A Roman doctor holds the pump (Reuters).

Italian doctors successfully implanted the world's smallest artificial heart into a 16-month-old boy, keeping him alive for 13 days with a titanium pump until a heart transplant donor was found.

At 0.4 ounces, the astoundingly small piece of equipment weighed 80 times less than a standard artificial heart for an adult human, Reuters reported. It can pump a little over 3 pints of blood a minute. 

The little boy had a condition known as dilated myocardiopathy and spent almost his entire first year of life at Rome's Bambino Gesu hospital, where the artificial heart was also implanted. 

The device was invented by Robert Jarvik, esteemed creator of the first permanent total artifical heart, but had only been tested in animals.

PROBLEM: Women's bare bodies are on display in billboards, movie posters, and many other kinds of ads. Though plenty of studies have looked at the ramifications of this pervasive sexual objectification, it's unclear if we see near-naked people as human beings or if we really do view them as mere objects.

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METHODOLOGY: Researchers led by Philippe Bernard presented participants pictures of men and women in sexualized poses, wearing a swimsuit or underwear, one by one on a computer screen. Since pictures of people present a recognition problem when they're turned upside down, but images of objects don't have that problem, some of the photos were presented right side up and others upside down. After each picture, there was a second of black screen before each participant was shown two images and was asked to choose the one that matched the one he or she had just seen.

RESULTS: The male and female subjects matched the photos similarly. They recognized right-side-up men better than upside-down men, suggesting that they saw the sexualized men as persons. On the contrary, the women in underwear weren't any harder to recognize when they appeared upside down, indicating that the sexy women were consistently identified as objects.

CONCLUSION: People objectify women in sexualized photos, but not men.

SOURCE: The full study, "Integrating Sexual Objectification With Object Versus Person Recognition: The Sexualized-Body-Inversion Hypothesis," is published in the journal Psychological Science.

I've been following the legal battles between the Federal Trade Commission (FTC) and the makers of POM juice and other pomegranate juice products with avid interest, mainly because they deal with the credibility of sponsored scientific research.

This week, an administrative law judge ruled that POM violated federal law when it deceptively advertised its products as able to "treat, prevent, or reduce the risk of heart disease, prostate cancer, and erectile dysfunction."

The judge ruled that reasonable consumers would interpret the ads as making such claims but that the company had not produced convincing evidence to support them.

The judge's decision makes entertaining reading for someone like me who enjoys debates about whether sponsorship of scientific studies influences results and interpretation--as evidence shows they most definitely do.

POM has invested more than $35 million in research to prove that pomegranate juice has health benefits. It has sponsored about 100 studies at 44 different institutions. At least 70 of these studies were published in peer-reviewed journals.

It is not difficult to design research studies to give sponsors the answers they want and to make sure they are conducted well. POM is getting the best research that money can buy.

One such study, of the effects of drinking pomegranate juice on myocardial perfusion (MP, blood flow to the heart), was conducted by Dr. Dean Ornish, who runs a preventive medicine institute in California (the quotes come from pages 268-269 of the decision).

The Ornish MP study was originally designed to last 12 months, with measurements at baseline, 3 months, and 12 months. [The FTC] charges that the study was cut short when the three-month data came in favorably and Dr. Ornish faced cost overruns.

Dr. [Frank] Sacks [expert witness for the FTC] opined that the shortened study period and failure to report the planned duration are inconsistent with widely accepted standards for conduct of clinical trials and undermine any confidence in the findings.

Dr. Ornish testified that the Ornish MP Study was terminated after three months only because the Resnicks did not provide the funding that they had previously committed to this study....[he said the study]constitutes credible and reliable science showing that pomegranate juice lessens the risk of cardiovascular problems.

The judge found evidence on this study and many others conflicting. He ruled that this level of disagreement about the quality of the research means that the scientific evidence is not good enough to substantiate the claims.

I was interviewed for a story in Business Week about this decision.

This makes it clear why everyone should be suspicious of the results of sponsored studies...POM-sponsored studies produce results favorable to POM.

POM's owners have their own spin on the decision.

It says the ALJ's ruling affirms the scientific validity behind the general health benefits of pomegranates and "completely exonerates" POM regarding its claims in broadcast or print interviews.

Let's be clear what's at stake here. According to the decision document, the owners of POM control 18,000 acres of pomegranate orchards.

From September 2002 through November 2010, sales of POM juice alone totaled nearly $248 million (the supplements and other products add more).

The owners must believe that nobody will buy pomegranate juice and supplements for any reason other than health benefits.

Health claims are about marketing, not health.

Let's hope the FTC can make the decision stick.

This post originally appeared on Food Politics, an Atlantic partner site.

The first baby boomers turned 65 last year. The golden years of the boomers are likely to be a lot different from what they were for previous generations of Americans. Specifically, they're going to be a lot lonelier and poorer, according to a recent study from researchers at Bowling Green University.

About one-third of all boomers are unmarried, a percentage that's been steadily rising since 1980, when just 20 percent were unmarried. And this growth hasn't been because of widowhood. Most single boomers are divorced or simply never married. Apparently, the generation who trusted no one over 30 ran out of people to trust.

The overall picture painted by the study is a bleak one, with no obvious solution.

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Actually, the idea that baby boomers came of age during the days of peace, love and Woodstock is a misconception. Boomers were born between 1946 and 1964. Younger boomers came of age during the Reagan era, a time of very different sensibilities than the Vietnam War era their older counterparts grew up in. But they're all aging together. Seventy-nine million strong.

In the past, the American extended family provided some support to aging individuals. That system is basically gone, leaving single boomers with little of a support net. And studies have consistently shown that unmarried people report lower physical and psychological well-being than married people do. They're also poorer on average than their married counterparts, with those who never married or are widowed being worse off than those who are divorced, differences that the Bowling Green study found also held true for single boomers.

According to the study, one in five single boomers is living in poverty while only one in 20 of their married counterparts are. Single boomers are twice as likely to be disabled, but they're also less likely to have health insurance.

The study also dispels the myth that most single boomers are aging greybeards. They're disproportionately women, non-white and among the younger of the boomers.

Around 19 percent of single boomers said they were receiving food stamps, public assistance or supplemental Social Security income, compared to six percent of married boomers.

The overall picture painted by the study is a bleak one, with no obvious solution. The study concludes: "Boomers are a diverse group, with various risk profiles that must be recognized by health care providers, social service agencies, and other forms of institutional support to ensure that all Boomers age well and that society is able to provide adequate services to all Boomers, regardless of marital status."

As well as a little peace, love and happiness.

An article on the study appears in the The Gerontologist and is freely available. The entire issue of the journal is devoted to baby boomers.

This article originally appeared on TheDoctorWillSeeYouNow.com, an Atlantic partner site.

We've all been there. You start nibbling on some chips -- just a snack, you say to yourself -- and before you know it, you've reached the bottom of the bag. How does that happen? More importantly: how do we stop?

Researchers at Cornell University think they've discovered an answer to the second question. The solution involves colored chips that serve as an approximate visual indication of serving size. By slipping a colored chip every so often into a stack of normal chips, scientists found that study participants not only could report back how much they'd eaten with greater accuracy -- they also snacked less compared to control participants.

Study subjects were divided into two groups. One group was told to snack on a set of unadulterated chips while watching a video; the other group watched the same video but munched on a supply of chips in which one in every seven chips was dyed red. Researchers then repeated the experiment, inserting a red chip for every five normal ones. The subjects weren't told what the red chips meant, but at the end of the study, those who'd eaten the red chips had consumed about half as many as those who were eating from the normal supply.

What's more, the red chip-eaters were better at estimating how many they'd had. Most could guess to within one chip, whereas the normal chip-eaters generally lowballed their estimates by as many as 13 chips.

According to Food and Brand Lab director Brian Wansink, people rely on visual cues such as the bottom of a bowl, or an empty plate, as a signal to stop eating. Giving consumers the same cues in prepackaged foods may help discourage mindless snacking.

"By inserting visual markers in a snack food package," said Wansink, "we may be helping [participants] to monitor how much they are eating and interrupt their semiautomated eating habits."

Why chip manufacturers would ever embrace a technology that encourages people to consume less and not more seems like a mystery. But businesses might be tempted to get on board if they think it could attract snackers who previously avoided chips entirely for fear of eating too much.

The bigger challenge, it seems, is one of design: what do you do about chips that don't like to be stacked?

Medical mistakes are dangerous, costly, and often hidden until it's too late. Patients do their best not to think about them, because of their need to trust in their doctors. Who wants to study a surgeon's error rates right before going under the knife? For their part, doctors don't like to admit they erred, especially when they might get sued. But a culture that avoids confronting mistakes will only perpetuate them.

Medical leaders and patient groups have made some progress reducing one type of error: infections contracted in hospitals. Organizations like the Institute for Healthcare Improvement and medical schools like Johns Hopkins University have engaged and educated doctors and nurses about preventing these infections. Consumers Union and other patient groups have won enactment of legislation in 30 states to require hospitals to report how often their patients contract a preventable infection. Congress has provided funds for additional infection reporting in the Affordable Care Act (ACA). As a result of all of this effort, infection rates are declining. The Centers for Disease Control and Prevention has found declines of as much as 58 percent for various hospital infections over the last several years.

However, there remain a  vast number of safety problems in desperate need of improvement. Thirteen years ago, the Institute of Medicine estimated that between 44,000 and 98,000 hospital patients die each year from preventable medical errors. That's roughly the same level of deaths revealed in a recent study by the Inspector General at the Department of Health and Human Services, which pegs the number of  Medicare patient deaths from preventable errors at 79,000 each year. In addition to the senseless tragedy of unnecessary death, such errors cost Medicare nearly $2 billion annually, in part because many non-lethally injured patients require additional care to fix the mistakes.

From any point of view, the response to these errors has been wholly inadequate. On the one hand, the research clearly shows that too little is done to identify and prevent them. On the other hand, doctors often provide excessive care to shield themselves in case of a malpractice lawsuit. Although estimates of the cost of this defensive medicine vary considerably due to differences in research methodologies, the potential savings is at least in the tens of billions of dollars.

By ensuring that the effort to reduce medical errors is a fully open and productive enterprise, we can greatly improve patient care and decrease health care costs. To achieve this critical transparency, policy makers and medical professionals should draw from the successful process that hospitals forged in fighting against infections:

• Develop error prevention techniques for medical professionals through hands-on research;
• Set standards for identifying and collecting data on all types of medical errors through regulations; and
• Apply pressure to prevent errors through legal reforms.

The president and Congress should set a national goal to cut medical errors in half by the end of the next presidential term in the following ways:

Develop prevention techniques. One of the early successes in the fight to reduce infection rates came from the Michigan Health & Hospital Association Keystone Center. With the support of federal and state agencies and insurance plans, Michigan hospitals worked with the Johns Hopkins University medical school to develop a simple but effective checklist to prevent infections from central-line catheterization, a process that involves inserting a tube in a patient's vein. This checklist reduced those infections by two-thirds in Michigan hospitals. Today, according to Consumers Union research, 166 hospitals throughout the nation have completely eliminated this type of infection.

Such techniques may seem obvious in retrospect, but only research can prove how well they work in the first place. Congress needs to continue funding this hands-on research through the Agency for Healthcare Research and Quality so that successful prevention efforts will be recognized and replicated.

Set standards for data collection on errors. The battle against hospital infections has succeeded in part by setting standards for precise definitions of infections that both make sense to clinicians and provide meaningful data for collection and research. Without some degree of uniformity, hospitals and other providers are not able to compare their results against benchmarks or each other.

Putting aside infections, the reporting process for medical errors is underdeveloped. For example, medication and prescribing errors are the leading causes of preventable errors, but current reporting requirements are haphazard at best, failing to clearly identify whether pharmacists or physicians should be responsible for reporting, which federal agency should collect the data, or even how often such mistakes should be reported. The federal government should use its authority under the Affordable Care Act to improve reporting on health care that hurts patients.

Apply the right kind of pressure to prevent errors. Checklists for preventing infections and reporting infection rates have created clear lines of responsibility for prevention among teams of providers. The legal system, however, often muddles responsibility by making individuals accountable instead of recognizing the teamwork needed to avoid injuries. Additionally, malpractice cases do not set precedents that can serve as legal standards for doctors who want to stay within clear legal boundaries of care. Instead, malpractice decisions can appear random and unpredictable to physicians, who consequently learn nothing from them.

The current medical malpractice system undermines an open, collaborative model for preventing errors. Jury decisions offer no reasoning, while settlements are generally sealed at the request of the defendants, which prevents research and discussion about how the injuries could have been prevented. Thousands of tragic mistakes can occur each year because lawsuits have chilled open interaction within hospitals. Doctors and nurses are often trained not to speak up when they suspect something is wrong with someone else's patient, in order to avoid additional legal responsibility. Malpractice liability plays only a limited and inconsistent role in doing what it should: giving doctors an incentive to practice safely.

To remedy this, Congress should fund, strengthen, and expand the pilot program in the ACA for specialized health courts. Based, in part, on alternative forms of justice like worker's compensation, a health court would establish automatic awards for clear-cut cases of malpractice. A specialized judge with medical training would hear more complex cases, hire experts to advise the court about medical standards, and make precedent-setting rulings. Caps on damages have a role as well--but not as thinly veiled efforts to limit the already scant access to justice that injured patients have today. A cap of $250,000 is hardly fair to a person who becomes quadriplegic for life from a surgical error. That said, standards for awards based on the severity of an injury can help patients with similar injuries receive similar compensation.

By stopping the legal system from forcing errors underground and investing in research and data collection to prevent errors, we may finally receive health care with a good safety record. And with it we may gain some peace of mind.

More episodes from the series can be found on the Atlantic Video channel here.

For more information about The Perennial Plate, visit http://www.theperennialplate.com/. 

Research has shown that the bigger your plate, the likelier it is you'll overeat. The same logic may apply to fast food, where according to a new infographic by the Centers for Disease Control, portion sizes for popular items have increased dramatically since the 1950s.

Since the dawn of the Cold War, the volume of an order of french fries has grown 180 percent. The weight of the average burger has more than tripled. And get this -- sodas are six times larger than they were back in the days of "I Love Lucy."

PROBLEM: Previous research has shown that lifelong musical training improves the biological processing of sound in ways that enhance attention and working memory. Does bilingualism lead to similar benefits?

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METHODOLOGY: Northwestern University researchers led by Jennifer Krizman examined the subcortical auditory regions of 23 bilingual English- and Spanish-speaking teenagers and 25 English-speaking teens. To inspect how bilingualism affects the subjects' brain, they recorded brainstem responses as they heard speech sounds in a silent and noisy setting.

RESULTS: The monolingual and bilingual subjects responded similarly in the quiet condition. Against a backdrop of background noise, however, the bilingual brains were better at encoding the fundamental frequency of speech sounds known to underlie pitch perception and grouping of auditory objects, indicating improvements in auditory attention and working memory.

CONCLUSION: Bilingualism yields functional and structural changes in cortical regions of the brain dedicated to language processing and executive function.

IMPLICATION: Dual language speakers are highly efficient in processing auditory information. "Bilinguals are natural jugglers," says co-author Viorica Marian in a statement. "The bilingual juggles linguistic input and, it appears, automatically pays greater attention to relevant versus irrelevant sounds."

SOURCE: The full study, "Subcortical Encoding of Sound Is Enhanced in Bilinguals and Relates to Executive Function Advantages," (PDF) is published in the journal Proceedings of the National Academy of Sciences.

Heart patients benefit from counseling about when it is safe to resume sex, according to a recent study. Patients who had been sexually active before a heart attack were 1.5 times more likely to resume their previous level of sexual activity if they received counseling about when to do so prior to discharge from the hospital.

Researchers found that patients who had a heart attack or an acute myocardial infarction (AMI) unnecessarily delayed or refrained from sex if they did not receive counseling from a doctor before they left the hospital.

Even after a year, only 41 percent of men and 24 percent of women reported discussing with their doctor when and how often they could resume having sex.

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The researchers, from the University of Chicago, University of Missouri, and Yale University, surveyed 1,879 patients who had been hospitalized for an AMI. They found that less than a half of men surveyed and about a third of women recalled receiving instructions about when they could safely resume sexual activity before they left the hospital. Even after a year, only 41 percent of men and 24 percent of women reported discussing with their doctor when and how often they could resume having sex.

Stacy Tessler Lindau, lead author of the current study, said it highlights the need for more doctors to address sex as an important part of life, even after a serious event such as a heart attack. Harlan Krumholz, another author and a professor of medicine and epidemiology and public health at Yale University School of Medicine, said, "This study may help doctors address issues that they're traditionally reluctant to discuss."

Receiving instructions about resuming sex is an important predictor of whether or not patients resume sexual activity in the year following AMI. In fact, for women, counseling was the only significant predictor. "Doctors need to understand the significant role they play in helping AMI patients avoid needless fear and worry about the risk of relapse or even death with return to sexual activity," said Lindau, an associate professor of obstetrics and gynecology at the University of Chicago School of Medicine in a press release.

Current guidelines state that patients who do not have any complications can resume sexual activity within one week to 10 days. In January, the American Heart Association (AHA) published a review of research on sexual activity among patients with heart disease. The report supported the long held notion that those who can engage in moderate exercise - such as walking up a few flights of stairs - are usually healthy enough for sex.

The study was published in the American Journal of Cardiology.

This article originally appeared on TheDoctorWillSeeYouNow.com, an Atlantic partner site.

One of the big explanations behind the alarming rise in healthcare spending is that America's fee-for-service system of payment encourages doctors to order lots of expensive procedures, even if they do nothing to help patients. Because fee-for-service emphasizes quantity over quality of care, it tends to lead to the overuse of medical services. And that extra consumption naturally drives up spending on healthcare.

But some new data suggest that overuse, though problematic, isn't the catch-all bogeyman many think it is. In fact, the prices of the services themselves are increasing. According to a massive database of five billion health insurance claims put together by the Healthcare Cost Institute, medical prices increased three times faster than the rate of inflation between 2009 and 2010. Even as healthcare usage dipped somewhat on account of the recession, hospital prices in particular jumped by 5.1 percent. Prices for outpatient visits grew more than 10 percent. General inflation over the same period? That rose just 1.6 percent by comparison.

That raises a question: how are healthcare providers able to jack up their prices this way and still get away with it?

To grasp the issue one way, consider prostate cancer screenings. In a long-awaited announcement yesterday, a federal task force recommended against being screened for prostate-specific antigen (PSA), the blood protein that's linked to prostate cancer. PSA tests are practically worthless, the task force argued. They can't tell you how serious a tumor is -- only that you might have one. As a result, many more men get treated for prostate cancer than is probably necessary. And since treatment carries serious side effects -- people have been known to die from it, if they didn't become incontinent or impotent -- the screenings may be doing society more harm than good.

If the screenings don't help, why has it taken so long for the task force to come out against it? Well, one reason may be because some insist the tests really do help. Our emotional tendency to think that more healthcare leads to better healthcare could be another. But Otis Brawley, the chief medical officer at the American Cancer Society, has a different theory: mass screenings are popular because they're a cash cow.

In an op-ed yesterday for CNN.com, Brawley recounts a conversation he had with a hospital's marketing executive. The exec was bragging about how he'd managed to take a free (free!) cancer screening event and use it to turn a buck:

The marketer had figured out how many men would be treated with surgery, radiation, and hormones. He had estimates of all the money the center would make from treating all 45 cancer cases. He knew how many men would be treated for urinary incontinence, and what his net profit for treating that would be. Amazingly, he even knew how many of the men would want penile prostheses surgically implanted to treat their impotence.

In other words, Brawley's saying that medical providers have an incentive to keep the PSA test around because not only do they make money from treating the cancer -- they also stand to gain from treating the side effects later. And if a million men who didn't need any of that treatment to begin with decide they want those services anyway? So much the better.

The fight over prostate cancer screenings offers a rare glimpse into the surprising relationship among healthcare providers, patients, and insurance companies. We usually think of insurers as the major villain in American healthcare, since much of the debate in the last few years has revolved around expanding coverage and ending discrimination. But it's also the case that healthcare providers wield an inordinate amount of power.

In some cases, the providers become so powerful they can push the insurance companies around. That story was famously told in an epic two-part production of This American Life back in 2009. Due to its domination of the San Francisco Bay area, one hospital network managed to force Blue Cross of California to raise insurance premiums for all its customers in the region. Although Blue Cross was able to slow the rate of increase in a negotiated settlement with the hospital, the incident did far more to highlight the hospital's power to manipulate prices against everyone else's will.

Which brings us back to the HCCI report. News outlets spent much of Monday reporting that medical providers, not overuse, were to blame for recent increases in healthcare spending. But why those providers found it so easy to jack up their rates is another question. The answer appears to be that nobody's around to stop them.

Experts all agree that controlling Medicare and Medicaid spending is crucial to slowing rising health care costs. However, under the current system, the most expensive subset of Medicare and Medicaid beneficiaries are lost in a complicated web of multiple payers and programs that lack both the incentive and the ability to curb risings costs. These beneficiaries are "dual eligibles"--people who are eligible for both Medicare and Medicaid at the same time--and they are among the poorest and sickest individuals in our society.

Providing care for these individuals under two entitlement programs proves that two is truly not always better than one. Instead of working together to coordinate care, Medicare and Medicaid split responsibility, dividing up who pays for what based on which service is provided and in which setting. This bifurcated payment structure leaves dual eligibles in a black hole between Medicare and Medicaid, resulting in poorer care and increased costs for taxpayers. 

Congress should do away with the dual eligible model and instead place responsibility for this population in one federal program that can ensure quality of care and cost control.

Who Are "Dual Eligibles?"

Dual eligibles include approximately nine million people who are among the most vulnerable in our society. To be eligible for both programs, they must be low-income, to qualify for Medicaid, and either over age 65 or disabled, to qualify for Medicare (they are often both). More than half of dual eligibles live below the poverty line. They are more likely to suffer from chronic conditions--particularly diabetes, cardiovascular disease, and Alzheimer's--than are the Medicare or Medicaid beneficiaries who qualify for only one program. 

Unsurprisingly, dual eligibles are an extremely expensive population to insure, and represent a disproportionate percentage of both Medicaid and Medicare expenditures: approximately 40 percent of total Medicaid expenditures, despite their making up only 15 percent of Medicaid enrollment. One study calculated that a dual eligible costs Medicare almost twice as much as the average Medicare beneficiary.

The current payment system for dual eligibles is set up in a way that denies both programs the ability to control overall costs. Rather than being covered by two programs, dual eligibles are more accurately a part of neither, as neither program has clear responsibility, and both programs have incentives to shift costs onto the other.

Conflicting Incentives

Under the current system, a dual eligible is caught in a complicated division of financing between the two programs. For many dual eligibles, Medicaid pays for nursing home services or supports and services at home. In fact, more than two-thirds of Medicaid funding for dual eligibles goes to long-term care. Meanwhile, Medicare pays for hospital care, outpatient physician care, and prescription drugs--but Medicaid must pick up a dual eligible's premiums, deductibles, and copays. Medicaid also pays for many support services that are not covered by Medicare, such as transportation, dental, and vision.

In reality, this fragmented payment structure creates a system whereby neither Medicare nor Medicaid has an incentive to control costs, because the cost-controlling program is unlikely to reap the rewards. For example, because Medicare will cover the entirety of a beneficiary's hospital stay, Medicaid has no incentive to invest in services, technologies, or staff that will prevent hospital stays for long-term care recipients. Indeed, the Centers for Medicare and Medicaid Services estimated that approximately 40 percent of hospitalizations for dual eligibles in 2005 were potentially avoidable, costing the government more than $3 billion.   

Meanwhile, providers must bear the additional costs of having to deal with complex reimbursement provisions for not just one insurer but two. Often, providers are required to first bill Medicare, then to bill Medicaid to cover the beneficiary's Medicare deductible or co-insurance. Then, if Medicaid reimbursement rates are less than Medicare, as they often are, providers are instructed to claim a portion of the unreimbursed amounts as "bad debt," a portion of which can be reimbursed by Medicare. Confused yet?

Symptomatic of a Larger Problem

While the financial cost and administrative burden of dividing the responsibility for providing health care to dual eligibles are particularly acute, they are symptomatic of a larger problem: multiple government programs--each with its own bureaucracy, regulations, budget, and oversight--that fail to coordinate in any meaningful way and sometimes undercut each other. The decisions of the Supplemental Nutrition Assistance Program on what food purchases to support, the Department of Housing and Urban Development on low-income housing, and the Social Security Administration on disability assistance all affect each other. In addition, the decisions of these seemingly disparate agencies often affect the level of medical services needed by someone who is served by them--medical services that will likely be the responsibility of Medicare or Medicaid or, as in the case of dual eligibles, both. Yet no single program absorbs all of the costs of those decisions or undertakes the responsibility to make sure that the needs they are trying to address are met in a rational, coordinated way.

A Step in the Right Direction

The Affordable Care Act takes a number of positive steps to correct the disconnect in care for dual eligibles, including the creation of the Medicare-Medicaid Coordination Office, which works with Medicare and Medicaid to help manage care. Currently, 15 states are participating in a demonstration program to design new approaches to better coordinate care for dual eligibles and to share savings between the programs. While these demonstration programs are laudable, more wholesale reform is needed. For needy Americans who are likely to require aid from a variety of assistance programs, Congress should consider a holistic approach that would let states assign full responsibility for these people to a single program. Such an approach would not only better serve taxpayers but the beneficiaries themselves.

(Dena Feldman provided invaluable research assistance for this essay)

PROBLEM: There's plenty of anecdotal evidence on athletes who bravely "play through the pain." Still, the scientific evidence to support the belief that athletes experience pain differently has not been as consistent.

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METHODOLOGY: University of Heidelberg researchers led by Jonas Tesarz reviewed 15 studies that compared experimentally induced pain threshold or tolerance in athletes and moderately active people. They analyzed experiments that included adult men and women; tested 568 athletes and 331 normally active control participants; and involved endurance sports, game sports, and strength sports.

RESULTS: Though the athletic subjects can stand more pain than the other active adult subjects, the magnitude they can stand varies. Endurance athletes had a fairly consistent, moderate tolerance for pain while athletes involved in game sports had greater tolerance scores that varied more widely. As for pain threshold, or the minimum intensity at which a stimulus is perceived as painful, the athletes and the control subjects did not significantly differ.

CONCLUSION: Athletes can endure more pain than moderately active people.

IMPLICATION: The finding that regular exercise is associated with higher pain tolerance may have clinical implications. Tesarz says in a statement: "It may be advisable in exercise treatment for pain patients to focus on the development of their pain-coping skills that would affect tolerance, rather than the direct alleviation of pain threshold."

SOURCE: The full study, "Pain Perception in Athletes Compared to Normally Active Controls: A Systematic Review With Meta-Analysis," is published in the journal Pain.

An outbreak of salmonella has sickened at least 141 persons in 20 states from Texas to Massachusetts and in the District of Columbia. It's been traced to a yellowfin tuna product used in raw seafood dishes such as sushi, sashimi and ceviche.

Many of the people who became ill reported eating a sushi selection called spicy tuna.

Since the fish may have passed through many distributors before ultimately reaching the restaurant or grocery store and may not have been clearly labeled, the FDA sums up its advice as: 'when in doubt, don't eat it.'

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The outbreak has been traced to a product called Nakaochi Scrape, which is tuna scraped directly off the bones (backmeat). It's rarely sold directly to consumers but most often to restaurants and grocery stores for use in raw food dishes. To the eye, it looks like a ground product, not firm fish flesh.

On April 13, Moon Marine Corporation, also known as MMI, of Cupertino, California, recalled 58,828 pounds of frozen yellowfin product suspected of being tainted with Salmonella Bareilly. It was labeled as Nakaochi Scrape AA or AAA.

The FDA advises consumers to check with the establishment before eating or purchasing any raw fish dish or product, to make sure that it does not contain any of the recalled fish.

Since the fish may have passed through many distributors before ultimately reaching the restaurant or grocery store and may not have been clearly labeled, the FDA sums up its advice as: "when in doubt, don't eat it."

The largest number of cases so far has been in New York (28), with Wisconsin second (14).

The state by state numbers: Alabama (2), Arkansas (1), Connecticut (6), District of Columbia (2), Florida (1), Georgia (6), Illinois (13), Louisiana (3), Maryland (14), Massachusetts (9), Mississippi (2), Missouri (4), New Jersey (8), New York (28), North Carolina (2), Pennsylvania (6), Rhode Island (5), South Carolina (3), Texas (4), Virginia (8), and Wisconsin (14).

The earliest illnesses occurred January 28, and the outbreak is ongoing. So far there have been 21 hospitalizations and no deaths reported.

The most common symptoms of salmonella infection are diarrhea, abdominal cramps and fever. Symptoms occur within eight to 72 hours of eating the contaminated food. While only a nuisance for most people, the illness can be severe or even life threatening for infants, older people, pregnant women and people with weakened immune systems. Anyone who suspects that they have been infected should see their doctor.

This is the third salmonella outbreak of 2012. The Centers for Disease Control and Prevention (CDC) reported 11 in 2011. Prominent recent outbreaks have been traced to contaminated ground turkey (2011), whole eggs (2010) and peanut butter (2009).

The CDC posts updates on the current outbreak at its website, CDC.gov.

This article originally appeared on TheDoctorWillSeeYouNow.com, an Atlantic partner site.

Researchers have long suspected that the more active a person is, the lower his or her risk of age-related cognitive decline and dementia, including Alzheimer’s disease. Studies have generally found good support for the relationship, but some rely on the participants to recall how active they’ve been. This method can be unreliable for a number of reasons, not the least of which is that people’s memories are not always dependable.

The people in the bottom 10 percent of intensity of activity were 2.8 times more likely to develop the disease as those in the top one percent of intensity level.

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To avoid this issue, researchers in a recent study had 716 participants wear actigraphs on their wrists for 10 days so that their average activity levels could be calculated. Participants were an average of 82 years old when the study began and none was affected by cognitive decline. They took cognitive tests every year for an average of 3.5 years. At the end of the study period, 71 of the participants had been diagnosed with Alzheimer’s disease.

People who did the least amount of daily physical activity -- those in the bottom 10 percent -- were over twice as likely to have developed Alzheimer’s disease than people in the top 10 percent. The benefit of physical activity was even more pronounced for people who got some intense physical activity: The people in the bottom 10 percent of intensity of activity were 2.8 times more likely to develop the disease as those in the top one percent of intensity level.

Interestingly, the association held strong even after removing other variables from the equation, like body mass index (BMI), motor function, vascular diseases, chronic health conditions, and the APOE4 gene variant, which puts one at higher risk for Alzheimer’s disease.

It’s worth noting that the study does not actually show cause and effect. It’s possible, for example, that Alzheimer’s develops first and inactivity follows; or, perhaps, there is a third variable at play, which could lead to both inactivity and cognitive decline. However, given what we know about the neuroprotective effects of exercise – reducing inflammation, boosting the birth of new brain cells, and increasing blood flow to the brain – it seems more likely that exercise might also work reduce the risk of cognitive decline.

Lead author Aron Buchman stresses that the results are especially encouraging since they suggest that engaging in even the simplest activities may help reduce Alzheimer’s risk. He says in a news release that “activities like cooking, washing the dishes, playing cards and even moving a wheelchair with a person’s arms were beneficial. These are low-cost, easily accessible and side-effect free activities people can do at any age, including very old age, to possibly prevent Alzheimer’s.”

If the effects of exercise are cumulative, and doing the dishes or cleaning the house can help reduce one’s risk of cognitive decline, imagine what getting active in more significant ways, over the course of a lifetime, could do.

The study was carried out by a team at Rush University Medical Center, and published in the journal Neurology.

This article originally appeared on TheDoctorWillSeeYouNow.com, an Atlantic partner site.

I haven't said anything recently about the current status of the farm bill, mainly because it is too early in the political process to know what is going to happen.

On April 26, the Senate Ag Committee voted to pass the Agriculture Reform, Food and Jobs Act of 2012.

The bill still has a long way to go. It must be passed by the Senate. The House has to pass an equivalent bill. The two bills must be reconciled. The final bill must be signed by the President.

Otherwise, the current farm bill expires on September 30.

As is always the case with anything having to do with the farm bill, the devil is in the details. The number of programs covered by the bill is vast, and the details even more so.

In efforts to align agricultural policy with health policy, the current proposal makes a little headway. The proposed bill funds:

• $150 million annually for the Fresh Fruit and Vegetable program
• $50 million per year for the Defense Department Fresh program, which provides fresh fruits and vegetables to schools and service institutions
• $70 million annually for the Specialty Crop Block Grant program
• $25 million annually for the Specialty Crop Research Initiative, to go to $50 million by 2017
• $60 million in 2013 up to $65 million 2017 for pest and disease management programs
• $200 million annually for The Market Access Program and $9 million for the Technical Assistance for Specialty Crops program
• $100 million over 5 years for the Hunger-Free Communities Grant Program for fruit and vegetable SNAP incentives
• $100 million over 5 years for the Farmers Market and Local Food Promotion Program
• $406 million annually for Section 32 specialty crop purchases

This looks like a lot—and from the standpoint of incremental change it is a lot—but these numbers are millions, not billions, and in farm bill terms can be considered "mere rounding errors."

The farm bill currently costs taxpayers $85 billion a year, with $72 billion of that going for SNAP (food stamp) benefits.

The rest of the big money goes to the Big Agriculture growers of commodity crops, mainly in the form of crop insurance.

Here too, the proposed bill includes one small but significant measure. For the first time, it provides for crop insurance for diversified farms--those that grow a variety of "specialty" crops (translation: fruits and vegetables).

Even the most critical commentators think the current proposal, despite its evident flaws, represents the best that can be expected given current political realities.

Let's hope the good parts of the proposal survive the rest of the legislative process.

This post originally appeared on Food Politics, an Atlantic partner site.

Even among those who don't buy their groceries there, Whole Foods Market has something of an unfortunate nickname: Whole Paycheck. The company's reputation for selling up-market, healthful goods is both its saving grace as well as its curse, and Whole Foods CEO John Mackey has struggled to walk the line between defending his brand and accidentally sparking a class war.

"There's a significant portion of the population that doesn't want to keep eating crummy food, and they're willing to pay for it," said Mackey at a conference last year. Left unsaid is the implication that the rest of us sheep will continue to eat slop either because we don't know any better or we can't afford it -- and them's the breaks.

Mackey's apparent self-righteousness may not be a figment of your imagination. According to a study published this month in Social Psychological and Personality Science, people who are exposed to organic foods tend to judge others more harshly.

Kendall Eskine, an associate professor of psychology at Loyola University, says those who are primed to think about healthy organic foods like spinach, apples, and tomatoes are more likely to criticize morally questionable activities. He took 62 Loyola undergrads and divided them up into three groups. One group was given images of fruits and vegetables bearing organic labels; another saw comfort foods like cookies and ice cream; and the third group looked at "neutral" foods such as grains and beans.

All the participants were then polled on the acceptability of certain scenarios, including incest and eating a dead pet. The survey took the form of a seven-point ranking system where 1 meant "perfectly acceptable" and 7 meant "totally unacceptable." Finally, they were asked whether they could spare some additional time to help another professor with a different study.

Those who'd seen images of healthy foods were more likely to rank the morally questionable activities as not okay, and were least likely to say they could give their time to the other professor's study:

"On a scale of 1 to 7, the organic people were, like, 5.5, while the controls were about a 5 and the comfort food people were, like, a 4.89." The organic people also only offered to volunteer for a mere 13 minutes, as compared with the control group's 19-minute offer and the happy comfort-food group's 24-minute commitment.

Eskine suggests the images of organic food reinforced feelings of moral certitude, making those participants more judgmental than those in the processed-food and control groups. There's been some pushback to this explanation, such as the fact that sugar can make people more altruistic, and that many of the non-organic products Eskine showed were sweet foods. Another possibility is that feelings of guilt associated with eating junk food could be making people more empathetic. Then there's the fact that only a handful of people participated in the study, and all of them were undergraduate students -- not exactly a wide-ranging sample.

Still, Eskine's research raises other interesting questions about the limits of morality regardless. We already know that willpower is a finite resource -- making decisions we don't like actually reduces our ability to make similar decisions later. It'd be fascinating to know if our capacity for morality and sympathy are under the same constraints.

"Medicare" means different things to different people. Some say it's the best argument for a national single-payer health insurance system. Others will tell you that it's the federal budget's biggest villain, while election strategists call it a campaign defining issue. However, for the nation's 50 million Medicare beneficiaries, Medicare is neither an ideological argument nor a political talking point. For them, Medicare is their health insurance plan. 

Of course, it's more than just a health insurance plan. It is a lifeline for millions of our senior citizens. Before Congress created Medicare, in 1965, more than 50 percent of American seniors didn't have health insurance, mostly because the increased health risks associated with aging made health insurance unaffordable. At the time, it was not uncommon for the sick elderly to be treated like second-class citizens, and many aging Americans ended up destitute without necessary health care.

Medicare changed that. As a rock-solid guarantee of essential health services for every American over the age of 65, Medicare has been our country's most important social safety net. But as a health insurance plan, Medicare has never been perfect.

From its outset, Medicare only covered essential inpatient (Part A) and outpatient (Part B) services, which has long meant that seniors had to purchase supplemental private insurance to cover what Medicare does not. One of the reasons I ran for Congress in the early 1980s was to help regulate the market for supplemental Medicare insurance plans, because unscrupulous agents were exploiting holes in the Medicare law to sell seniors worthless policies. (In 1990, former Senator Tom Daschle and I passed the "Medigap" law to regulate the market for supplemental Medicare insurance.)

In 1997, Congress passed Medicare Part C to give Medicare beneficiaries the choice to receive their Medicare benefits through a private health insurance plan. This reform has become a lifeline for seniors in states like Oregon, where Medicare's low reimbursement rates have made it increasingly hard for seniors to find a doctor. Right now, 41 percent of Oregon's Medicare beneficiaries get their Medicare from a private insurance company.  

In 2003, Congress added Medicare Part D to give seniors a prescription drug benefit that had not previously been available through Medicare. And the Affordable Care Act (ACA), passed in 2010, included a number of provisions to enhance Medicare's preventative care services, while ensuring that more seniors have high-quality private sector options in addition to traditional Medicare.

Yet some seniors still find that Medicare fails to meet all of their health care needs. While the ACA included an annual out-of-pocket cap and removed lifetime limits for insured Americans under the age of 65, there remains no catastrophic benefit in the Medicare program, and Medicare continues to enforce a lifetime limit on the number of days Medicare beneficiaries can spend in the hospital.  

Medicare's copays and deductibles are also not insignificant for American seniors, 62 percent of whom currently live on a fixed-income of less than $30,000 a year. For example, while Americans under the age of 65 pay an average of 3 percent of their total income on health care, Americans over the age of 65 are currently spending 16 percent of their total income on their health needs.  

As a fee-for-service health insurance plan, Medicare, like much of our health care system, promotes quantity over quality, by reimbursing providers for the number of services they perform versus the quality of their care. States that have found ways to lower Medicare costs, like Oregon, continue to be punished with lower reimbursement rates for providers, for the very reason that they have established lower annual costs. Meanwhile, Congress's inability to come up with a long-term solution for Medicare's provider reimbursement problems means that more and more doctors are limiting the number of Medicare beneficiaries they are willing to treat--just at the time when, as of the beginning of this year, 10,000 Americans turn 65 every day, a rate that will continue for the next 20 years. The Congressional Budget Office projects that the Medicare Hospital Trust Fund will run out of money in ten years. If Congress does nothing before that time, we will be reneging on the promise of Medicare to millions of American seniors.

Yes, Medicare means many things to many people. But upholding the guarantees of Medicare requires each of us to start thinking like the 50 million Americans who rely on it for their health benefits. Those 50 million Americans don't care about talking points or ideological battles nearly as much as they care about being able to find a doctor and get the care they need when they need it. Unless Congress starts looking for meaningful solutions to ensure that every Medicare beneficiary will be able to find a doctor and get needed care, seniors are going to be the ones forced to endure increasingly higher premiums and arbitrary cuts to benefits--until Medicare doesn't guarantee much of anything.

The quality of medical care is a popular subject of debate, and oftentimes complaint. Sometimes gripes are legitimate and sometimes they're not. But a new study finds that patients' opinions of the care they receive can be quite different from the actual quality of the medical care. More alarming is that opinions and experiences vary greatly by race.

Researchers asked 374 women who had received treatment for early stage breast cancer at New York City hospitals about their opinions of the care they got. Just over half of the women (55 percent) said they received "excellent" care. But most women - 88 percent - actually got care that was considered in line with the best current treatment guidelines.

The ease or difficulty of obtaining the treatment in the first place has a big impact on one's experience of the whole process.

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The process of obtaining medical treatment had a great influence on how satisfied patients were. Many women (60 percent) who said they got excellent care also said the process of getting the care was excellent; but only about 16 percent of women who said they got less-than-excellent care said the process of getting the care was excellent. This suggests that the ease or difficulty of obtaining the treatment in the first place has a big impact on one's experience of the whole process.

The way the women felt they were treated by medical personnel also affected the total experience. Women who said they got "excellent" care were more likely to say they had good communication with their doctor, knew which person to go to with questions, and received excellent care by the medical staff in general. Importantly, they also felt less mistrust of the medical system overall.

Finally, another significant finding was that perception of treatment varied greatly by race. African-American women were less likely to report excellent care than Caucasian or Hispanic women, less likely to trust their doctor, and more likely to say they experienced racism during the process. There was, however, no difference in the actual quality of medical care they received, compared to Caucasian or Hispanic women.

The researchers suggest that, "something is being communicated to black women that results in their lower levels of trust and higher perceived racism. These sentiments vary among black women, which suggests that there are ways to redress this critical issue."

Making changes to improve the process of getting care - making appointments easier to arrange and test results simpler to obtain, for example - might make the process less unpleasant for patients. The researchers believe that this is doable and necessary.

The study was carried out at the Mount Sinai School of Medicine and Columbia University Medical Center, and published in the Journal of Clinical Oncology.

This article originally appeared on TheDoctorWillSeeYouNow.com, an Atlantic partner site.

PROBLEM: Last year, a study in the journal Pediatrics highlighted the link between profanity in media and teen aggression. Though foul language onscreen has been studied and monitored extensively, swear words in books aimed at teens have been subjected to far less scrutiny.

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METHODOLOGY: Brigham Young University researchers led by Sarah Coyne analyzed the frequency and portrayal of profanity in 40 books on an adolescent bestsellers list. The final sample for analysis consisted of 13,884 pages of text from novels aimed at readers age nine and above.

RESULTS: Thirty-five of the 40 books, or nearly nine in 10, had at least one instance of profanity. On average, the teen novels contained 38 occurrences of cursing between the covers, and this translates to almost seven instances per hour spent reading. Characters with higher social status, better looks, and more money tended to be the most vulgar. Age guidance or content warnings were not found on the books.

CONCLUSION: Bestselling authors of teen literature portray their more foul-mouthed characters as rich, attractive, and popular. Coyne says in a statement, "From a social learning standpoint, this is really important because adolescents are more likely to imitate media characters portrayed in positive, desirable ways."

IMPLICATION: Coyne says parents should talk with their children about the books they're reading and make use of online resources, such as Common Sense Media, that give content guides for popular books.

SOURCE: The full study, "A Helluva Read: Profanity in Adolescent Literature," is published in the journal Mass Communication and Society.

Sandor Ellix Katz, The Art of Fermentation: An In-Depth Exploration of Essential Concepts and Processes from Around the World, Chelsea Green, 2012.

This is a big book--498 pages--packed full of anything you'd want to know about fermented foods, not only as something healthful we seem to have evolved with, but also as something delicious to eat and drink. Think: cheese, yogurt, sourdough, beer, kimchi, and soy sauce, but also such exotica as kombucha candy or cod liver oil. The book's coverage is international, the directions explicit (equipment, gear, troubleshooting), and the design beautiful. Michael Pollan's introduction says he found it inspirational. Me too.

Peter Kaminsky, Culinary Intelligence: The Art of Eating Healthy (and Really Well), Knopf, 2012.

I blurbed this one:

Kaminsky's rules for taking pounds off and keeping them off are based on a really good idea: Flavor per Calorie. That works for him and should make dieting a pleasure.

You can eat well and healthfully and everywhere if you apply your inborn Culinary Intelligence. Kaminsky says the CI story can be summarized in ten words: Buy the best ingredients you can afford. Cook them well.

Can't beat that.

Seamus Mullen, Hero Food: How Cooking with Delicious Things Can Make Us Feel Better, Andrews McNeel, 2012.

I don't usually blurb cookbooks, but it wasn't hard to talk me into doing this one.

Take a look at what Seamus Mullen does with vegetables, fruit, grains and everything else he cooks. I can't wait to try his 10 Things to Do with Corn. His food can't guarantee health, but it will surely make anyone happy.

This gorgeous book proves without a doubt the point I've been making for years: healthy food is delicious!

Mullen cooks Spanish food at Tertulia, Manhattan. The food is delicious (but bring ear plugs!).

This post originally appeared on Food Politics, an Atlantic partner site.

This just in, from the Department of Dumb Logical Fallacies: your face is going all droopy, and your electronics are to blame:

Our growing reliance on smartphones and laptops is elongating our faces into jowly, sagging messes, according to cosmetic surgeons and other beauty pundits. They've even come up with a suitably distressing name for this phenomenon: "Smartphone face."

You read that right: "Smartphone face." The condition is evidently characterized by sagging jowls, double chins, and "'marionette lines,' those vertical creases that run from the corners of the mouth towards the chin." As evidence for the widening epidemic, The Week cites the astonishing rise in chin surgeries that's gripped the developed world in recent years. Chin implants are a $38 million-a-year industry, and last year alone, surgeons performed one mentoplasty every 25 minutes.

Judging by the exploding popularity of chinjobs, screen-induced droopiness must be a clinical ailment worthy of our collective alarm!

To which we say: really?

While the mentoplasty numbers are indeed factual, it's hard to say the same for the rest of it. So much of this smells completely wrong. Let's start with the fact that counting chinjobs has got to be the worst way of proving the existence of a health condition, much less assessing its prevalence. The popularity of a surgical procedure -- a cosmetic procedure, at that -- does not a diagnosis make.

Leaning on the surgery statistics is problematic for a related reason: it doesn't rule out other explanations for mentoplasty. It could be that people always had slightly saggy chins but didn't realize it until they started looking at their Google Hangout reflections all the time (who am I kidding? I meant Skype, of course). Or maybe the peculiar way in which we look down at our devices, combined with the eerie glow of our screens, combine to create a visual illusion of disfigurement. Or perhaps chin surgeries are spreading like wildfire for no other reason than that everyone else seems to be getting them -- so why not me, too?

Then there's the reddest red flag: the guy who's warning the world about this new threat is -- you guessed it -- a cosmetic surgeon. Given that there's no public health risk associated with looking down (that we know of, knock on wood), that leaves altruism and the economic motive as the only two realistic factors that could explain the surgeons' urgent exhortations.

And if you're still concerned, you can at least rest easy knowing you won't end up like this.

Eating foods that are high in saturated fat -- red meat, butter, and other animal products -- clog your arteries and increase your risk for heart disease and stroke. Until now, that's all we thought they did. Now it seems that saturated fats may also be linked to how efficiently our brains work.

In a paper published today in Annals of Neurology, a team of scientists analyzed dietary data from 6,000 women over age 65. Over the course of a four-year monitoring period, women who consumed more saturated fat scored worse on cognitive function tests than those who ate less of the stuff.

What's more, women who ate healthier types of fat, such as the monounsaturated fats found in olive oil, actually showed improvements in their test results. The findings suggest that swapping one kind of fat for another may not only improve your cardiovascular health, but may also enhance your brain function. That's particularly important for middle-aged adults who may be at risk for Alzheimer's, dementia or other degenerative brain disorders.

"The total amount of fat intake did not really matter, but the type of fat did," said Olivia Okereke, the study's lead researcher. "Substituting in the good fat in place of the bad fat is a fairly simple dietary modification that could help prevent decline in memory."

The study drew data from the Women's Health Study, a 10-year clinical trial of 40,000 women aged 45 and up -- so it looks like the jury's still out for men.