking. We must prepare a curriculum for physician leaders, and that is one of our main leadership responsibilities.

The third challenge recognizes certain political realities. We must have the political will to implement these changes at the highest level. It must be sustained and executed appropriately. While certain organizations such as Geisinger, Mayo, and the Cleveland Clinic are held up as national examples, they are, regrettably, not nationally applicable. We need a new political reality.

Finally, colleagues, let me summarize: We have outlined the four pillars of reform, we have described five specific themes for action, and we must appreciate three critical challenges moving forward. In conclusion, to paraphrase the work of Dr. Frank Davidoff, all physicians have two jobs: the job of doctoring and the job of improving the first job. Every day, when we come to work, we must keep this admonition in mind.5

There you have it. A little bit of fire and brimstone, for sure, but my talk was met with sustained applause by more than a thousand individuals representing the current leadership of academic medicine from across the nation.

What is your P&T committee doing to work with trainees at all levels in your organization? How are you preparing your P&T committee members of the future? Who is tracking the possible implications of health care reform in your organization?
As always, I’m very interested in your views. My e-mail address is david.nash@jefferson.edu. Be sure to visit my blog at
http://nashhealthpolicy.blogspot.com/.

REFERENCES
1. NashDB.Meaningful response to health care reform. Presented
at Academic Internal Medicine Week 2009, October 23, 2009,
Philadelphia.
2. Ramsey PG,Miller ED. A single mission for academic medicine.
JAMA 2009; 301(14):1475–1476.
3. Asch DA, Nicholson S, Srinivas, et al. Evaluating obstetrical residency
programs using patent outcomes. JAMA
2009;302(12):1277–1283.
4. Shojania KG, Levinson W. Clinicians in quality improvement: A
new career pathway in academic medicine. JAMA 2009;
301(7):766–767.
5. Batalden P, Davidoff F. Teaching quality improvement: The devil
is in the details. JAMA 2007;298(9):1059–1061.

warm berry snack

This is a little snack or dessert to finish off a meal. I like it warm in winter. Shown in this picture is blueberries.

Ingredients:

3-4 walnut halves (or any nut or seed), chopped (about 0.5 oz), (OPTIONAL)

1/2-1 cup fresh or frozen berries

1 Tsp shaved coconut (unsweetened), or more if you prefer

Combine in a bowl, microwave until warm.

Sea Levels NOT Rising?

Obama was right when he promised that his election would be the historical marker indicating when the global sea levels would stop rising.  What he didn't realize is that the claim was an error and it was only during his first term as POTUS that scientists would retract the claim!  This goes back to that whole bone of contention that I have with much of Global Warming Alarmism - models. 

"Unfortunately, we have since found that our projections were affected by two oversights in our model approach. "

This is the point with models and "science".  The two are not the same.  A model is the hypothesis, but scientific discovery/conclusions must come as a result of testing the model/hypothesis - not just declaring we have a model that extrapolates all the data we included.  The reason this is not credible is because our ecosystem is so big and complex, for the most part, that we don't know all the factors that influence and effect climate change.  Additionally, the Alarmist camp seems so dedicated to an ideological conclusion that they ignore other factors (i.e. the sun, regular climate cycles, etc.).

Run the models - I have no objection to that.  But don't declare the findings as science until you can see reality verify the model is accurate.  And as a result:

"Thus we no longer have confidence in our projections for the twentieth and twenty-first centuries, and for this reason the authors retract the results pertaining to sea-level rise after 1900."

Magnesium and Insulin Sensitivity

From a paper based on US NHANES nutrition and health survey data (1):

During 1999–2000, the diet of a large proportion of the U.S. population did not contain adequate magnesium... Furthermore, racial or ethnic differences in magnesium persist and may contribute to some health disparities.... Because magnesium intake is low among many people in the United States and inadequate magnesium status is associated with increased risk of acute and chronic conditions, an urgent need exists to perform a current survey to assess the physiologic status of magnesium in the U.S. population.

Magnesium is an essential mineral that's slowly disappearing from the modern diet, as industrial agriculture and industrial food processing increasingly dominate our food choices. One of the many things it's necessary for in mammals is proper insulin sensitivity and glucose control. A loss of glucose control due to insulin resistance can eventually lead to diabetes and all its complications.

Magnesium status is associated with insulin sensitivity (2, 3), and a low magnesium intake predicts the development of type II diabetes in most studies (4, 5) but not all (6). Magnesium supplements largely prevent diabetes in a rat model* (7). Interestingly, excess blood glucose and insulin themselves seem to reduce magnesium status, possibly creating a vicious cycle.

In a 1993 trial, a low-magnesium diet reduced insulin sensitivity in healthy volunteers by 25% in just four weeks (8). It also increased urinary thromboxane concentration, a potential concern for cardiovascular health**.

At least three trials have shown that magnesium supplementation increases insulin sensitivity in insulin-resistant diabetics and non-diabetics (9, 10, 11). In some cases, the results were remarkable. In type II diabetics, 16 weeks of magnesium supplementation improved fasting glucose, calculated insulin sensitivity and HbA1c*** (12). HbA1c dropped by 22 percent.

In insulin resistant volunteers with low blood magnesium, magnesium supplementation for four months reduced estimated insulin resistance by 43 percent and decreased fasting insulin by 32 percent (13). This suggests to me that magnesium deficiency was probably one of the main reasons they were insulin resistant in the first place. But the study had another very interesting finding: magnesium improved the subjects' blood lipid profile remarkably. Total cholesterol decreased, LDL decreased, HDL increased and triglycerides decreased by a whopping 39 percent. The same thing had been reported in the medical literature decades earlier when doctors used magnesium injections to treat heart disease, and also in animals treated with magnesium. Magnesium supplementation also suppresses atherosclerosis (thickening and hardening of the arteries) in animal models, a fact that I may discuss in more detail at some point (14, 15).

In the previous study, participants were given 2.5 g magnesium chloride (MgCl2) per day. That's a bit more than the USDA recommended daily allowance (MgCl2 is mostly chloride by weight), in addition to what they were already getting from their diet. Most of a person's magnesium is in their bones, so correcting a deficiency by eating a nutritious diet may take a while.

Speaking of nutritious diets, how does one get magnesium? Good sources include halibut, leafy greens, chocolate and nuts. Bone broths are also an excellent source of highly absorbable magnesium. Whole grains and beans are also fairly good sources, while refined grains lack most of the magnesium in the whole grain. Organic foods, particularly artisanally produced foods from a farmer's market, are richer in magnesium because they grow on better soil and often use older varieties that are more nutritious.

The problem with seeds such as grains, beans and nuts is that they also contain phytic acid which prevents the absorption of magnesium and other minerals (16). Healthy non-industrial societies that relied on grains took great care in their preparation: they soaked them, often fermented them, and also frequently removed a portion of the bran before cooking (17). These steps all served to reduce the level of phytic acid and other anti-nutrients. I've posted a method for effectively reducing the amount of phytic acid in brown rice (18). Beans should ideally be soaked for 24 hours before cooking, preferably in warm water.

Industrial agriculture has systematically depleted our soil of many minerals, due to high-yield crop varieties and the fact that synthetic fertilizers only replace a few minerals. The mineral content of foods in the US, including magnesium, has dropped sharply in the last 50 years. The reason we need to use fertilizers in the first place is that we've broken the natural nutrient cycle in which minerals always return to the soil in the same place they were removed. In 21st century America, minerals are removed from the soil, pass through our toilets, and end up in the landfill or in waste water. This will continue until we find an acceptable way to return human feces and urine to agricultural soil, as many cultures do to this day****.

I believe that an adequate magnesium intake is critical for proper insulin sensitivity and overall health.


* Zucker rats that lack leptin signaling

** Thromboxane A2 is an omega-6 derived eicosanoid that potently constricts blood vessels and promotes blood clotting. It's interesting that magnesium has such a strong effect on it. It indicates that fatty acid balance is not the only major influence on eicosanoid production.

*** Glycated hemoglobin. A measure of the average blood glucose level over the past few weeks.

**** Anyone interested in further reading on this should look up The Humanure Handbook

I love me salads

I've posted this salad many times, but I just love it and it's so easy. It's just a bag of spinach, a bag of frozen mixed berries, some seeds (today was hemp), and some D'angou pear vinegar. Takes 5 minutes to prepare, including slicing the strawberries and thawing the berries for 30 seconds in the microwave. This is my favorite dinner these days.

I didn't take a picture of my lunch today. It was beans over steamed collard greens and brussels sprouts. It was very yummy. I felt I was missing something and I realized, it was salad. I've become addicted to salads. Cooked food is delicious but it goes down too quickly and leaves me wanting more. So I think to my cooked lunches I will add my other favorite salad, which is lettuce (or bok choy), raw veggies (such as broccoli, cauliflower, red bell pepper, zucchini), cut up green apple (with skin but not core), seeds, and D'angou pear vinear. Yep, I'm in kind of a rut, but it's an enjoyable one.

Brekky was my usual blended salad and sunflower seeds.

Lindeberg on Obesity

I'm currently reading Dr. Staffan Lindeberg's magnum opus Food and Western Disease, recently published in English for the first time. Dr. Lindeberg is one of the world's leading experts on the health and diet of non-industrial cultures, particularly in Papua New Guinea. The book contains 2,034 references. It's also full of quotable statements. Here's what he has to say about obesity:

Middle-age spread is a normal phenomenon - assuming you live in the West. Few people are able to maintain their [youthful] waistline after age 50. The usual explanation - too little exercise and too much food - does not fully take into account the situation among traditional populations. Such people are usually not as physically active as you may think, and they usually eat large quantities of food.

Overweight has been extremely rare among hunter-gatherers and other traditional cultures [18 references]. This simple fact has been quickly apparent to all foreign visitors...

The Kitava study measured height, weight, waist circumference, subcutaneous fat thickness at the back of the upper arm (triceps skinfold) and upper arm circumference on 272 persons ages 4-86 years. Overweight and obesity were absent and average [body mass index] was low across all age groups. ...no one was larger around their waist than around their hips.

...The circumference of the upper arm [mostly indicating muscle mass] was only negligibly smaller on Kitava [compared with Sweden], which indicates that there was no malnutrition. It is obvious from our investigations that lack of food is an unknown concept, and that the surplus of fruits and vegetables regularly rots or is eaten by dogs.

The Population of Kitava occupies a unique position in the world in terms of the negligible effect that the Western lifestyle has had on the island.

The only obese Kitavans Dr. Lindeberg observed were two people who had spent several years off the island living a modern, urban lifestyle, and were back on Kitava for a visit.

I'd recommend this book to anyone who has a scholarly interest in health and nutrition, and somewhat of a background in science and medicine. It's extremely well referenced, which makes it much more valuable.

George Will on the Dependency Culture

Here is George Will's speech at CPAC this year.  Will has always fascinated me as a marvellously insightful AND articulate thinker.  He is brilliant in understanding and explaining our current political climate, and sadly hysterical in the process.  A take-away quote for me, which resonates with a lingering thought I keep mulling over:

"People more often need to be reminded than instructed." ~ Samuel Johnson

Quote of the Day

By George Will:

"It is now a tissue of assertions impervious to evidence, assertions which everything, including a historic blizzard, supposedly confirms and nothing, not even the absence of warming, can falsify."

potato, corn, and pea chowder

This soup was inspired by a Potato and Corn Chowder recipe from the "Fat-Free and Easy" cookbook by Jennifer Raymond. But I modified it enough to call it a new recipe. And boy do I like it. It is rich and creamy and feels decadent.

Ingredients:

6 medium-large potatoes, peeled and cut

2 parsnips (optional, but adds sweetness)

1-2 onions or leeks

3 garlic cloves

2 red bell peppers

1/4 tsp black pepper

1 tsp ground cumin

1 tsp basil

2 cups frozen or fresh corn

2 cups frozen sweet peas

3-4 cups soy milk (unsweetened)

1/3 cup raisins (there's your sweetness, which makes a good salt replacement)

Cook some of the parsnips and onion in a separate pan in some water (about 20 minutes), then blend it up. At the same time, cook the potatoes, garlic and onions in some water (about 20 minutes). Mash them up some, but not completely so there are chunky bits. Add the red bell pepper. the blended parsnips/onions, and spices, and cook for another 10 minutes until the bell pepper has the desired consistency. Add the corn, peas and raisins and cook for another 5-10 minutes. Add the soy milk and heat up. Add the amount of soy milk to match your desired consistency. Don't bring to a boil or the soy milk separates.

weekend cooking and eating

Yesterday I made a week's worth of smoothies for housemate and myself (these get frozen). I nibbled on those for breakfast. Lunch was very late and I was starving so I ate a giant salad of romaine lettuce topped with broccoli, cauliflower, apples, sunflower & flax seeds, edamame, and d'angou pear vinegar. Then I was very full. So at dinner I wasn't very hungry and just ate these 3 delicious pink oranges. And then I was hungry in the middle of the night and didn't sleep well. I don't sleep so well when I'm hungry.

Today's brekky was a blended salad and some veggie juice I made for the beans I was cooking. And a few carrots and some sunflower seeds. The beans were sooo good, and I'll get to enjoy them all week. I mixed several beans, left in various jars: small red, white, split peas, and lentils. I juiced 5 lbs of carrots, plus some kale and celery, and a chopped onion. I cooked up a leek and big parsnip separately in water, blended them and added them in. Boy was it good. I got those started early in the morning and then was gone for several hours. By lunch I was very hungry and ate some beans over kale. That didn't quite fill me up since I shared it with housemate. So I also ate some raw broccoli. Then I made some potato-corn-pea soup for housemate. Boy was that ever good. I couldn't stop eating it as I was test-tasting it and adding things to it. Then I got really full. oops. Then I wasn't real hungry for dinner but had a yankering for some berries, and there was a little soy milk leftover from house-mate's soup, so made a sorbet from frozen mixed berries and soy milk. I didn't feel like having it sweet (I don't know why but it's a good thing), so didn't add any date sugar or sweet fruit to it. I really enjoyed it. It was just what I was in the mood for. It had the same texture as the frozen custard my companions were eating yesterday. In case you aren't from the midwest, frozen custard is a rich soft-serve ice cream. We were at this burger/custard shop with the kids we were babysitting. It was kind of interesting as I recalled how I used to enjoy a burger, fries and frozen custard. I had good memories of the tastes but fortunately didn't have a desire to repeat the experience. I could enjoy the smells and that was enough. Knock on wood!

It was a fun cooking weekend as usual.

yesterday and today

When following Dr. Fuhrman's "Eat to Live" plan, you measure your food intake by weight rather than calories. Here's a brief description of his recommendations. Yesterday, out of curiosity, I weighed all my food. Here's what I ate:

Brekky: blended salad & 2 Tbsp sunflower seeds (I eat the seeds after my workout, and the blended salad when I get home)

Lunch: last of the kale-fennel soup on steamed veggies (broccoli and cauliflower) and baby bok choy. raw carrots for dessert.

Dinner: spinach & apple & veggie salad with edamame. raw carrots & celery.

This turned out to be 2 lbs or raw veggies (!), and about 1/2 lb of cooked; 4 servings of fruit, probably 1 cup of beans, and 1.5 oz of seeds. That's twice as many raw veggies and half as many cooked as recommended. So I guess it is pretty easy to eat the recommended amount of veggies. I woke up hungry today. I wonder if the raw veggies don't digest as well as cooked so less calories are used. So if you want to lose weight, eat more raw veggies. I don't need to lose weight but I really like chewing on the raw veggies.

Today I had the usual brekky (sunflower seeds & blended salad); lunch was raw veggies and black bean hummus. Visitor Kenny confirmed that this is his favorite meal. Dinner was a yummy salad with grapefruit and leftover raw veggies from lunch. And I am a little hungry again at bedtime. So I probably need more cooked veggies. But I didn't have much time today to cook. Tomorrow will be hectic too, but I'll try to cook up my kale.

salad with grapefruit & veggies

Lately I've been enjoying eating whatever veggies and fruit are available on my salads with seeds and flavored vinegar. Easy and good! Today at the store, the grapefruit was on sale and it looked good so I decided to have one with my dinner salad. And I had leftover raw veggies from lunch.

Ingredients

baby bok choy (or lettuce or spinach)

1 grapefruit (best is Texas Riostar)

raw veggies: broccoli, orange, yellow or red bell pepper, cauliflower

2 Tbsp blood orange vinegar

1-2 Tbsp seeds (hemp, sunflower)

Chop up the greens. Peel the grapefruit and cut up the pieces. Add everything else. yum! The grapefruit and vinegar are juicy. You could probably make this with raw kale and let it sit for hours (good lunch or dinner to take on the go) and it would get tender but not soggy.

salad with apples and veggies

Ingredients:

lots lettuce or spinach

2 small apples or 1 large, chopped

chopped veggies: broccoli, cauliflower, red, orange or yellow bell pepper

1/2 cup edamame or 2/3 cup sweet peas (optional)

2 Tbsp seeds (e.g., sunflower, hemp, ground flax, ground sesame)

2-3 Tbsp D'Angou Pear vinegar

Combine everything in a large bowl

Salad frenzie

I've been into salads lately. I've been having blended salads for brekky (and sunflower seeds); lunch has been leftover soup over salad (from last weekend and kale fennel soup the freezer); dinner has been salad with apples and veggies. I took a bunch of apples to a meeting this weekend and there were lots leftover so I've been eating them all week on my salads.

Guest Commentary: Henrietta Lacks - A Thought-Provoking Case

Martha C. Romney, MS, JD, MPH
Project Director
Jefferson School of Population Health

On Monday, February 15th, the Kimmel Cancer Center hosted Ms. Rebecca Skloot to discuss her new book, "The Immortal Life of Henrietta Lacks" at its Grand Rounds. The story of Ms. Lacks' contribution to research is remarkable. The associated ethical questions are equally notable.

So who was Ms. Henrietta Lacks? Ms. Lacks, born in 1920, is described as a "poor and illiterate" tobacco farmer in Virginia. She died at age 31 from cervical cancer, leaving behind 5 children. During the course of her treatment, her cancerous cervical cells were harvested for research without her knowledge. Ms. Lacks' cells, subsequently identified as "HeLa" cells, multiplied prolifically and were easily cultured in laboratories, enabling scientists to use them for research on many different medical issues. HeLa cells have been sold around the globe for decades.

HeLa cells have been used in more than 60,000 medical and scientific studies, contributing to the development of the polio vaccine, and our knowledge about chemotherapy, gene mapping, Parkinson's disease, and AIDS, as well as nuclear and space research.

However, while HeLa cells have been used to develop treatments to help people around the world, Ms. Lack's family was unaware of the significance of the HeLa cells to research until two decades after her death, and lives today in poverty and without health insurance.

The case raises significant issues around informed consent, ownership of bodily tissue, financial compensation, communication and public education, and access to health care.

Last few days

It's been a busy few days so no time to post. Yesterday was my first nutritarian meetup. It was fun. However, I stupidly ate too much while preparing so I wasn't hungry during the meeting. I didn't even eat the ice cream, which I was looking forward too all week. oops! I made West African lentil okra stew (a Fuhrman recipe). It wasn't as good as I was expecting but maybe that's because I used boiled peanuts (ground in the blender) instead of peanut butter (which is roasted). So I'm curious to try it again. We get really good fresh-ground peanut butter at my co-op. Other people brought great salads and fruit. Dessert was banana walnut ice cream (with some date-cashew cream and vanilla for a little extra treat). Then we made another batch that had frozen bananas & cherries, cocoa and (raw) cacao powder, coconut, vanilla and date-cashew cream. Date-cashew cream is just cashews, dates, and water blended in the blender (which is one of the things I taste tested a bit too much of before the meeting). The ice cream was a big hit.

I also made a big batch of sweet potato/peanut dip but didn't like it so much. I put in too many peanuts. I didn't think you could ruin it by putting in too many peanuts, but you can. The boiled peanuts mixed with water are a bit on the bland side, so it's better as a minor component of the recipe. So I didn't bother to put out the dip and didn't bother to cut up the raw veggies I was going to include with the dip.

Anyway, the meetup was good. There were lots of questions about Dr. Fuhrman's program, and lots of sharing of experiences and advice.

Minced Fish

I saw this commercial recently and it reminded me of my neice, Charli.

Academy Health Annual Policy Meeting

Despite a record snowfall, the Academy Health Annual Policy Meeting this past week in Washington DC was chock full of news about prospects for real reform of the health system, new payment schemes, and states that are making progress. The Secretary of HHS made it pretty clear that the Administration still will fight for some aspects of reform but the Democrats appear weak and disorganized from my perspective. Experts from the Brookings Institute and elsewhere noted that real reform means changing the pernicious payment system and that means changing Medicare. Well, we don't even have a Medicare Administrator so CMS is not going to be the wellspring for lots of change---unless the widespread demonstration projects get real traction but nothing is going to happen here until at least 2011. Finally, The Governor of Wisconsin gave a compelling luncheon address about BadgerCare---using the principals of Population Health(even quoting David Kindig multiple times!!), he noted that it can be done---you can cover the uninsured, you can practice based upon the evidence and you can get good outcomes that we can all afford. He got a rousing round of applause so it leaves me with hope for the future. Speaking of HOPE and CHANGE....hope you let us know how you feel about the stalled reform in Washington and what can we do to re-start the conversation in a more serious tone...Thanks, DAVID NASH

Climate Expert Jones Concedes UPDATED

He doesn't come out and actually admit he lied. In fact he says he did not "cheat" the data nor did he "unfairly influence the scientific process." But he does concede that:

"two periods in recent times had experienced similar warming. And he agreed that the debate had not been settled over whether the Medieval Warm Period was warmer than the current period...."

This effects the "hockey stick" graph that shows global warming in this century is unprecedented. If it is not, than this could imply what is happening now is NOT related to humans or CO2. Stay tuned...

UPDATE: Now there is a study that suggests there was no warming to begin with, but rather the instruments that measure warming were capturing land development and urbanization. The study also notes that many of the temperature measuring sites are in questionable sites like water treatment plants or incinerators.

UPDATE AGAIN: Here is a great article detailing the various revelations in the IPCC report. I think there are 14 main issues detailed... so far.

Guest Commentary: The U.S. Government and Computerization of Healthcare

Richard Jacoby, MD
Associate Professor
Jefferson School of Population Health

A key factor contributing to high cost and poor quality of health care in the United States is the lack of computerization in health care, and specifically the low adoption rate of electronic medical records (EMRs). In the world of quality, the fundamental elements are the triad of structure (personnel and equipment), process (the things that you do), and outcome (the results you achieve). Having adequate structure (EMRs in this context), is a necessary but not sufficient building block to achieve optimal outcomes.

Computerization is acknowledged to be the single largest factor contributing to increased productivity in the civilized world. EMRs, a technology that has the ability to break down the current silos of information and poor communication that exist among providers are used by less than 20% of physicians in the United States. Cost, interruption of workflow, and lack of adequate technical support are cited as the main barriers to adopting EMRs.. In other parts of our economy, the marketplace has fueled the drive toward computerization. Given the failure of the marketplace to drive health care in that direction, the U.S. Government through the Department of Health and Human Services (DHHS) has stepped in to try to accelerate the adoption of EMRs.

The American Recovery and Reinvestment Act of 2009 (the “stimulus bill”) contained within it the Health Information Technology for Economic and Clinical Health (HITECH) Act. This program allocated $19 billion to subsidize the purchase and “meaningful use” of EMRs by physicians and other providers in the United States. In the criteria for achieving the subsidy, the government laid a roadmap by which health care providers will not simply adopt EMRs, but use them to achieve health and efficiency. The DHHS defined “meaningful use” carefully so as to further five specific, comprehensive, and unifying health care goals: improving the quality, safety, and efficiency of care while reducing disparities; engaging patients and families in their care; promoting public and population health; improving care coordination; and promoting the privacy and security of EMRs.

Providers engaged in ambulatory care can generally earn up to $44,000 in extra payments if they become meaningful users of EMRs (more if they are eligible for the Medicaid program). Hospitals that succeed in achieving “meaningful use” are eligible for payments in the millions of dollars.The intent of these payments is to offset the cost of the purchase of the EMRs. Additional funds have been made available to establish centers that will provide consultants to support providers in the selection, adoption and use of EMRs. If getting providers to do the “right things” in our current healthcare environment is a matter of proper planning and aligning incentives, the HITECH Act is surely a step in that direction.

Feb. 10

Brekky today was blended salad, an apple and a kiwi.

Lunch was beans & kale and leek and onion and 1 Tbsp ground sunflower seeds. The kale and leeks and onions cooks up in a few minutes in the pressure cooker so this is a quick and easy lunch. This was really good, because the beans were really good. I think it was those parsnips I blended into it. They have a sweet and spicy flavor. These beans were leftover from weekend before last (frozen). My dish is on the left. Housemate's (on right) has potato in it.

I finished this off with some carrots as usual.

Dinner was spinach salad and carrots, as usual.

Tonight I was at a meeting and watched people eat cookies. Then I went grocery shopping and wondered if I was going to be tempted to have my own splurge as a result. But rational thinking won this time (I wasn't hungry and splurges never satisfy, they just keep going and going, like the energizer battery). Still, it's interesting how easy it is to get influenced by watching other people eat.

broccoli stalks

I've always thought of broccoli stalks as garbage or compost. Here's a picture:

Does that look edible to you? Well, I heard the inside is tender and tasty. So I peeled of the outer layers with a potato peeler:

and guess what, it does taste good. It's quite tender. Who knew!

Saturated Fat and Insulin Sensitivity

Insulin sensitivity is a measure of the tissue response to insulin. Typically, it refers to insulin's ability to cause tissues to absorb glucose from the blood. A loss of insulin sensitivity, also called insulin resistance, is a core part of the metabolic disorder that affects many people in industrial nations.

I don't know how many times I've seen the claim in journal articles and on the internet that saturated fat reduces insulin sensitivity. The idea is that saturated fat reduces the body's ability to handle glucose effectively, placing people on the road to diabetes, obesity and heart disease. Given the "selective citation disorder" that plagues the diet-health literature, perhaps this particular claim deserves a closer look.

The Evidence

I found a review article from 2008 that addressed this question (1). I like this review because it only includes high-quality trials that used reliable methods of determining insulin sensitivity*.

On to the meat of it. There were 5 studies in which non-diabetic people were fed diets rich in saturated fat, and compared with a group eating a diet rich in monounsaturated (like olive oil) or polyunsaturated (like corn oil) fat. They ranged in duration from one week to 3 months. Four of the five studies found that fat quality did not affect insulin sensitivity, including one of the 3-month studies.

The fifth study, which is the one that's nearly always cited in the diet-health literature, requires some discussion. This was the KANWU study (2). Over the course of three months, investigators fed 163 volunteers a diet rich in either saturated fat or monounsaturated fat.

The SAFA diet included butter and a table margarine containing a relatively high proportion of SAFAs. The MUFA diet included a spread and a margarine containing high proportions of oleic acid derived from high-oleic sunflower oil and negligible amounts of trans fatty acids and n-3 fatty acids and olive oil.

Yummy. After three months of these diets, there was no significant difference in insulin sensitivity between the saturated fat group and the monounsaturated fat group. Yes, you read that right. Even the study that's selectively cited as evidence that saturated fat causes insulin resistance found no significant difference between the diets. You might not get this by reading the misleading abstract. I'll be generous and acknowledge that the (small) difference was almost statistically significant (p = 0.053).

What the authors decided to focus on instead is the fact that insulin sensitivity declined slightly but significantly on the saturated fat diet compared with the pre-diet baseline. That's why this study is cited as evidence that saturated fat impairs insulin sensitivity. But anyone who has a basic science background will see where this reasoning is flawed (warning: nerd attack. skip the rest of the paragraph if you're not interested). You need a control group for comparison, to take into account normal fluctuations caused by such things as the season, eating mostly cafeteria food, and having a doctor hooking you up to machines. That control group was the group eating monounsaturated fat. The comparison between diet groups was the 'primary outcome', in statistics lingo. That's the comparison that matters, and it wasn't significant. To interpret the study otherwise is to ignore the basic conventions of statistics, which the authors were happy to do. There's a name for it: 'moving the goalpost'. The reviewers shouldn't have let this kind of shenanigans slide.

So we have five studies through 2008, none of which support the idea that saturated fat reduces insulin sensitivity in non-diabetics. Since the review paper was published, I know of one subsequent study that asked the same question (3). Susan J. van Dijk and colleagues fed volunteers with abdominal overweight (beer gut) a diet rich in either saturated fat or monounsaturated fat. I e-mailed the senior author and she said the saturated fat diet was "mostly butter". The specific fats used in the diets weren't mentioned anywhere in the paper, which is a major omission**. In any case, after 8 weeks, insulin sensitivity was virtually identical between the two groups. This study appeared well controlled and used the gold standard method for assessing insulin sensitivity, called the euglycemic-hyperinsulinemic clamp technique***.

The evidence from controlled trials is rather consistent that saturated fat has no appreciable effect on insulin sensitivity.

Why Are We so Focused on Saturated Fat?

Answer: because it's the nutrient everyone loves to hate. As an exercise in completeness, I'm going to mention three dietary factors that actually reduce insulin sensitivity, and get a lot less air time than saturated fat.

#1: Caffeine. That's right, controlled trials show that your favorite murky beverage reduces insulin sensitivity (4, 5). Is it actually relevant to real life? I doubt it. The doses used were large and the studies short-term.

#2: Magnesium deficiency. A low-magnesium diet reduced insulin sensitivity by 25% over the course of three weeks (6). I think this is probably relevant to long-term insulin sensitivity and overall health, although it would be good to have longer-term data. Magnesium deficiency is widespread in industrial nations, due to our over-reliance on refined foods such as sugar, white flour and oils.

#3: Sugar. Fructose reduces insulin sensitivity in humans, along with many other harmful effects (7).

As long as we continue to focus our energy on indicting saturated fat, it will continue distracting us from the real causes of disease.


* For the nerds: euglycemic-hyperinsulinemic clamp (the gold standard), insulin suppression test, or intravenous glucose tolerance test with Minimal Model. They didn't include studies that reported HOMA as their only measure, because it's not very accurate.

** There's this idea that pervades the diet-health literature that all saturated fats are roughly equivalent, all monounsaturated fats are equivalent, etc., therefore it doesn't matter what the source was. This is beyond absurd and reflects our cultural obsession with saturated fat. It really irks me that the reviewers didn't demand this information.

*** They did find that markers of inflammation in fat tissue were higher after the saturated fat diet.

Feb. 9 food

Brekky: boy was I hungry after not eating too much yesterday and then biking in the snow to and from my exercise class. This doesn't look like much maybe but lunch was only 2 hours away so it was the perfect amount to eat: blended salad, apple, and carrots.

Lunch was leftover red beans and rice over veggies. The veggies were broccoli, cauliflower, carrots, and asparagus, pressure cooked for 1 minute on high. It was shared between 3 people so the leftovers are all gone now, as are the veggies. Time to go grocery shopping. Dessert was a delicious sweet orange bell pepper, while housemate and guest ate chips and salsa.

Dinner was my usual spinach salad. Yep, I'm in a rut. This was followed by a raw carrot, my usual finisher.

Feb. 8 food

I wasn't hungry for brekky after eating all the red beans & rice yesterday.

Lunch was blended salad and cabbage salad.

Dinner was spinach salad only I used a whole head of romaine instead of spinach. That was a lot of lettuce. That was topped with seeds, a bag of frozen mixed berries (thawed 30 sec in the microwave) and spicy pecan vinegar. I love this dinner, though I do get cold afterwards, so I have to finish it off with a cup of warm herbal tea. I also had 3 carrots and a little bit of raw broccoli and cauliflower leftover from yesterday.

Thank You

I'd like to extend my sincere thanks to everyone who has supported me through donations this year. The money has allowed me to buy materials that I wouldn't otherwise have been able to afford, and I feel it has enriched the blog for everyone. Here are some of the books I've bought using donations. Some were quite expensive:

Food and western disease: health and nutrition from an evolutionary perspective. Staffan Lindeberg (just released!!)

Nutrition and disease. Edward Mellanby

Migration and health in a small society: the case of Tokelau. Edited by Albert F. Wessen

The saccharine disease. T. L. Cleave

Culture, ecology and dental anthropology. John R. Lukacs

Vitamin K in health and disease. John W. Suttie

Craniofacial development. Geoffrey H. Sperber

Western diseases: their emergence and prevention. Hugh C. Trowell and Denis P. Burkitt

The ultimate omega-3 diet. Evelyn Tribole

Our changing fare. John Yudkin and colleagues


Donations have also paid for many, many photocopies at the medical library. I'd also like to thank everyone who participates in the community by leaving comments, or by linking to my posts. I appreciate your encouragement, and also the learning opportunities.

Economic Solutions

George Will has a great article in the Washington Post re: "How to get the country to solvency on entitlements." 

Here's a sample, but it's well worth the whole thing:

Some calamities -- the 1929 stock market crash, Pearl Harbor, Sept. 11 -- have come like summer lightning, as bolts from the blue. The looming crisis of America's Ponzi entitlement structure is different. Driven by the demographics of an aging population, its causes, timing and scope are known.

Funding entitlements -- especially medical care and pensions for the elderly -- requires reinvigorating the economy. Ryan's map connects three destinations: economic vitality, diminished public debt, and health and retirement security.

Superbowl food

Today I had guests over for the superbowl so had fun making food for it. Before that though, I had a blended salad for brekky and cabbage salad for an early lunch. Then I prepared the superbowl food: red beans & rice, raw veggies and sweet potato/peanut dip (I love this!), sweet pea guacamole, and salsa. We also provided the following SAD (Standard American Diet) food to our guests (and housemate enjoyed it too): beer, tostado chips (salted), vegan hot cocoa, hot cider, and chocolate candy. So everyone was happy. I overate on the red beans & rice because I was tasting it a lot while playing with spices, and then, well, then I just ate too much of it!

Feb. 6 food

Yesterday I made 11 smoothies to freeze. ha. First I made 6 smoothies for housemate. There's a little bit leftover from each smoothie, so the snacking on the leftovers was my brekky. It was probably less than 1 smoothie, but enough. Then I went to yoga, came home, and made my blended salads. I only needed 5 because I had a couple leftover from last week. Again, snacking while making them was enough to call lunch, along with some carrots and raw veggies. Dinner was cabbage salad, and a little bit of walnuts and frozen sweet peas. So I've learned not to eat meals while making the smoothies. I enjoy snacking on them. They are like a treat, especially housemate's. But if I eat brekky and lunch in addition to this, I get overfull.

"Open the Doors" to Climate Change Science

This is article from The Globe and Mail has a good summary of my thoughts on the subject. This is what I have been a "denier" of, if anything - advocacy in the name of science. Science is not about concensus, nor is it agenda-driven. Furthermore, models are just that - models. Policy is a wholly other thing.

None of this is to say that global warming isn't real, or that human activity doesn't play a role, or that the IPCC is entirely wrong, or that measures to curb greenhouse-gas emissions aren't valid. But the strategy pursued by activists (including scientists who have crossed the line into advocacy) has turned out to be fatally flawed.

By exaggerating the certainties, papering over the gaps, demonizing the skeptics and peddling tales of imminent catastrophe, they've discredited the entire climate-change movement. The political damage will be severe. As Mr. Mead succinctly puts it: “Skeptics up, Obama down, cap-and-trade dead.”

These thoughts are echoed in this HA post, as well:

The IPCC doesn’t do science. They do advocacy, mainly for the idea of international control of energy and manufacturing, with a healthy dose of redistribution of wealth. These revelations should put an end to any reliance on IPCC work for American policy, and the UN should be pressured to fire everyone involved in this sham, starting with railroad engineer Rajendra Pachauri.

Economic Lessons From France

Here is a great article from Fortune that a friend emailed me. It retells the situation of French President Mitterrand and his economic policies from the 80's. Here's a brief review of some important details:

Mitterrand won the presidential election on the Socialist ticket in mid-1981, pledging an ultra-Keynesian agenda of government expansion, and a program of sweeping nationalizations. His moderate supporters were certain that he would take a far more centrist approach once in office. But to their horror, Mitterrand kept his most radical promises. At the time, France, like the rest of Europe, was mired in recession. Mitterrand's strategy was to revive the economy by boosting consumer demand through vast increases in wages and government spending.

The Mitterrand plan was the ultimate experiment in extreme stimulus, a Gallic campaign to out-Keynes even Keynes. The new president raised pay for civil servants and employees of state-owned companies.... He created 250,000 new government jobs, and lavishly increased payments to mostly middle-class families through a program called Allocations Familiales. The minimum wage rose sharply, and the government flooded the banks with easy money.

To pay for all the new spending, Mitterrand tripled the budget deficit. Mitterrand not only talked like a Socialist, he acted like one, nationalizing 38 banks, including Paribas, and seven big industrial giants, ranging from chemical colossus Rhone-Poulenc to container producer Pechiney.

The results were an unmitigated disaster. In 1982 and 1983, inflation stood in double digits, twice the level in the Germany and America. Unemployment soared to over 10%. Mitterrand devalued the franc no less than three times to keep France's exports of wine and insulation competitive. The French economy was growing by millimeters while its European neighbors recovered in long strides. Top talent was fleeing: Bernard Arnault, now the CEO of luxury goods marketer LVMH, departed for the U.S., declaring that his homeland was becoming a "banana republic."

Then, in early 1983, Mitterrand made an historic change in direction. Admitting that he'd been "intoxicated" by his Keynesian vision in 1981, Mitterrand, as the French say it, "put water in his wine" by shifting to far more conventional, prudent, and, frankly, capitalist policies.

It sounds very familiar, doesn't it? Check out the rest of the article to find out what happened. Ultimately, the article concludes:

"So Americans should hope for what they can get, a president willing to put water in his wine, and recognize the virtues of a policy that revived France 27 years ago, when François Mitterrand traded fantasy for austerity."

Feb. 5 food

Today was heavy on the salads, out of convenience.

Brekky: blended salad, apple

Lunch: huge salad consisting of head of romaine chopped, red bell pepper chopped, topped with sweet pea dressing. I ate this at a hamburger joint with 10 other people. They had burgers and fries. I should have started eating my salad before the food came because I was still eating it after we finished paying the bill.

Dinner: spinach salad with additional baby bok choy. I used spicy pecan vinegar and that was really good! And the frozen berries (thawed 30 sec in microwave) were a lot better than yesterday's fresh. Finished with some carrots and frozen peas and then felt too full. Didn't need the peas.

Feb. 4 food

brekky: veggie juice early. Then blended salad and grapes (too many) later. This was too close to lunch.

Lunch: raw veggies and leftover sweet potato/peanut dip (shared with housemate). steamed kale (2 minutes in pressure cooker) and beans. This was all good. Here's a picture:

I overate because of the late brekky (and because I overate). I noticed overeating makes me want to eat even more. So I ate another carrot even though I was full. Oh well, at least it was just a carrot (a big carrot).

Dinner: spinach salad followed by a couple of carrots even though I was full. Note for future reference: I used fresh blackberries and blueberries. Guess what, they weren't as good as frozen. They came from South America and that's a long trip to Wisconsin. Maybe it was just a bad batch. Anyway, I'm really full and it's 3 hours after dinner. I definitely ate too much today even though it doesn't seem like that much but it was clearly more than I needed.

JK Rowling on Failure

Here is the 2008 commencement speech at Harvard given by "Harry Potter" author JK Rowling (20 min). I was very impressed and think it very wise. She obviously is a great story-teller, and thus a good speech-writer. She addresses two topics in her time: Failure and Imagination. Of course she stands as a successful woman, even the richest women in England. But this was not always so. One poignant line from her speech: "Rock bottom became the solid foundation on which I rebuilt my life."

When discussing the idea of Imagination, she gets there in an unexpected way. In describing her early life experiences at Amnesty International, she comes to the rare expression of gratitude for living in a country of laws and personal human rights. This idea struck me (and I was grateful for her expressing it), because it is something that I have understood from my own study of genocide. We truly do live in an exceptional time and place. The majority of the world, both past and present, has never known our comfort and our opportunities. We live in the exception, not the rule.

She ends her speech by quoting Senneca: "As is a tale, so is life: not how long it is, but how good it is that matters." Honestly, one of the best speeches I've ever heard.

J.K. Rowling Speaks at Harvard Commencement from Harvard Magazine on Vimeo.

The Impact of the Internet - UPDATED

I enjoy checking out The Technium every once in a while (Link in the margin). Below are some excerpts from a post related to the title above. It is interesting to consider how the internet does change the way we think (and live). I'm sure there are many ways, but here are some of Kevin Kelly's thoughts:

We already know that our use of technology changes how our brains work. Reading and writing are cognitive tools that, once acquired, change the way in which the brain processes information.... Psychologists...concluded that "the acquisition of reading and writing skills has changed the brain organization of cognitive activity in general is not only in language but also in visual perception, logical reasoning, remembering strategies, and formal operational thinking."...

... I now no longer to try remember facts, or even where I found the facts. I have learned to summon them on the Internet. Because the Internet is my new pencil and paper, I am "smarter" in factuality. But my knowledge is now more fragile. For every accepted piece of knowledge I find, there is within easy reach someone who challenges the fact. Every fact has its anti-fact. The Internet's extreme hyperlinking highlights those anti-facts as brightly as the facts....

My certainty about anything has decreased. Rather than importing authority, I am reduced to creating my own certainty — not just about things I care about — but about anything I touch, including areas about which I can't possibly have any direct knowledge . That means that in general I assume more and more that what I know is wrong. We might consider this state perfect for science but it also means that I am more likely to have my mind changed for incorrect reasons. Nonetheless, the embrace of uncertainty is one way my thinking has changed....

While hooked into the network of networks I feel like I am a network myself, trying to achieve reliability from unreliable parts. And in my quest to assemble truths from half-truths, non-truths, and some other truths scattered in the flux (this creation of the known is now our job and not the job of authorities)....

I no longer can tell when I am working and when I am playing online. For some people the disintegration between these two realms marks all that is wrong with the Internet: It is the high-priced waster of time. It breeds trifles. On the contrary, I cherish a good wasting of time as a necessary precondition for creativity, but more importantly I believe the conflation of play and work, of thinking hard and thinking playfully, is one the greatest things the Internet has done....

My thinking is more active, less contemplative. Rather than begin a question or hunch by ruminating aimlessly in my mind, nourished only by my ignorance, I start doing things. I immediately, instantly go. I go looking, searching, asking, questioning, reacting to data, leaping in, constructing notes, bookmarks, a trail, a start of making something mine. I don't wait. Don't have to wait. I act on ideas first now instead of thinking on them....

Compared to the passive consumption of TV or sucking up bully newspapers, or of merely sitting at home going in circles musing about stuff in my head without any new inputs, I find myself much more productive by acting first.... To my eye they are not wasting time with silly associative links, but are engaged in a more productive way of thinking then the equivalent hundred of millions people were 50 years ago....

This approach does encourage tiny bits, but surprisingly at the very same time, it also allows us to give more attention to works that are far more complex, bigger, and more complicated than ever before. These new creations contain more data, require more attention over longer periods; and these works are more successful as the Internet expands....

[UPDATE] As it relates to the third quoted paragraph, I stumbled on this Chesterton quote that is very fitting:

“What we suffer from today is humility in the wrong place. Modesty has moved from the organ of ambition. Modesty has settled upon the organ of conviction, where it was never meant to be. A man was meant to be doubtful about himself, but undoubting about the truth. . . .

We are on the road to producing a race of men too mentally modest to believe in the multiplication table.” Orthodoxy (Garden City, 1959), pages 31-32.

The Thorn

I love poetry and even write some occasionally. Here is a poem I found over at BTW.

The Thorn
by Martha Snell Nicholson

I stood a mendicant of God before His royal throne
And begged him for one priceless gift, which I could call my own.
I took the gift from out His hand, but as I would depart
I cried, “But Lord this is a thorn and it has pierced my heart.
This is a strange, a hurtful gift, which Thou hast given me.”
He said, “My child, I give good gifts and gave My best to thee.”
I took it home and though at first the cruel thorn hurt sore,
As long years passed I learned at last to love it more and more.
I learned He never gives a thorn without this added grace,
He takes the thorn to pin aside the veil which hides His face.

Hebrews 10:19,20 "Therefore, brothers, since we have confidence to enter the holy places by the blood of Jesus, by the new and living way that he opened for us through the curtain, that is, through his flesh...."

Guest Commentary: Taking a "Bite" out of Obesity

Marty Romney, MS, JD, MPH
Project Director
Jefferson School of Population Health

Just how effective will Philadelphia's Menu-Labeling ordinance be in encouraging healthier food selections in chain restaurants? Statistics show the number of meals and money spent for food away from home have increased over the past three decades. Meals away from home are associated with larger portions and foods higher in saturated fats and calories, contributing to the obesity epidemic.

On January 1st, Philadelphia’s “Menu-Labeling” Ordinance, touted as the strictest in the nation, took effect. However, City Council granted restaurants, convenience and ice cream shops, bakeries and delis a one-month reprieve. As of February 1st all “chain restaurants,” defined as retail food establishments with 15 or more locations, must list calorie counts adjacent to items on menu boards and food tags (www.philly.com/inquirer/health_science/daily/20100131_What_s_on_the_menu__Food_facts.html). Additional nutrition information must be provided upon customer request.

As of April 1, 2010, in addition to calorie counts, individual menus listings in chain restaurants must include the grams of carbohydrates and fat, with milligrams of sodium. The federal recommendations for sodium and fat for a 2000-calorie diet are required as well. The exceptions to the ordinance are "specials or items offered fewer than 30 days, sealed package with federal labeling, customer special requests and complimentary condiments.”

Interestingly, the few studies exploring the impact of calorie information at point-of-purchase has demonstrated a positive but weak impact on food selection. Presenting nutritional information on menus lays it right on the table for discussion. The opportunity is “ripe” for healthcare providers, public health professionals, nutritionists and health educators to educate consumers about the nutritional components of food and product labeling. This is especially important for consumers with multiple health conditions where monitoring sodium, fats and carbohydrates is critical.

Soup’s on! Dish up the details! For more information, please visit www.philly.gov.

The 5000 Year Leap by W. Cleon Skousen

Last summer I read this book and have wanted to write a review ever since. It is a fascinating review of our Founding Fathers' literature (both what they had to read to influence their thinking, and what they wrote). The subtitle clarifies the focus: "The 28 Great Ideas That Changed the World". There are many quotes in the book that I had never heard before related to views our Founding Fathers held about various topics. I'll include some of the more profound below.

Over all, it was not a well-written book in that it seemed like a prof's lecture notes simply transcribed for publication. There were a lot of connect-the-dot jumps in the material and not a fluid presentation, like someone who was telling a story. This made it a bit difficult to slog through the book. I think it could be better organized, but grant it is a substantial amount of material compressed into just over 300 pages.

I would recommend it in the end for the content, with the understanding that the presentation is weak.

Some quotes from the author:
de Tocqueville found that Americans were the freest people in the world. "Eventually, the world found that they were also the most generous people on earth. And all this was not because they were Americans. The Founders believed these same principles would work for any nation. The key was using the government to protect equal rights, not to provide equal things" p 119.

"Under no circumstances is the federal government to become involved in public welfare. The Founders felt it would corrupt the government and also the poor. No Constitutional authority exists for the federal government to participate in charity or welfare" p 121.

The real genius of the Constitution is that it "was designed to control something which has not changed and will not change - namely, human nature" p166.

Some quotes from the Founding Fathers:
"Only a virtuous people are capable of freedom. As nations become corrupt and vicious, they have more need of masters." Benjamin Franklin

"If there be [no virtue among us], we are in a wretched situation. No theoretical checks, no form of government, can render us secure. To suppose that any form of government will secure liberty or happiness without any virtue in the people, is a chimerical idea." James Madison

"Our Constitution was made only for a moral and religious people. It is wholly inadequate to the government of any other." John Adams

"I, however, place economy among the first and most important of republic virtues, and public debt as the greatest of the dangers to be feared." Thomas Jefferson

"...if we desire to secure peace, one of the most powerful instruments of our rising prosperity, it must be know that we are at all times ready for war." George Washington to Congress

"The very fame of our strength and readiness would be a means of discouraging our enemies; for 'tis a wise and true saying, that 'One sword often keeps another in the scabbard.' The way to secure peace is to be prepared for war." Benjamin Franklin

"That some should be rich shows that others may become rich and hence is just encouragement to industry and enterprise. Let not him who is houseless pull down the house of another, but let him work diligently to build one for himself, thus by example assuring that his own shall be safe from violence...." Abraham Lincoln

Feb. 3 food

Brekky: blended salad, grapefruit, apple. I was at a restaurant with friends. Oddly, I wasn't jealous of their food. I felt like having my fruit.

Lunch: raw veggies and sweet potato/peanut dip. This was so good. I loved it. I love boiled peanuts and sweet potatoes, and together they make a great dip. And I'm starting to love raw cruciferous veggies, which is a new one for me.

Dinner: spinach salad. This version consisted of spinach, 1 bag blueberries, 2 Tbsp blueberry vinegar, 1 Tbsp coconut flakes, 1 Tbsp hemp seeds, and 1 Tbsp sunflower seeds. This was yummy.

sweet potato/peanut dip

Ingredients:

1 large sweet potato

1/2 cup raw peanuts

1/4 tsp cinnamon (optional)

pinch nutmeg (optional)

Bake the sweet potato (350 F for 1 hour 15 minutes). Let it cool a bit, peel the skin (I eat it and it is good!). Boil the peanuts for an hour. Combine peanuts, water it cooked in, sweet potato, and seasoning in blender until smooth. That's it! It is really good. I had this with raw veggies for lunch today. yum!

kale with peanut/sweet potato/bean sauce

Ingredients:

1-2 bunch kale

1 bunch baby bok choy (optional)

1/2 onion, coarsely chopped

1/2 large sweet potato

1/4 cup raw peanuts

1-2 cups beans

Bake the sweet potato (1 hour, 350 F), cover the cut half with foil. Boil the peanuts for an hour. Cook the kale and onion (few minutes in the pressure cooker, or 10-20 minutes steamed). Blend the peanuts and sweet potato with cooking water (from the kale). Combine everything. It's like a kale stew. It's very yummy.

Feb. 2 food

Brekky: cabbage, apple & raisins. without the curry and onion. here's a picture before cooking.

I cooked it for a couple of minutes in the pressure cooker. I think I'm more in the mood for the raw version, easy cabbage salad these days. That's surprising because it's winter.

Lunch was kale with peanut/sweet potato/bean sauce. It was soooo goood. Housemate enjoyed it too.

Dinner was my usual spinach salad with spinach, a bag of frozen mixed berries, a couple Tbsp of seeds, and blueberry vinegar. finished off with some carrots.

Five Major Poisons found in Animal Foods

This is an interesting article from Dr. McDougall's latest newsletter. The standard American diet is poisonous!

Jana Banana's Carrot Cupcakes with Cinnamon Raisin Icing

This looks good for a treat (from Jana's blog). I used to love carrot cake. Maybe I'll try this for one of my nutritarian potlucks sometime, or any gathering of friends.

yesterday and today

I'm having fun with my nutritarian meals these days. On Saturday, I did a lot of food prep for the week, so now my meals are quick and easy.

Yesterday, I wasn't hungry for brekky, and so had my blended salad and spinach salad at lunch along with some fruit (star fruit, kiwi, a few apple pieces). That was filling and then I got home late for dinner so didn't want to prepare much, and just had a bowl of raw stuff: red bell pepper, carrot sticks, baby bok choy, broccoli and cauliflower. I poured some blueberry vinegar on it. It was good and I enjoyed taking 30 minutes to eat it while conversing with house-mate and house-guest as they ate their weird Standard American food (have you noticed that it's mostly shades of brown in color?). So that ended up being an all-raw day, by accident.

Today, I had brekky at the co-op with a friend, after my exercise class. I brought my blended salad (thawed from the freezer), and bought a small apple and a small box of strawberries to eat with it. Lunch was really good. yummmmm. I made kale with sweet potato sauce, with variations: only 1/2 large sweet potato was baked, no pom. juice, and just a few raw walnuts (about 1/2 oz). I cooked kale and onion in the pressure cooker. Then blended the potato, walnuts, and cooking liquid. It didn't blend vary well because of the small amounts but that's okay. I combined that with my weekend beans and mixed it all up with the kale and onion. so yummmmy! I should have taken a picture but I just wanted to eat it. Dinner will be some sort of quick salad. I forgot to get spinach at the co-op, so I'll just use a baby bok choy and arugula, and dump some frozen berries, seeds, and vinegar on it, like the spinach salad. and I'll eat my raw carrots because I love raw carrots. I finish off most meals with carrot sticks.