Be Active: Asking Questions, Advocating Change

Older Is Better, even with oral contraceptives

2011-12-07T11:17:00.000-05:00

New stories, including this one,

Bayer Withheld Yasmin Data From U.S., Former Agency Chief Tells Court - Bloomberg

highlight the elevated risks with the new oral contraceptives. The one under major scrutiny is drospirenone, also known as Yaz or Yasmin.

First, the most important thing: The increased risk of blood clots is small. Your risk of blood clots is probably still higher if you are pregnant. Yes. Your risk of blood clots is higher being pregnant, than being on Yaz or Yasmin. So, patients: Please do not suddenly stop your OCP suddenly. Talk to your doctor first.

When you do talk to your doctor, consider switching to an older contraceptive. One of my mantras in prescribing is that older drugs are usually better, as we know more about their safety. One of my mentors told me, "Never be the first or last to prescribe a new drug." I tend to use norethindone, but any older oral contraceptive will do.

I never understood the hype of Yaz and Yazmin. The drug companies just did a good job marketing it as an acne drug. The truth is, most OCPs work for acne. It appears that Bayer also did a good job of hiding drospirenone's side effects. How many times will we hear this story?

McDonald's: Doing it Wrong

2011-11-30T18:07:00.000-05:00

San Francisco's ordinance on free give away toys at fast food restaurants was intended to nudge restaurants to improve the health of their kids meals. The ordinance requires meals that have free toys to meet certain nutritional requirements. The ordinance is a great idea, as the toys are just marketing gimmicks, designed to create brand loyalty with McDonald's.

As this article states, McDonald's, instead of improving their meals, will charge 10 cents for each toy. This will get them around the ordinance and allow them to change meals on their own terms. Still, the pressure from this law got McDonald's to make some changes to the kids meals, such as reducing the portion of fries. But, they are still not healthy. The extra charge will also likely prevent some from buying the toy, as it's not included with that meal.

So it's time to put more pressure on McDonald's, and we have more legal tools that we can use. I want to know why McDonald's has to sell toys. Aren't they in the business of selling food? Why should food establishments sell toys? Why not create a law that states that restaurants cannot sell toys? I'm not yet sure if this is legal, but I would like to find out.

Do Kids Need 3-4 servings of Milk a Day?

2011-11-17T12:16:00.000-05:00

Many of you know that I have long said that the benefits of milk were overstated. The article below does a good job of reviewing the evidence why:

Wisconsin milk board overstates dairy’s benefits to children, some experts say | WisconsinWatch.org

The key statements are this:

“The so-called calcium requirement in the United States is based on very short-term studies (that are) irrelevant to long-term calcium needs,”

-Dr. Walter Willett, who chairs the nutrition department at the Harvard School of Public Health

“We know that those individuals who avoid milk and animal products that contain calcium do just fine in terms of their growth, their development, and their bone health,” - Jennifer Nelson, director of clinical dietetics at the Mayo Clinic

“I wonder how the marketing board explains why the highest rates of osteoporosis are found in countries that drink the most milk, or how cows manage to make huge bones that support their weight while eating mostly grass?”- Marion Nestle, Chair of Nutrition at NYU

“It’s hard not to be sarcastic about this kind of marketing,” Nestle added. “Milk is a fine food if you like it, but it is not an essential nutrient.”

Healthy Checkout At Walmart

2011-11-13T20:47:00.000-05:00

This video is a great example of a couple of things:

1. Creating healthy checkout aisle shows that behavioral economics works: kids want fruit when it's in their check out aisle.

2. Walmart is doing some more great things in encouraging healthy eating. This was however, a local store initiative. Big Walmart is not yet doing this. Let's how they do.

3. Federal money can work for good. The reason these changes happened was because West Virginia got a grant from the CDC, likely as part of the Affordable Care Act. Federal Money -> States -> Promoting Healthy Changes and Increased Sales.

WATCH IT HERE:

Life in the health lane - News - The Charleston Gazette - West Virginia News and Sports -

Is the Food Industry a Partner in Battling Obesity?

2011-11-03T22:36:00.000-04:00

Check out this debate about whether the food industry can be a partner in fighting obesity. Our study is featured about half way through.

Food Industry Friend or Foe Debate: Yoni's opening arguments from Yoni Freedhoff on Vimeo.

This is just the first in a series of videos by Yoni. For more, see his blog.

Every day is Medicine Day. But, today is Food Day.

2011-10-24T11:08:00.001-04:00

Every day is Medicine Day. Every time a family doctor like me sees a patient who struggles with weight gain, diabetes, or high blood pressure, I give them medicine. But today is different. Today is Food Day.

To be honest, I have long tried to emphasize the importance of food choices in preventing and treating disease. I high-five my patients when they lose weight or cut out sugar-loaded beverages from their diet. When people pick a food to eat, they are making one of the most important health decisions of their day. The vast majority of problems I see in primary care are related to what people eat. Our food system and our health system are closely linked. It's no surprise that the faults or our food system contribute to the problems of our health system.

Our general taxes fund massive giveaways to large agribusinesses, so that they can grow corn (for sugar) and soy. This makes the major ingredients for most processed foods and beverages cheap, allowing the big food companies to spend billions of dollars a year getting Americans to eat a lot of junk. And it works. Obesity and diabetes rates are skyrocketing, leading to increased patient suffering and corresponding health care costs. Guess who pays for those costs? The same taxes that fund agricultural subsidies help our seniors buy the medications to treat the conditions the subsidies helped cause.

There is a very simple way to break this cycle. And we don't have to rely on politicians to do it. All we have to do is know where our food comes from. Then we just vote with our fork and start eating food that is not part of the industrial food system.

This is the idea behind the first annual Food Day, today, October 24^th (www.foodday.org). Food Day was founded on six national priorities: reduce diet-related disease by promoting healthy foods, support sustainable farms & cut subsidies to big agribusiness, expand access to food and alleviate hunger, protect the environment & animals by reforming factory farms, promote health by curbing junk-food marketing to kids, and obtain fair wages for all workers in the food system.

One of the best ways to do this is to visit a farmer’s market. At farmer’s markets we can directly ask the food producer: Where does this strawberry come from? Did you spray it with pesticide? Is there any chance it is infected with bacteria from a nearby animal slaughterhouse? How much do you pay your farm workers? So visit your farmer's market this week, ask these questions, buy some fruits and vegetables, and provide your family with a few healthy meals.

For those of you who want to celebrate food day in other ways, you can celebrate Meatless Monday by not eating any meat or poultry today (and every Monday). You can turn your child's television (and internet) off so they do not see all the junk food ads. Stand outside McDonald's or Taco Bell and warn people about the dangerous food they are planning to eat. Celebrate water by joining the "Life is Sweeter" campaign and get sugar-loaded beverages out of the buildings where you work. Or grow a tomato plant on your porch. You can involve your family in any of these activities, while teaching your children where food comes from.

While I'm hoping that the 2012 Farm Bill will fix some of the problems with our food system, I'm not optimistic. However, I am optimistic that many of our food issues can be solved without relying on politicians. By choosing to eat non-industrial food, we can start our own food movement.

So when I see patients tonight, instead of picking up my pen and writing a prescription for a new medicine, I'm going to write a food prescription for my patients. I'll give my patients three choices of what I can write: "Eat seven vegetables a day," "Don't Drink Sugar-loaded beverages," or "Give up meat on Mondays." I hope other doctors follow my lead, and that my patients do too.

Protecting your Prostate and your Package

2011-10-06T15:59:00.000-04:00

According to reports out today, the United States Preventive Services Task Force will give a D rating to prostate cancer screening. This means they recommend men should not get the test.

Physicians who have watched the data on prostate cancer screening for awhile could have seen this coming. When I counsel men on PSA (the antigen that screens for prostate cancer) screening, I tell them that the test more likely to harm them then help them. Most prostate cancers are slow growing and never cause problems. How can this be? Cancer is a growth of abnormal cells in your body. The body is always fighting off abnormal growths. It often suppresses early cancers through the immune system and other mechanisms. Even if a cancer continues to grow, it may take years and years to cause something bad. Most people die of a heart attack before the prostate cancer does anything bad.

Now there are a very small amount of people where prostate cancer kills people. The problem is that medicine does not have a way to detect these people. So as in breast cancer, universal screening of women under 40 will result in a lot of people getting mastectomies to prevent one "bad" cancer in women. In prostate cancer, if we screen everyone, we will make millions of men unable to get an erection or be able to hold on to their urine while trying to prevent one prostate cancer.

Screening is not the best way to stop cancer deaths. The best way to prevent them is to stop them in the first place. According to the World Cancer Research Report, you can prevent prostate cancer by eating a lot of fruits, vegetables, and whole grains; and by avoiding a high calcium diet. And that doesn't involve becoming impotent or incontinent.

A Contagious Blog

2011-09-22T18:03:00.002-04:00

Having loved the movie "Outbreak," I had to go see Contagion. I was hoping it was going to bring as much intensity as "Traffic." It didn't reach that level. This is not to say it was a bad movie. It was a fairly realistic portrayal of what could happen with an outbreak of a global pandemic.

I felt the most compelling pieces were about who gets what first. We will surely have to ration in a situation like this. Who should get the vaccine or treatment first? Of course, we don't think about rationing in our current health system, even though we do it all the time. Who gets cancer treatment first? Probably the rich insured patients. But not many people are up in arms over this. Things will be different when massive amounts of people are dying daily.

Another lesson of the movie is that most of these emerging viruses are likely to come from humans being close to dead animals. We can do a lot to assure a non-infectious animal. However, even the USDA does not have enough animal inspectors, and Republicans are currently trying to cut food safety initiatives. Compare this to other countries, where there are even less regulations in food preparation. Animal agriculture will continue to create risks for humans in many ways. Kind of makes me want to continue to the call for more people to eat less meat. If you do eat meat, know exactly where it came from. (I.e. buy it yourself from a local farmer.)

The movie also remind us about preparation. Everyone procrastinates this. If we were actually prepared, there would be no rush to the grocery stores last minute. Ready.gov has some good examples of what you need. If you are a camper, you might have many of the supplies already: a stove, freeze-dried food, and a lantern. If you are not a camper, get started! Everyone should remember to get a few jugs of water and leave them in a closet.

The biggest thing we can do to get prepared for these things, is to get vaccinated for things we know about. Influenza kills people. Last year it killed young people. I see too many patients that are afraid of getting the flu shot. I've heard, "It gives you the flu," over and over again. It does not give you the flu. It can't. Some people get an immune response to the vaccine which makes them feel under the weather for a day. For most people, this is tolerable. Consider the other option: dying. It happens. Get your flu shot!!

Most of all, this movie reminds us how critical our public health departments are to our health. We forget about them. But everyday they are investigating new viruses, food poisonings, and poor sanitary conditions. The current climate talks about defunding all governments institutions. This is clearly not the smart thing to do.

Why I Race Bikes

2011-07-24T17:02:00.000-04:00

A few weeks ago I participated in the Leesville Gap Road Race. It was my hardest race of the season: 64 miles, horrible roads, climbing, headwinds, with temperatures near 38 Celsius. (That is 100 Farenheit. One thing I learned this year is that to be a cool cyclist, everything has to be Euro.) I almost didn’t finish due to the heat and dehydration, despite drinking over 3 liters of fluid and consuming 1000 calories while riding. After the race my Mom asked me, “Why are you doing this? What are you trying to prove?” I’ve been thinking a lot about that question.

I started cycling with the UCLA cycling team last fall. I joined them to have a group of people to ride with. I never thought I would race. I don’t remember what changed my mind, but I wanted to race. It’s been an amazing year, where I thought I’d stop racing at least twice. Yet I continued on and finished my last (13th) race of the year yesterday.

I sacrificed a lot this year: Thousands of dollars in bike equipment, sports massages, and energy foods; not skiing at all this year so I could keep up with my training and racing (despite a great snow season); weekends with my friends and girlfriend; and SLEEP (especially on those mornings I wanted to stay in bed).

So why sacrifice all this?

Maybe it was all the friends I was making in the cycling community. Maybe it was that I like gear, and cycling has a lot of it. Maybe it was I just wanted a regular way to stay active and in shape.

But I could have been in good shape just riding my bike a few times a week, and not pushing myself with an aggressive training plan. I could have trained for charity/century rides. I could have just exercised on my bike and not taken the risks of racing, which sometimes includes crashes and broken bones. (I’ve been in a few of them this year, but got out with only a few scrapes.)

So why race?
I like winning.

Whether it is in academics, sports, or a debate over some issue, I like to win. There is no winner in exercising. There is no winner in charity rides. (Not that I think charity rides are a bad idea. I may do one this fall.) I know life isn’t all about winning. But winning is what propels humans. It gives us a sense of our ability and purpose.

I just finished watching the Tour de France, which I believe is one of the hardest sporting events in the world to win. (Maybe only second to the Stanley Cup.) If you look a the faces on the winners as they cross the finish line, you will see the excitement in bike racing. While I haven’t won a race, nor done heroin, I think the two probably give a similar feeling.

I almost won a race. I was in the #6 position at the Stanford Road Race with 200 meters to go. But there was a crash from the front and I didn’t get the chance. But that feeling of almost winning is still with me. It was so close and felt so good.

But, as I started in my first non-collegiate races, I realized that winning would be tough. While I still believed, I wasn’t sure I’d win one in my first season. Still, I wanted to race, despite the pain of pushing my legs to their limit in 2-3 hour races. Why?

What else would I be doing? Spending time on facebook? Cleaning my apartment? Watching TV? Reading? Writing a research grant? So many people just sit on their bums all day. Our bodies are not built for that. Pushing myself hard on a bike reminds me what my body was built for: to push, to endure, to work hard.

As Peter Flax said, “We spend our so-called modern lives coddled-breezing through airports on people movers, accepting meeting requests nestled in Aeron chairs, engaging in cruise control to avoid the demands of the gas pedal. Our amazing muscles and capillaries and neural pathways are built to do something far more profound if we put them to the test.” My day job requires me to test my mind. Bike racing allows me to test my body and forget about my day job for a few hours.

There is something primal about racing. One human against another, with a prize at the end. Humans were meant to battle and to pursue speed. Cycling combines the two.

I feel alive on my bike. And I’m having fun. What I’ve described above may not sound like fun to some of you. But, remember that first time you were able to ride a bike? Remember the freedom to push your body into the wind? Remember racing your friend down the street? Remember the feeling of triumph?

Bike racing is fun. I don’t think I need another reason to continue. Except for the fact that I still want to win.

(This post is dedicated to all my team members and my Koach who pushed me beyond my limits this year. I’ll wait for you all at the top of Latigo.)

It's time to stop marketing junk food to kids

2011-07-01T20:16:00.001-04:00

(cross post from the NPA Blog)

I’m often faced with parents who want to know what do do with their kids who are overweight. There are a lot of causes of obesity, but the major causes are soda and junk food. The increase in consumption is due to the food industry’s aggressive marketing of junk food to kids.

In 2009, the fast-food industry spent $4.9 billion on marketing. How are parents supposed to fight with an industry that is telling kids to eat more junk food at school, while watching tv, and while on the internet? It’s time to make parenting easier. It’s time for the food industry to stop marketing to kids.

A bi-partisan bill in Congress asked a group of government organizations to come up with VOLUNTARY standards for the food industry on what products it’s ok to market to kids. They came up with very good guidelines. But, they are under big pressure from big food to be weakened, even though they are VOLUNTARY. The government group (the Interagency Work Group- IWG) needs to hear from you on why these standards are really important. They will provide a blueprint on where we should start in stopping marketing junk food to kids.

Please click here to add your comments. Parents around the country will thank you.

Marijuana and Terrorism

2011-04-25T19:22:00.002-04:00

Recently, I've turned on some of those Border Patrol tv shows and tv documentaries. They are usually trying to catch marijuana smugglers and growers. It seems marijuana smoking is booming in California, and the cross border trade is feeding this demand. Now I do not have a big problem with people smoking small amounts of marijuana, especially for medical purposes. But, I do have a problem with where the marijuana is coming from.

If you grow your own marijuana, fine. But as some of these programs show, Mexicans are being forced to smuggle or grow marijuana to feed American's desires. In one recent documentary I saw, there were Mexicans who snuck over the border to grow massive amounts of marijuana in forests in California. It's hidden and hard to find, but they have whole camps in rural California growing the stuff. According to the officials most of the men are forced to live in these camps and protect the crop. If they lose the crop, they are threatened with the killing of their families back home. This is terrorism.

Everyone has heard about the Mexican drug crime going on. Is it possible that this is America's fault? Is our greed for drugs forcing families into the drug trade, with no way out. (I also recently saw the great (fictional) movie, Sin Nobre, about what it's like to live in one of the drug gangs.) Think about it: Do you want your weed smoking to be responsible for the rape or murder of families in Mexico?

I spoke to a source in the marijuana business who told me that even if you buy your pot at a legal shop, it's in no way guaranteed that it was grown legally. I think if we want to legalize marijuana, we have to do it fully, and put all operations under supervision. Anyone that sells marijuana should have to verify that it is from a legal growing source.

In the meantime, know where your weed comes from. Just think about the families in Mexico, and the power the drug rings have right now. And if that does not move you, remember that Afganistan is now a prime drug exporting country.

Slowing Down Cars to Speed up Cycling Growth

2011-02-19T00:03:00.002-05:00

Another one of my friends was hit while riding her bike this week. She has significant injuries, but is going to be ok. After the shock wore off I started thinking about my new favorite hobby. Most cities, like Los Angeles, are designed for cars, not people or bikes. This is despite the fact that I think biking can save the world, as I mentioned on a previous blog.

New research out describes how separate bike transit ways can reduce bike deaths. (Read the full news coverage here.) Some striking statistics from this story:

about 51,000 American cyclists suffered injuries as a result of encounters with motor vehicles in 2009, with such accidents accounting for two percent of all traffic fatalities in the United States (according to 2008 figures).
In the U.S, bike lanes typically consist of merely a painted stripe on the pavement delineating cyclists' portion of the road. In contrast, the Netherlands -- a country half the size of South Carolina, with just under 17 million residents -- is home to about 18,000 miles of separate cycle tracks.

While more than a quarter of all Dutch commuters get around by bike and 55 percent of Dutch cyclists are women, in the U.S. less than one-half of 1 percent of Americans ride a bike to work and fewer than one-quarter of those riders are women.
Cycle injury rates are at least 26 times higher in the U.S. than in the Netherlands, the researchers noted.
The research team pegged the overall relative risk of injury as 28 percent lower on the separated tracks versus biking on a street in traffic.

While I think we need to reconstruct our cities around biking, public transportation, and walking (again see my previous post), I don't think this will happen tomorrow. In the meantime, everyone PLEASE SLOW DOWN WHILE DRIVING. I mentioned the city of Davis, CA as a great biking city, where speed limits are 25mph to make it safer for bikers. Here are some great tips for driving safe around cyclists: please read them. Just slowing down and being extra careful may make you 5 minutes late for a meeting, but could prevent another one of my friends (or me) from having a serious, life-changing injury.

Guideline Experts Fail Again: and this time it costs us

2011-02-15T22:33:00.000-05:00

One of the buzz-phrases of health reform and cutting costs has been, "We are going to pay physicians for quality, rather than quality." This sounds good. I would agree with this method.

The question becomes: What is quality health care? For hospital care, one can get pretty good measures of things that happen acutely. Some examples:

-Paying less to a hospital when a patient gets a hospital-acquired illness (e.g. a fall or infection due to lack of sanitary conditions)

-Pay more when a hospital discharges patient with a complete plan for post-hospital care

But for outpatient care, the measures are much harder. Here are some candidates for diabetes care:

1. Pay doctors for how much their patients like them

2. Pay doctors for how long their patients live or what their quality of life is

3. Pay doctors for what their patient's lab values are

Each of these choices has its problem. Option #1 seems like a pretty good option. But you could be a really bad, friendly doctor. (That's not me.) Option #2 seems the best measure, because this is what patients care about. But you can imagine the problems: patients switch doctors, some patients do things that a doctor cannot control, etc.

So we are left with #3, which is how the current proposals urge to pay doctors. The following article reveals how this process has gone terribly wrong:

Sudden Acceleration of Diabetes Quality Measures, February 16, 2011, Pogach and Aron 305 (7): 709 — JAMA

Basically we are using measures that have little research behind them. We are using lab values that do not matter much to patients. Why do we use them? Because the quality experts messed up. They jumped the gun and made quality standards before the research was finished that would give them the answers. I do not think this problem will end. I think we should not rely on paying doctors based on lab values, or intermediate tests that don't have a big effect.

My solution: a mixed payer model. Pay primary care doctors a set fee to take care of patients for a year. Based on a person's age and some other factors, a doctor would get a set amount for the year. The doctor could do whatever they want for that patient. But, if the costs goes above this amount, it's on the doctor's shoulders.

Next: pay doctors like all other professionals, by the hour. Some patient visits take 5 minutes (a cold). Others take an hour (a cancer diagnosis). Fairly simple.

Finally: Pay a group of doctors based on the community's health. So if one city's overall health is increasing more than another's, increase their pay a little bit.

Any of these options is better than paying doctors for lab tests that patients do not care about, and that may not even indicate how good a doctor is.

Which animals should we kill?

2010-11-24T10:55:00.000-05:00

Save a Turkey. Eat a Bean.

That's my new facebook/twitter status. It's pretty simple. But the issue of Eating Animals is a lot more complicated than that.

I recently saw the Oscar-winning documentary The Cove. The movie documents the slaughter of 20,000 dolphins each year on the shore of a Japanese town. (The Japanese also slaughter lots of whales every year. Sea Shepard is trying to stop this.) Any American watching the bloody beating of these dolphins is likely to cringe. We are likely to ask why they do this. How could they be so cruel?

Yet we have to be careful not to be ethnocentric. I imagine if we put cameras in the places where we slaughter chickens, turkeys, and cows, people from other countries would cringe. Actually, I think Americans would be disgusted too. No wonder these places are off limits to cameras. (Although sometimes PETA sneaks cameras in. Warning: This is graphic. But it's where your food comes from.)

Now, I do not think that it is always unethical to eat animals. In full disclosure, I eat environmentally friendly fish about once a month. So how should we decide what living beings are ok to eat? Are dolphins ok to eat? Cows? Chickens? Dogs? The answer probably depends on where you live and which animals you were brought up eating.

Everyone has to decide what they are comfortable with. There are many food rules that people go by, whether they be religious or cultural. Both Jewish (Kosher) and Islamic (Halal) rules specify that an animal must be killed instantly, with minimal pain, by a slit through the throat. Others have written that you should buy your meat/fish from a local farm, so you can ask how it was raised and killed. Some even say that if you want to eat meat, the most humane way is to kill it yourself. This way you know how it was treated and you know that it fits with your values.

Whichever food rules you choose, I think most of us can agree that large scale slaughter, such as the dolphins in the cove, or the turkeys in a factory farm, is not the way to get our meat. All I ask is that you think about this during this Thanksgiving. Use some of the links above to learn more and get involved. (Be Active!)

Maybe it's not as simple as "Save a Turkey. Eat a Bean." Maybe it's more like, "Eat less factory slaughtered turkeys. Eat more veggies from your garden." Whatever the correct phrase is, we need to think more about what we eat and where it comes from.

Happy Turkey Day!

P.S. For the guys out there, that need a little inspiration to go vegetarian: Check this out.

My First Conversation with a Tea Partier

2010-11-08T14:43:00.003-05:00

I was just at the barber shop and the talk became politics. The man I was speaking with believed in the tea party. Most of his anger was over the requirement that every American purchase health insurance. He believed that that took away the freedom of Americans.

Me: We take care of people when they come in to the hospital and our sick anyway. Shouldn't they have insurance so they pay for their own care, instead of us footing the bill?

Him: That's not freedom.

Me: Universal mandatory coverage was championed by Mitt Romney (a Republican) in the MA Health Insurance Plan.

Him: It was a mistake. He's not a leader in the Republican party.

Me: Should all kids have insurance? Should we leave kids dying on the streets because they have no health care?

Him: That is up to their parents. If their parents are taking care of the kid, their are other ways to take care of that. You can call the authorities. You cannot tell a parent to purchase health insurance for their child. That is not freedom.

Me: I'm a doctor and and worry about my patients. I just want everyone to be able to have good health care.

Him: What you liberals don't get is that socialism didn't work. The Nazis and Russians failed because they didn't allow Freedom. [Note: the Nazis were not socialists and the Russians were communists.]

So I guess he's calling me a Jewish Nazi? He was so angry, and just kept repeating, "Freedom." Is there a conversation to be had about shared American values, or should progressives just talk to the majority of Americans that believe in health for our communities and families?

He shook my hand at the end and said he had no hard feelings against me. I told him I believed in Freedom too.

Hi, I'm a Tea-Partier Video

2010-10-31T21:39:00.000-04:00

This video is funny and a good reminder of us of the facts. But it also demonstrates the classic problem of the Democrats: focusing on facts. The Democrat gets better toward the end with values-based messaging.

Remember to vote and keep the Democrats in power, so we can keep moving forward on improving the lives of families in our country.

A Few Nudges Might Help

2010-09-25T18:46:00.001-04:00

I just finished reading: Nudge: Improving Decisions about Health, Wealth, and Happiness

It was named one of the best books of the year by the Economist. The basic premise is that classical economic thinking is misguided. In classic economic thinking we all make choices by weighing the benefits and risks of each decision. But most humans do not act like economists.

This book shows that in decisions about health, wealth, and other areas, the maxim of "Give as many choices as possible," does not work. Choices are determined by a lot of subconscious factors that we are unaware of. The liberalistic paternalism the authors speak of is a nonpartisan way of designing choice architecture.

I suggest you read it and think about where you could make simple nudges for you, your family, and your community. Every time you hear a policy maker talk about how great their plan is just because it gives citizens lots of choices (i.e. Medicare Drug Benefit, school choice, retirement savings), tell them to read this book.

Benefits of Health Care Reform Coming to You

2010-09-14T11:26:00.002-04:00

I just got a letter from my insurance company informing me that:

1. If I have children, I can now keep them on my policy up to age 26.

I don't have children. But, if I did, this would allow me to keep them insured through graduate school or an early career. Should our kids be insured until they can get a job with benefits? Yes!

2. They will discontinue any lifetime caps on coverage.

This means if you get really sick (think cancer) and need lots of treatment, they won't cut off your coverage. Shouldn't you be covered for the whole course of your cancer treatment, instead of just $400,000 worth? Yes!

These are two of the benefits that Americans will benefit from right away.

Abigail Disney: Taxes Make Our Country Great

2010-09-11T19:53:00.001-04:00

In this linked story, the granddaughter of Roy Disney, states why she thinks the estate tax is important.

Showdown Over Bush Cuts Revives Estate Tax Fight : NPR

Taxes are not a penalty for working hard. They are a contribution to building a stronger America. From the Story:

"Disney, a filmmaker and philanthropist, spent a lot of time shooting a film in Liberia. [Abigail Disney] says there, unlike the United States, there are no safe roads or schools and therefore no safe investments. And she says those who make money in a secure society like the U.S. also owe the society a debt.
She joined a group of wealthy individuals called United for a Fair Economy in part, she says, because she felt wealth is fundamentally unfair.

Warren Buffett and Robert Rubin are also members of United for a Fair Economy.

Remake The Dietary Guidelines into FOOD Guidelines

2010-08-11T00:39:00.001-04:00

In this new editorial, two prominent nutrition researchers, call for changing our Dietary Guidelines drastically.

JAMA -- Dietary Guidelines in the 21st Century--a Time for Food, August 11, 2010, Mozaffarian and Ludwig 304 (6): 681

The current guidelines are based on nutrients: Eat less fat, more fiber, less salt. However, most of the disease we have today can be prevented by eating healthy FOODS (not nutrients). The guidelines shy away from foods, so that a particular food industry does not get offended. Imagine Coca Cola's response to a "Do not drink soda" guideline put out by the government.

But a focus on food is what we need. The food industry has been able to craft fake-healthy foods by including a healthy phrase on the package: "fat-free cookies", "Trans-free chips", "Calcium-enriched Juice." This mislead consumers and may actually promote disease.

As the authors of the editorial state: "the greater the focus on nutrients, the less healthfulfoods have become".

Their conclusion: "nutrient targets should largely bereplaced by food-based targets."

Doing so would bring us back to a way of eating that is based on food, using modern nutrition knowledge.

As Michael Pollan says, "Eat FOOD. Not Too Much. Mostly Plants."

Disclosure: I worked for one of the authors of this article, David Ludwig.

Breastfeeding: Why the health benefits aren't enough to increase rates.

2010-07-29T17:53:00.000-04:00

It would be best for the health of our country if all women were given the tools and the environments that supported breastfeeding.

Notice how I framed that message?

This brief on messaging around breast feeding shows why advocates cannot just use the "it's healthier for the baby" argument.

Advocacy rests on framing, as I've argued before. We need to frame breast feeding with the Berkeley Media Studies formula:

Environmental Cue + Value + Policy= Desired Message

We need to focus on values. Health of the baby is one, but so are ingenuity, and equity. We need to focus on providing these types of environments to support the health of women and children.

Protect Bikers and Save the World @lacbc @laist

2010-07-18T21:08:00.000-04:00

A real battle is going on at the World's Oldest Bike race. Lance is out of contention. Contador and Schleck are going at it on the mountains of France. There is still hope for American Levi Leipheimer. Team Radioshack is leading the team contest.

But a much bigger bicycle battle is going on in the streets of our cities. One of my best friends (and a great family doctor) was hit while riding in a bike lane last week. He's ok, but needed some surgery. One of my sister's friends was hit while riding in New York City a few months ago. Also injured. A renowned researcher and one of the Deans of my Medical School was hit a few years ago, and is recovering from partial paralysis. Now the Mayor of LA was hit by a taxi, while riding his bike.

Now I don't want to scare anyone. Biking's health benefits outweigh it's risks. I think more of us need to get out on our bikes. More biking can save the world. How? Here's my top 10:

10. More Biking= more activity= healthier people.

9. More biking= less vehicular traffic. Less pollution and global warming.

8. Biking gets people to interact as they travel. You can't talk to the person in the car next to you, but you can converse with a fellow biker.

7. Biking makes you happy. Ask my sister.

6. Imagine the boost to our economy if everyone went and bought a bike.

5. Fun activity for child-parent bonding.

4. You can bike to beautiful places and see nature.

3. It gives super cool legs.

2. You can wear cool bike clothes.

1. It is super fun.

We need to make our communities safer to biking. Here are some ways we can do this, courtesy of the Bike League:

1. Adopt a target level of bicycle use (e.g. percent of trips) and safety to be achieved within a specific timeframe, and improve data collection necessary to monitor progress.

2. Provide safe and convenient bicycle access to all parts of the community through a signed network of on- and off-street facilities, low-speed streets, and secure parking. Local cyclists should be involved in identifying maintenance needs and ongoing improvements.

3. Establish information programs to promote bicycling for all purposes, and to communicate the many benefits of bicycling to residents and businesses (e.g. with bicycle maps, public relations campaigns, neighborhood rides, a ride with the Mayor)

4. Make the City a model employer by encouraging bicycle use among its employees (e.g. by providing parking, showers and lockers, and establishing a city bicycle fleet).

5. Ensure all city policies, plans, codes, and programs are updated and implemented to take advantage of every opportunity to create a more bicycle-friendly community. Staff in all departments should be offered training to better enable them to complete this task.

6. Educate all road users to share the road and interact safely. Road design and education programs should combine to increase the confidence of bicyclists.

7. Enforce traffic laws to improve the safety and comfort of all road users, with a particular focus on behaviors and attitudes that cause motor vehicle/bicycle crashes.

8. Develop special programs to encourage bicycle use in communities where significant segments of the population do not drive (e.g. through Safe Routes to Schools programs) and where short trips are most common.

9. Promote intermodal travel between public transport and bicycles, e.g. by putting bike racks on buses, improving parking at transit, and improving access to rail and public transport vehicles.

10. Establish a citywide, multi-disciplinary committee for nonmotorized mobility to submit to the Mayor/Council a regular evaluation and action plan for completing the items in this Charter.

Let's do it in LA and around the country! We should all aim to be like the #1 Bike friendly city in America, Davis, CA! Start us out by donating to Los Angeles County Bicycling Coalition.

Obama Understands the Importance of Primary Care

2010-06-10T11:28:00.001-04:00

Based on these remarks, it is clear to me that President Obama has a vision for changing our healthcare system to improve primary care:

President Obama Calls for Better Payment System for Primary Care Physicians -- AAFP News Now -- American Academy of Family Physicians

"It used to be that most of us had a family doctor," said Obama. "You would consult with that family doctor. They knew your history. They knew your family. They knew your children. They helped deliver babies."

Now we often have a mishmash of consultants dealing with each organ in a patients body, instead of having someone deal with the whole person:

"Now in these big medical systems, so often, what happens is that you're shuttled around from (sub)specialist to (sub)specialist," said Obama. "Oftentimes, people don't have a primary care physician that they're comfortable with, so they don't get regular checkups. They don't get regular consultations. Preventable diseases end up being missed, and you don't have the kind of coordination that's necessary between all these different specialists."

Then he agrees with my JAMA editorial from early this year:

"Right now you've got a situation where if a primary care physicians says to a patient, 'You know what, you need to lose some weight because you're at risk of diabetes, and I've got a good exercise program that makes sense, and here's a dietitian that you should talk to,' sometimes Medicare may not reimburse that consultation," Obama said.

But, he noted, Medicare will pay $30,000 for a foot amputation that results from the ensuing diabetes.

Let's fix this. One first step is to get Dr. Don Berwick confirmed as director of Medicare and Medicaid Services. We need an innovative thinker to help transform our system into a modern health system, that focuses on primary care, prevention, and everyone having a personal physician.

Bring back Home Economics: JAMA Editorial

2010-05-19T12:57:00.001-04:00

I gave a talk two weeks ago, where I spoke about the origins of the college I went to, the College of Human Ecology at Cornell. It was originally started as the school of home economics. Its leader was Martha Van Rensaleer, a visionary female. The goal of the college was to teach women the skills they needed to be effective in the home in NY farms.

Martha Van Rensaleer went on to become a advocate for women and children's health and wellbeing. In 1930 she helped form the National Children's Charter which said:

"“For every child health protection from birth through adolescence, including: …the insuring of pure food, pure milk, and pure water.”

I think we can help guarantee this to our children by teaching them home economics skills, as this editorial states. We can also continue the great work of Martha Van Rensaleer, by teaching people nutrition through state cooperative extensions, such as the same Cornell Cooperative Extension that MVR was a leader of in the 1900s. The country's agricultural schools can be the birthplace of educators in nutrition and innovative farmers. They successfully improved nutrition in the early part of last century. They could do the same in this century.

Food Politics � Here’s a thought: bring back Home Ec

Mr.Evil Creates Fake Charities to Fight Public Interest Groups like MADD, CSPI, and the Humane Society

2010-05-11T23:57:00.000-04:00

Anyone who is familiar with nutrition advocacy will know the group, "Center for Consumer Freedom." It is an industry front group (started by Phillip Morris) that fights against food policies that could help us become a healthier nation. It just so happens that the man behind this, Mr. Berman, creates these fake charities to fight a bunch of organizations, from the Humane Society to MADD. He makes a fortune off these fake charities. This articles exposes it all.

Investigative Report: Richard Berman : The Humane Society of the United States

I found the quote from his son most damning:

"'My father is a despicable man. My father is a sort of human molester. An exploiter. A scoundrel. He props up fast food/soda/factory farming/childhood obesity and diabetes/drunk driving/secondhand smoke. He attacks animal lovers, ecologists, civil action attorneys, scientists, dieticians, doctors, and teachers. His clients include everyone from the makers of Agent Orange to the Tanning Salon Owners of America. …'"