Junkfood Science: May 2007

May 31, 2007

Our future?

Another woman has been denied a hip operation to relieve her of debilitating pain because she was deemed “too fat” by the government...by six pounds. But even if it had been 106 pounds, this story would just the same. She was another of millions of patients who will be denied care as part of efforts in the UK to contain healthcare costs. As reported here last month, joint surgeries are being rationed as its healthcare system faces “huge cash deficits,” beginning with those seen as un-deserving.

Most Americans will probably find this story upsetting and would probably agree that whether a patient looks like or if he/she abides by what the government decides is a “healthy lifestyle” should have nothing to do with access to needed medical care. Especially, when the reasons being used to justify who gets limited resources are not evidence-based. Today, the Sun reports:

Too fat for op at a size 14

A WOMAN was denied a hip op because she is SIX POUNDS overweight. Anjelica Allan, 49, is a size 14, smaller than the UK female average of 16. But NHS chiefs turned her down to save cash. Last night Anjelica, who is in terrible pain, said: “The decision is ruining my life. I’m not obese and I eat healthily. I hate junk food.”

Anjelica...has had to stop work because she can barely move. She added: “As soon as I get my new hip I’ll be up and about.” Lincs Primary Care Trust — £35million in debt last year — admitted it aimed to save £500,000 a year by reducing hip and knee replacements....

As was discussed in an earlier post, some Americans are advocating for a similar government healthcare system here. The realities of universal healthcare, as is available in the UK or Canada, however, rarely become part of the discussions. We hear only of the crisis of our system and huge numbers of Americans not being able to afford or get care. What is problematic in sorting through the claims, however, is that each paper defines “adequate” medical care differently. A disturbingly large number of them embellish their figures by including preventive “wellness” screenings and interventions being promoted by various insurer, special interest or government programs that some might argue against. Others leave it totally undefined and leave it up to the person answering the survey question to decide.

Coincidentally, the Centers for Disease Control and Prevention’s MMWR Weekly Report for June 1st was just released this morning with timely QuickStats from the latest U.S. National Health Interview Survey. It reported:

In 2005, approximately 7 percent of persons delayed medical care during the preceding year because of worry about the cost, and another 5 percent did not receive needed medical care because they could not afford it. Persons whose health was assessed as fair or poor were four to five times as likely as persons whose health was assessed as excellent or very good to delay or not receive needed medical care because of cost.

The sad realities of medical care means some of us do put off non-emergent care for financial reasons. But, of course, everyone taken to an emergency room will receive lifesaving emergency care. And our country does try to care for the poorest among us. All poor children, for instance, are eligible for Medicaid and there are subsidized clinics and federal children’s programs (such as Women, Infants, and Children - WIC) to help them receive some preventive care and immunizations. Still, as disturbing as those CDC figures on delayed care are, that recent Frazier Institute report from Canada put them into perspective. It reported:

Of [Canadian] patients who received health-care services in 2005, 11 percent waited longer than three months to see a specialist; 17 percent waited longer than three months to get necessary non-emergency surgery; and 12 percent waited longer than three months to get necessary diagnostic tests.

The worsening financial situation in the Canadian healthcare system was made real this morning when the Canadian news put a face to it. It reported that available resources and services are in such short supply there, a woman and mother of three children had her brain surgery postponed six times. Sadder was learning that she is not alone. This is a tragic story:

Woman’s 6 nixed surgeries draw fire

“This is a human example of what we mean when [we say] there isn't enough capacity," [NDP health critic Adrian] Dix said. “The number of surgeries that have been cancelled has become epidemic at Royal Columbian."

In March 2006, Mary Lou Frye had a seizure and drove off the Fraser Highway into a ditch. A CAT scan revealed a golf ball-sized tumour behind her left eye. She had surgery in May 2006, but bleeding cut the operation short, leaving part of the tumour. She now has two tumours in her brain, but since January Frye has had her surgery postponed six times, the latest last Friday when four other neurosurgery cases were also postponed.

The previous day, four neurosurgery cases were postponed due to a lack of beds. Meanwhile, Frye, 64, who raised three kids as a single mom, is failing. Doctors have declared her urgent...

Last week, the chief of surgery at Royal Columbian said he had cancelled more than 70 elective surgeries this month....

None of us would wish this for ourselves or our loved ones. Before we jump behind ideas to completely dispense with America’s healthcare system and replace it with ones like these, let’s be sure we have all the facts. Perhaps, we can learn from these countries and look for ways to improve things without throwing the baby out with the bathwater.


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Little League - itis?

Doctors in Madison, Wisconsin, are urging caution with today’s promotion of intense exercise and sports for children. They are seeing more adult-type overuse injuries caused by repetitive motion and impact in kids as young as 8.

Already, joint replacements due to overexercising have become such an epidemic among Babyboomers, it’s been called “boomeritis.” But many adults ignore the advice of experts on children’s physiology and exercise, and expect children to exercise like adults. If kids aren’t doing 60-90 minutes of continuous exercise, they’re seen as “inactive” couch potatoes. As was reviewed here, children are not little adults and they are naturally active in very different ways from grown-ups. Adult types and durations of exercise can be harmful to their growing and developing bodies, as Dr. Brian Reeder explained to WISC-TV viewers:

Doctors Warn About Repetitive Motion Injuries Among Young Athletes

Injuries can now being seen increasingly in 8- and 9-year-olds that doctors say used to occur more typically in late high school or college-age students are overuse injuries caused by repetitive motions and impacts in sports...

“The most common thing is just that it's used a lot," said Dr. Brian Reeder who specializes in treating the aches and pains that are becoming more serious. Reeder said that such problems are worth paying attention to in young athletes. "Something is done over and over and over again -- repetitive running or stress on use of the legs or arms or other parts of the body can make things wear out or wear down to where they get fatigued or tired," he said.

Reeder said that children's bodies are still growing, and injuries can happen in those areas known as growth plates because they're more vulnerable. “The growth plate is an area of the bone that allows the bone to get longer," Reeder said. “Those tend to be the weak link in the chain, the muscles to tendons, the tendons to bones. The bone-to-bone growth plate area is a relatively weak link. It's (an) active growing tissue that doesn't handle stress quite as well as a closed growth plate bone would handle stress."

Those growth areas are near joints. Impact created by running and throwing, over time, can cause stress fractures.... Doctors said that overuse injuries can get worse during growth spurts, but also can be aggravated by the growing trend of playing the same sport all year round.


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May 30, 2007

Big bad bones

The news recently reported on a study that claimed to dispel one of the most established “obesity paradoxes.” Its conclusion — “obesity is not good for bone health” — went unquestioned by the media. But it should have been.

First, the news:

Obesity bad for the bones: study

New U.S. research does not support the general belief that obesity increases bone mass and is therefore good for bone health. A new study where investigators corrected for the mechanical loading effect of increasing body weight, suggests the opposite. Dr. Hong-Wen Deng from the University of Missouri-Kansas City says the study found increasing body fat mass decreases bone mass in people of similar weight. “Therefore, increasing obesity (fat mass) is not good for bone health," he said....


The investigators say when the mechanical loading effect of body weight on bone mass was adjusted for, fat mass was negatively associated with bone mass. This means in general, the greater the fat mass, the lower the bone mass. The research team says the results of the study reaffirm the beneficial effects of appropriate weight-bearing and mechanical loading on a healthy skeletal system.

“Our study found that increasing body fat mass decreases bone mass, for people of similar weight,” Dr. Deng told Reuters Health. ...

But not a single media story reported what should have been the rest of that sentence to give a more accurate picture. The researchers had compared thin Asians who were in their 20s to heavier Americans in their 60s! The key point to remember with any association with lower bone densities is — bone density decreases with age. Yet there’s still more to this story, as we’ll see...

This study provides an ideal illustration of one of the most common ways we can be misled in population studies looking for a correlation between lifestyle, physical or dietary characteristic and ill-health.

You’ll often see it employed by those trying to make us believe that a certain diet — usually one of all-natural, wholefood, vegetarian, “good” fats, traditional fare — eaten by primitive cultures or in underdeveloped regions of the world is healthier, claiming as proof that those people had/have lower rates of obesity, heart disease, or chronic diseases. They often fail to account for age and reveal that life expectancies among those peoples are considerably less than we enjoy today in developed countries — they typically don’t live long enough to get the chronic diseases of advanced aging. As we’ve seen, incidences for chronic diseases spike noticeably with age. We have to be especially alert to confounding factors, such as socioeconomic and genetic factors, whenever an epidemiological data dredge is comparing different cultures or very different groups of people. The ability of a computer model to accurately account and adjust for confounding factors when groups are so dramatically different gets shaky.


BMI and age

In this study, the researchers were looking at osteoporosis and correlations with body composition. They took measures of body weight, fat/lean mass and bone mineral density (BMD) that had been done on 1,988 Chinese adults and compared them with those on 4,489 Caucasians in the United States. BMD was measured at the lumbar spine and femoral neck using Hologic DXA scanners. The Caucasians were different genetically and nearly 40 years older than the Chinese cohort, and weight gain is a natural part of aging, making them taller and heavier. The Caucasian women and men weighed on average 50.38 pounds and 77.18 pounds more, respectively.

Their most significant finding was that BMI and body weight were positively related to bone density among both cohorts. The higher the BMI, the greater the bone mass. This unreported finding is consistent with the entire body of evidence.

The importance of heavier size in bone density proved so significant even in this study that, overall, the 60+ year-old Caucasians had comparable BMDs to the 20+ year-old Asians!

As most people know, bone density naturally drops with aging.

Women lose more than men and over their lifetimes, women lose about 30-50% of the bone mass they had at age 20. In 1994, the World Health Organization defined osteoporosis as a disease by using the average BMDs of 25 year old, white females. When values for older people reach 2.5 standard deviations below those of a 25 year old, they are considered “osteoporotic.” This pretty much ensures, like so many other ideal health indices based on young persons, we have another way to see aging as a disease.

But fat people have long been shown to have less osteoporosis and better bone densities than thinner people. It’s been suggested to be due to better nutritional status, a role of estrogen and the greater weight-bearing mechanical stress on bones (as is also found with weight-bearing exercise). In fact, in other studies, BMI was the “best independent predictor of bone density,” with BMIs over 30 and 35 seeing an 80% and 90% reduction in osteoporosis, respectively. A small preliminary study in OB/GYN News by Dr. Coleman of Wilford Hall Medical Center, Lackland Air Force Base, TX, found no cases of osteoporosis among those with BMIs greater than 33. If this is confirmed in a larger study, he said, it could mean substantial savings by just screening those below a certain BMI; the $200-$300 per screening could be saved by not screening obese people who “would have an extremely low likelihood of having osteoporosis.”


Genes and lifestyle

Yet, even the significance of body size still pales to our genes. The news also failed to mention that Deng’s genetic research has shown that bone density is even more determined by genes than by BMI. [Together with Dr. RR Recker, he also holds two provisional U.S. patents on gene mapping and identification of osteoporosis and obesity.]

Despite common beliefs that lifestyle factors — exercise, calcium intake, protein, salt, etc. — hold the critical roles in bone density, none of the risk factors used to predict osteoporosis have been shown to make much difference. For instance, researchers evaluating the efficacy of various popular osteoporosis risk assessment tools reported in a recent issue of Archives of Internal Medicine, that the variance in BMD is so wide that most is explained by genetics and only 20% remained for all of the lifestyle factors combined, including weight, diet, exercise, etc.

But being fat isn’t supposed to be good for us. Dr. Deng and colleagues did a second analysis, adjusting bone mass for body weight in their computer model, and said they found lean muscle mass, but not the fat mass, correlated with bone mass. The role of lean mass isn’t anything new, as large muscles are thought to put more mechanical loading (impact stress) on bones. Fat people also have more muscle, not just fat mass. While the Deng researchers emphasized the role of muscle and “appropriate” weight-bearing stress on bone density, muscles proved to not be everything. Even the significantly fatter and older Americans in their study, who had only about 20% more lean body mass than their thinner counterparts by DXA measurements, still came out ahead in bone density.

While there’s still that sticky age thing, the spin surrounding this finding — claiming obesity is bad for bones — certainly doesn’t accurately describe what they found.


Osteoporosis screening and risk factors

Moving on, things get complicated and enter the realm of emerging science. But what has and has not been shown may counter some common beliefs about osteoporosis. It’s become popular to assume that bone density and osteoporosis risk factors predict our risks for fractures. All of those recommended BMD tests and osteoporosis screenings would be meaningless unless they help reduce fractures, especially hip fractures which is one of the most critical factors for morbidity and mortality as we age. “The rate of hip fracture increases with age, doubling each decade after age 50 years,” according to Dr. Gigi R Madore, M.D., emergency medicine physician at New York University/Bellevue Hospital Center. “Nearly half of all hip fractures occur in adults older than 80 years....Overall mortality rates of hip fractures is 15-20%, yet in older persons this can increase to 36% over the year following hip fracture.”

But many older women who suffer hip fractures do not have particularly low bone densities, doctors at the Bone and Mineral Research Unit at the Oregon Health and Science University in Portland found. They measured the hip BMDs and osteoporosis risk factors (exercise, strength, falls, etc.) for 8,065 elderly women and found during five years of follow-up, more than half of the women who had hip fractures hadn’t been osteoporotic. Most people who will develop fractures don’t have osteoporosis.

It’s like heart attacks and strokes, where most events occur among those at moderate or low risk.

It may come as a surprise to learn that in September, 2002, when researchers did a review of the evidence on postmenopausal screening for osteoporosis for the U.S. Preventive Services Task Force, they concluded: “The role of risk factor assessment and different bone density techniques, frequency of screening, and identification of subgroups for which screening is most effective remain unclear. No trials have evaluated the effectiveness of screening; therefore, no direct evidence that screening improves outcomes is available.” Instruments developed to assess clinical risk factors for low bone density or fractures have moderate to high sensitivity and low specificity, they said.

The USPSTF’s latest Evidence Report (Number 28) “Osteoporosis in Postmenopausal Women: Diagnosis and Monitoring” found: “No marker was associated with increased fracture risk consistently across all studies. One study provides evidence that using markers in conjunction with densitometry may increase predictability, but this result has not been otherwise confirmed.”

[Sidenote: Nevertheless, the USPSTF went on to recommend “that women 65 and older be screened routinely for osteoporosis. For women at high risk for fractures, the USPSTF recommends that screening begin at age 60.” But these recommendations, they say, “should not be used to make treatment or policy decisions.” I’m not even going to try to make sense of that.]


Bone density versus strength

While it’s popularly believed that bone density is a measure of bone strength, they are different. At the American College of Sports Medicine’s annual meeting last year, more than 40 papers on DXA technology to measure bone density were specifically reviewed. First off, the scientists found this instrument wasn’t the ideal way to assess bones, especially for measuring the bone’s response to mechanical load. The scientists also found that measuring density was not as important as measuring bone strength when it came to identifying people at risk for fractures. But density or bone mass does not equal strength, stressed Dr. Moira Petit, Ph.D., University of Minnesota in Minneapolis. DXA only measures area density, not volumetric density.

While density is relevant, it’s not really the most important point when it comes to how bones respond to mechanical loading, he said. With mechanical loading, in animal studies there is a small increase in mass (less than 10%) but that leads to a substantial increase in strength (more than 70%), according to Petit. There are a number of new technologies for measuring bone strength (such as MRI, peripheral quantitative computed tomography, and QCT) which have made scientists rethink some of their old ideas, he said:

For example, we used to say that obese children and adults had high bone density because of their high body weight. From our pQCT data, we now know that obese children (and likely adults) actually have a normal bone “density” (both cortical and trabecular), but high bone strength. Their high bone strength is adapted to their higher muscle mass, but is actually low for their body weight.

It’s much the same as recent findings that younger runners have increased bone strength but equivalent bone density because of the distribution in mechanical load, he said. Muscles aren’t everything.

We can’t underestimate the wonders of the human body. Even a fat one.


© 2007 Sandy Szwarc


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May 29, 2007

Medical Privacy Update: Healthcare for all

For the Food for Thought file...

The May issue of Health Freedom Watch, a publication of the nonprofit Institute for Health Freedom, brought to light some of the realities of the single-payer health plans being proposed in several states around the country. Other healthcare reform proposals and analyses have also been in the news recently. If you’re confused by them all, you’re not alone. It’s difficult to sort out the plans and come to a reasoned opinion because the issues are so encumbered by marketing, politics and special interests. The only thing we can be certain of is that we’re probably not getting all sides of the story from the media.

Everyone seems to be taking “sides” even before we know what problem we’re trying to solve by these sweeping healthcare reforms. Is the main concern inequitable access to healthcare or lack of affordable health insurance coverage among poor and discriminated Americans? Or is it that healthcare/health insurance costs are out of control? If so, where are the biggest wastes of public healthcare dollars? Or do most Americans feel the quality of medical care in this country is inferior or corrupted by special interests?

What is it we’re most trying to fix? And are those problems real — are we working from sound facts — and, if so, how significant are they? How can they be addressed the most effectively and simply without imposing other problems that might be worse? We don’t want to get behind something that just sounds good and feels good, if it won’t be, because we’ll likely be stuck with it for a long time.

“Free universal health care for everyone” sounds wonderful and seems to be the vision most repeated in media, but what would that actually look like?

We might begin to see the picture by reading a few reviews (not making the news) of recent state plans which share remarkable similarities to the national universal health reforms being proposed or have been implemented in other countries.


Massachusetts

On July 1st, Massachusetts’ statewide universal healthcare mandate goes into effect. All residents will have to show proof of state-approved medical insurance. According to the Commonwealth Connector website, a health plan that meets the state’s mandates will cost $6,866 to $19,791 annually for a family of four. Compliance will be monitored through people’s state tax returns, and financial penalties of up to 50% of the cost of the insurance will be imposed on those who fail to purchase insurance, by withholding refunds and initiating collection proceedings. [Like all plans, the poorest families will still be covered under Medicaid, and various subsidized programs are in place for lower-income residents. The state’s estimates of $1 billion needed to cover these subsidies, however, have been estimated to be only one-fifth of what the costs to taxpayers will actually be. It’s unclear what provisions have been put in place to care for illegal aliens, a portion of the uninsured.]

Citizens’ Council on Healthcare (CCHC), a nonprofit patient and physician advocacy organization, did an analysis of the Massachusett’s plan last year and made troubling conclusions about its impact for consumers. While the plan was created “to expand access to healthcare for Massachusetts residents, increase the affordability of health insurance products, and enhance accountability of our state’s health system,” they found the plan would create an enormous set of new bureaucracies (no less than ten new agencies, six financial-management funds, and three new programs) to establish, oversee and enforce. There is no evidence to suggest that the government will do things cheaper, better or more efficiently.

The MA state plan essentially creates a monopoly of insurers residents can choose from. Every policy has to comply with the state’s coverage mandates, and mandates always cost more money than they claim to save. There are thousands of insurance mandates that have been passed by state legislatures over recent years and behind every mandate is a special interest that will benefit by the product or service. A recent analysis by the Council for Affordable Health Insurance estimated that mandated benefits increase the cost for basic health insurance for everyone by 20% to more than 50%, depending on the state. Worse, a number of these mandates are for preventive “wellness” programs, screenings and treatments that are unsound, ineffective, costly, unproven, unwanted or potentially dangerous.

One misconception among consumers is that the free market system hasn’t worked, so the government must step in. But we don’t have a free market system with health insurance. A free market system only works if it’s allowed to exist unfettered from government mandates that limit competition and allow certain companies to monopolize markets. The government has catered to special interests and created an insurer managed care system, which has resulted in higher premium costs and more people uninsured. Those who want affordable insurance alone, without a third-party managed care bureaucracy standing between them and their doctor, find it unavailable. Under the current managed care environment, it’s impossible to obtain insurance that stays out of your private life and doesn’t penalize you for a lifestyle or if you’re unlucky enough to have genes that make your health indices (BMI, cholesterol, etc.) targets for intervention.

Under the MA plan, said the CCHC, determinations of what healthcare would be available, how that care is delivered, who gets it and when, will fall under a state “Care Quality and Cost Control Council,” which is directed to lower or contain the growth in healthcare costs while improving quality. “Quality” will be defined by the Council, which will also determine the performance measures for providers, reporting requirements and fee schedules. Healthcare providers will be graded on their compliance and their performance measures posted online; and reimbursement to providers and hospitals will be made contingent on adherence to the state standards. Cost containment efforts will likely drive away healthcare providers and, as has been seen in other single-payer systems, result in shortage of providers and services; rationing of available care and resources; and long waits for tests, surgeries and treatment. [More on that in a moment.]

Health insurance coverage is not the same as access to care.

The state plan mandates all acute hospitals and ambulatory surgical centers to assess a surcharge on top of service charges, and enrollees will be required to pay the state-determined insurer commissions. Under the MA plan, there is also a troubling hint of price control on the insurers in the name of cost containment, which over time will remove even the limited degree of consumer choice among insurers, as they drop out of the state program because it won’t be profitable for them, thus strengthening monopolies among the few remaining.

Raising privacy concerns, the MA plan establishes an electronic database to track individual’s insurance status, verify incomes and personal records, and mandates penalties for healthcare providers and employers who do not turn over data to the state Council.

According to the CCHC, like all managed care plans, the MA state plan includes a provision for monitoring people’s lifestyles and their compliance with “wellness” goals established for them by the state:

The executive office of health and human services shall implement, in cooperation with the department of public health, a wellness program for MassHealth enrollees…The executive office shall report annually on the number of enrollees who meet at least one wellness goal.

Overall, Twila Brase, RN, president of CCHC, said of the plan:

[A]n intrusive and prescriptive bureaucracy will be authorized to ration health care and make decisions about who gets what health care when. Health-care decisions will be taken out of the hands of patients and doctors as the agendas of special interests, not the needs of patients, take precedence. The legislation is extremely intrusive.

To sum it up: People will have no choice but are being forced to buy the insurance plans the state dictates. But these are not health insurance plans, as might be believed or some might desire, which protect people from catastrophic health problems, this is managed care. The state is also the regulator, payer and enforcer — a recipe for conflicts of interest.

Some say that we are forced to get car insurance for the good of society, but that isn't a real comparison. At least we select a car insurance plan of our own choosing to protect ourselves and the public from financial catastrophy. Car insurance doesn't cover oil changes, tire rotations, body waxing, and basic preventive maintenance - if it did we'd have all sorts of mandates on how often we must change our oil, wash and wax our car, what products we must buy, who we can hired to do the work, the precise air pressure our tires must be and oil we put in our car (whether it's the best choice for our vehicle and usage), etc. You get the idea. Soon, to be perfectly safe, we'd have to have weekly preventive maintenance check-ups...


Minnesota

The Institute for Health Freedom also reviewed the Minnesota health insurance Exchange proposed under the Governor’s Health and Human Services omnibus bill.

The Governor’s website says the “Healthy Connections Health Care Reform” proposal will transform the state’s health care market. The new plan is “to drive down health insurance costs, improve quality, and increase access to affordable health care for the uninsured.” These goals will purportedly be achieved by paying providers according to new quality standards and rewarding consumers who “meet preventive care goals” and comply with disease management.

Concerns raised by consumer groups surrounding this state plan are very similar to those noted in Massachusetts. People would no longer be allowed to purchase health insurance privately because it would only be available through the Exchange or their employer. There would be no competing health insurance companies to help keep costs down (competition brings down costs, monopolies don’t) and the Exchange would be empowered to charge administration fees on top of health insurance premiums.

“The Exchange is a large ‘single-seller’ bureaucracy that threatens to assume powers over all aspects of health insurance. It will increase health-care costs, violate individual rights, and leave the public without the personalized services and options we have today,” Twila Brase said. “In the future, the Exchange could be empowered to determine insurance benefits, limit choice of insurers, set prices, and monitor every aspect of the insurance industry, included the insured.”

Other concerns that have been raised are that it violates individual’s privacy because the state Exchange would have full access to personal information on insurance, usage and medical conditions. And concerns have been raised about the lack of state liability for their actions.

To sum up: People would have no choice but to buy the health plans the state determines and these, again, are managed care programs, not true insurance plans. People would be forced to get the screening and preventive care, treatments and medications the state determines; lower their health indices to state-approved numbers; and their medical care would be managed by the state.

Healthcare professionals will be compensated according to their compliance with state-determined care guidelines, which as we’ve examined, may or may not be sound or “universally” best for everyone. Many also lead to compulsory prescriptions which may not be supported by the best clinical evidence. Government mandated practice guidelines also disregard the education and years of experience of physicians, and the actual situation and desires of each individual patient that are weighed by doctors when making clinical judgments. Healthcare providers are understandably concerned not only about having their care second-guessed by government bureaucrats, but also that “containing costs” may mean further losses of income. Medicare and health plans have been systematically cutting reimbursements for doctors to below their costs of doing business, insurers reject a significant portion of claims submitted, and physicians face their incomes falling further. Why doctors won’t flee the profession as predicted, like nurses have for years, and result in dangerous shortages of providers is an important consideration.


California

Things are heating up there. Governor Schwarzenegger supports a plan similar to the one in Massachusetts, ensuring coverage for all, while saying the government ultimately shouldn’t run healthcare. While a Universal Health Insurance bill (SB-840) in the legislature calls for a plan similar to Canada’s. You may have read about the Governor’s recent proposal to make health insurance mandatory. As the Los Angeles Times reported, “people who refuse to obtain health insurance could be tracked down by the state or a private contractor, enrolled in a plan and fined until they pay their premiums.” The first draft of his plan also included an initiative use state and private databases to track down those without insurance and “to attach the wages of people who don’t buy insurance and to increase the amount they owe in state income taxes.” Like the Massachusetts and Minnesota plans, those who might prefer to self-insure won’t have that option.

While the insurance industry understandably supports mandated insurance coverage, it’s apparent they don’t like one aspect of the California Governor’s proposal seen favorably by consumers — elimination of discrimination so that insurance is equally accessible for everyone. The San Francisco Chronicle and Associated Press reported this weekend that Blue Cross of California has set aside $2 million for a campaign to market against the plan in California. They object that it requires state-approved insurers to cover everyone, regardless of medical history. They want a public-funded pool to cover those with health conditions that make them more expensive to cover. [Isn’t that essentially admitting they cherry pick who they cover to include only the most profitable, negating the idea of risk pooling?]

With single-payer health plans, regardless of their permutation, will we solve one problem but make another one worse? Will we trade what we have for a system that will end up costing more and leave us unable to find doctors or having to endure extraordinarily long waits for basic care?

An analysis of Canada’s universal healthcare system by Frazier Institute in Vancouver, British Columbia, last August, for example, found 1.2 million Canadians were unable to find a regular physician in 2003 and that Canada has significantly fewer doctors per capita than most other developed nations. Their October report found Canada’s waiting times were increasing, with an average of 17.8 weeks wait time to see a general practitioner, with the longest waits of 31.9 weeks in some provinces. “[M]illions of Canadian patients wait so long for treatment that they are no better off than uninsured Americans,” said Brett Skinner, Director, Health, Pharmaceutical and Insurance Policy Research at the Frazier Institute. Yet, Canadians are forbidden to have private insurance or pay for care out of their own pocket unless they leave the country — although some countries with government healthcare have two-tiered care with the wealthier purchasing private insurance.

While it is popularly believed that universal healthcare systems save money and are financially sustainable, a careful examination shows that’s rarely the case. The Frazier Institute’s December report looked at costs adjusted for age, and found Canadians spend more on healthcare than any other industrialized OECD country except Iceland. Canadians are said to pay about a 50% tax rate for their free healthcare, but that coverage does not include many advanced medical treatments and technologies commonly available in the U.S. There are also fewer doctors, less high-tech equipment, older hospitals, and less availability of advanced medicines than in America, said Mr. Skinner. Of greatest concern, is the growing consensus among researchers in Canada that public spending on healthcare is growing faster than public revenue and their system faces financial crisis.

Would Americans want universal coverage if they knew it would mean higher taxes, rationed care, fewer choices, and long waits?


National

Speaking at George Washington University on Thursday, Senator Hillary Clinton announced her proposed healthcare initiatives to lower costs, improve quality and ensure everyone is insured.

· Obesity. She made the “obesity crisis” the cornerstone to her plan and her very first strategy is to “install a groundbreaking national prevention initiative to reduce the incidence of obesity and diseases such as diabetes and cancer that impose huge human and financial costs.” She said obesity has driven spiraling healthcare costs: “About 30% of the rise in health care spending is linked to the doubling of obesity among adults over the past 20 years.” Another third of healthcare spending is on diabetes, asthma and heart disease, she claimed. She said an “epidemic of chronic illnesses... some of which can be prevented, account for more about 75 percent of health care costs.” [sic]

She repeated the popular beliefs about obesity and childhood obesity: “Obesity contributes to a wide range of chronic conditions, from diabetes to stroke to cancer. If trends continue, children’s life spans may be shorter than that of their parents for the first time in about a century.” Citing the importance of obesity intervention for elderly women, she also said: “If obesity among the elderly were to return to the level in the 1980s, then savings could total a trillion dollars over a 25 year period.” She said fewer than half of Americans had had preventive services and been advised by their doctor about their weight, nutrition or exercise habits.

Junkfood Science readers will no doubt have reason to wonder about the efficacy in the rest of her plan, given the inaccuracies and untenable conclusions in these statements.

· “Wellness programs.” Her first idea to tackle “spiraling healthcare costs” is to require participation in government and workplace “preventive wellness programs” that must be “incentivized.” Of course, as we’ve examined, these programs are unsound and don’t actually save costs. To support her contention, however, she exampled Safeway Inc. that through its preventive wellness program supposedly lowered its healthcare costs by 15% for nonunion workers. That wasn’t the full story. As the San Francisco Chronicle reported in February, the company had instituted a new plan for nonunion workers in January 2006 that raised their deductibles to $2,000 ($3,000 for families). That was the primary factor in reducing the company’s costs for health insurance, not the “preventive” care or incentivization of “good behavior.” In fact, according to the Chronicle: “Safeway projects that this year outlays will be flat. The company said it enrolled more employees in the plan and added new chronic diseases to its care management program, all of which increased costs for 2007.”

· Government disease management. Her next initiative was centralized government management and coordination of treatment for those with chronic health conditions, such as heart disease. There again, as we’ve examined, while these disease management programs sound intuitively good, they do not lower costs or necessarily improve outcomes.

· Discrimination. While her plan was similar to the California Governor’s proposals in ending insurer discrimination against people with pre-existing conditions, such as obesity and high cholesterol, thus making getting insurance more equitable; once insured, people with those conditions will be targeted for discriminatory intervention and mandated compliance under preventive wellness programs and weight loss interventions.

With a single-payer system, however, there will be nowhere else to get coverage and you can’t fire your insurer if you don’t like it or it under performs. It is also much more difficult to sue should something go wrong, and damages would be limited as they would raise insurance costs for all, since the government pays claims and suing would go against “the common good.”

· Government practice guidelines. To drive down costs, Clinton would establish a “public-private Best Practices Institute to determine what drugs, devices, surgeries and treatments are best.” As we’ve seen with far too many government-funded health programs and clinical practice guidelines, they don’t necessarily follow the best evidence, as they become encumbered by various interests. According to an Institutes of Medicine report on patient safety, establishing best evidence is not clear cut: “There are gaps and inconsistencies in the medical literature supporting one practice versus another, as well as biases based on the perspective of the authors, who may be specialists, general practitioners, payers, marketers, or public health officials.”

While cost containment is critical, when it is the overriding, immediate consideration, the potential impact on slowing or inhibiting the adoption of new technologies and treatments, or the availability for treatments for less common or costly conditions, are additional concerns that deserve careful consideration.

· Electronic medical records. Among her other key proposals is computer technology to expand electronic databases to increase “accessibility of medical records” by spending another $3 billion a year. Those who most stand to benefit from electronic databases are large managed care insurer plans that provide insurance and nearly all of the care, including prescriptions. They are also behind the most aggressive efforts to institute electronic medical record databases, and they also have access to the most information on members to make them possible. These efforts are supported by America’s Health Insurance Plans, the main lobby for the insurance industry.

But Senator Clinton’s proposal appears to underestimate the costs and problems that have surfaced for more than ten years and overestimate the return. In fact, Information Week just published a comprehensive analysis of electronic medical records entitled: “Why Progress Toward Electronic Health Records Is Worse Than You Think.”

“Kaiser Permanente, which has the country’s most ambitious e-health effort, is in the midst of a $4.5 billion, 10-year project,” said Information Week. “Yet Kaiser Permanente’s experience — even with the advantage of closely held data and doctors who work for the company — shows how much work lies ahead of the rest of the industry.”

A number of attempts to establish electronic medical record systems across the country have found it more problematic and costly than any predictions. Santa Barbara County Care Data Exchange recently “shut down after spending at least $20 million over the past nine years trying to electronically link three hospital systems, county health care programs and dozens of doctors,” according to an investigative report in the San Diego Union-Tribune. “Despite undeniable advances, most hospitals and doctors remain years away from full-scale electronic records and for those that do use electronic records, there is little, if any, way to share information.”

Information Week reported the Santa Barbara program died when “the healthcare community didn’t see enough value to keeping it going.” Their conclusions on electronic medical records said:

Just 10% of doctors' offices use them. And while hospitals are expanding their use, the most difficult work—the exchange of data among health care providers, especially with rivals--has barely begun. Technology itself has caused problems, such as a system outage last year of a medical records network run by health care company Kaiser Permanente. There are legal questions, privacy issues, and competitive pressures surrounding the technology, as well as concerns about return on investment. And data-sharing practices have yet to be widely tested in the real world.

As we’ve reported here, privacy concerns among consumers have increased with the development of electronic databases and continue. Cost has proven a special hinderance for physicians. It will be at least 10 to 15 years before electronic medical records are adopted by physician practices, according to the National Coordinator of Health IT Office. That’s understandable, given the $30,000 it costs an office to implement — an amount difficult for most practices to afford.

· Medical error disclosure. One final aspect of Senator Clinton’s proposal deserves note, as it may be unfamiliar to consumers, although has been heavily debated among healthcare professionals. She proposes to reform medical malpractice to curb costs and reduce medical errors by enacting a National Medical Error Disclosure and Compensation (MEDiC) program, run by the Dept. of Health and Human Resources. She said this mediation program will give liability protection to doctors who disclose “medical errors” to patients and, rather than malpractice suits, this program will negotiate a fair compensation with patients.

While there are favorable aspects of this proposal — who can oppose improving communication between healthcare providers and patients? And government mediation to settle a malpractice case without going to court will clearly save the insurer and hospital money. But there may be reasons why it never got anywhere when she and Barack Obama first sponsored it back in 2005 in Senate Bill 1784. It’s worth taking a moment to consider, especially in light of her other proposals.

According to GovTrack.us (database of federal legislation), “this bill never became law.” It had been heavily promoted among medical professionals, such as a Perspective written in the May 2006 issue of the New England Journal of Medicine by Sen. Clinton and Barack Obama. It once had the support of such powerful interest groups as the insurance industry, American Medical Association (doctors trade organization), and the National Business Group on Health, while being opposed by groups such as the Association of American Physicians and Surgeons, Inc.

Going to the actual text of their bill, under this program, health care providers (defined as “a doctor, nurse, physician assistant, nurse practitioner, clinical nurse specialist, certified nurse anesthetist, certified nurse midwife, psychologist, certified social worker, registered dietitian or nutrition professional, physical or occupational therapist, pharmacist, or other individual health care practitioner”) would have been required to submit confidential reports to the government office about any incident involving a patient thought to be “due to medical error, negligence, or malpractice.” Under the Bill, patients had to receive the root cause analysis report of the incidence within five days of the analysis and be offered mediation to settle quickly.

But looking more closely at the actual text, a root cause analysis meant “an examination or investigation of an occurrence, event, or incident to determine if a preventable medical error took place or the standard of care was not followed.” Deviating from the “standard of care” would be treated the same as an error, noted the Association of American Physicians and Surgeons, Inc. And who will determine the standard of care? This is a covert way to pressure healthcare providers to comply with state mandated guidelines, regardless of whether in a physician’s clinical judgment they are appropriate for that particular patient. Providers can’t afford to risk deviating. Any adverse outcome in a patient could become a hunt for any departure from treatment measures.

Most healthcare providers want to do the right thing by the patients under their care and live with deep regret when an error occurs. And mistakes will happen. But most providers also know from experience that “confidential” incident reports are not confidential. Especially for nurses and others lower on the food chain of a large hospital or healthcare institution, writing an incident report means retaliation. But there were no provisions for protecting whistle blowers.


Conclusion

Are we being realistic to believe the promises being made in these popular, sweeping healthcare reforms? Free care for all. Can any government bureaucracy really dictate and contain costs; deliver quality, efficient care to everyone; and know what’s best for each of us — while remaining uncorrupted by special interests?

Can we trust politicians to suddenly start ignoring the huge contingent of health insurer and pharmaceutical lobbyists in Washington that have outnumbered congressmen on both sides of the aisle for years? As the New York Times reported, for example, as of July 12, 2006, Senator Clinton had received more campaign money from pharmaceutical and health insurance companies than any other candidate, with the exception of Senator Rick Santorum.

Being pro-government, trusting the government to know what’s best for us, and eager to obey government rule is antithetical to America’s long-held sense of individuality and anti-big government sentiment. Americans value freedom to make their own choices and independence from government intrusion into their private lives. So, most Americans and medical professionals probably read of these far-reaching government proposals with concern.

Whether Americans care enough to get involved and do the work to help identify and remedy the problems in our healthcare system is yet to be seen. It takes work to get involved, critically think and dig for the facts that might not jive with whatever is politically correct. It isn’t popular or easy to stand up to special interests and political agendas. But doing the best thing isn’t always easy.

© 2007 Sandy Szwarc


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What’s a parent to do? Trusting your parenting skills

In today’s culture focused “for the children,” parents are feeling the pressures to do everything “right” as much as kids. A mother speaks out on how to regain confidence in parenting for the sake of your sanity and your child’s wellbeing in this helpful article on “Intensive Parenting.”

Monitoring mums and dads

...Most parents, myself included, have become accustomed to living with a subtle sense of unease. It’s there in the playground and at the schoolyard gate. It permeates the atmosphere of children’s parties and sporting events, the doctor’s office, the supermarket checkout. It is a sense of watching and being watched; most of all, it is a feeling of being judged that seeps into every area of our lives, undermining confidence and transforming parenthood from a straightforward part of life into an angst-ridden ordeal....

If parenting is a big issue in the US, it is possibly even more so in the United Kingdom where seemingly almost any aspect of parenting can be politicised and made the subject of public policy....The evidence is unequivocal: you aren’t just imagining it - being a parent today is different than in the past....

While the term, “intensive parenting,” is not common here, it is common. It’s when parents are led to believe that they need expert guidance, childhood is medicalized and everything must be managed, and parenting is shaped by a pervading sense that children must be protected from anything even potentially risky. And frightened into believing that danger lurks everywhere! According to sociologist Frank Furedi, it normalizes the belief that parents are incompetent and need help in everyday life, undermining their self-confidence, while exagerrating the importance of every little thing parents do. Parents are led to fear for their children and doubt their own parenting skills. It’s no wonder he says it leads to “paranoid parenting.”

Rebecca Kukla of the University of South Florida gave a critical appraisal of the notion that ‘you are now what your child eats’, to the extent that even a single hotdog-of-convenience apparently risks ruining a child’s palate and ultimately jeopardising their long-term health and mental wellbeing. Public policy initiatives aimed at ‘supporting’ parents almost never improve things and sometimes make them far worse by denigrating parents’ ability to rise to the occasion. ...

Canadian academic Stephanie Knaak explained that we don’t so much make decisions as choose within ever-narrowing parameters of what is acceptable. As an example, she pointed to the question of bottle-feeding versus breastfeeding in several editions of Dr Spock’s childcare manual. In early editions of Dr Spock, breastfeeding and formula feeding are both treated as acceptable alternatives that take the needs of the parents into account. In contrast, the most recent edition makes it clear that breastfeeding is the morally superior choice and the needs of mothers are no longer part of the equation. Sure, you can formula feed, but you’d better have a good excuse....

Author Nancy McDermott concludes by answering the question “What can we do?” and offering other parents some common sense advice. The full article is here.


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May 28, 2007

Remember

Women placing flowers on the graves of their loved ones who had died serving in the Civil War may have been the origins of Memorial Day. More than 780,000 Americans died during that war. Unfathomable numbers.

It’s equally hard to invision the numbers who served in World War II — 16.1 million — and the more than 407,000 who died and the 671,000 more who were wounded. With strength and resolve, men and women have served and lost their lives for us. Across the county, there are Americans remembering someone today among the 116,708 who died in World War I, the 36,512 during the Korean War, the 58,193 in Vietnam, the 148 in the Gulf, the 279 in Afghanistan, and the 2,406 who’ve died so far in Iraq. All are heroes. And they've made our country proud.

Memorial Day has become a day to remember and honor the men and women who have paid the ultimate sacrifice to defend our country and ensure our freedoms. Some honor the fallen with great fanfare, barbecues and parades; others in very quiet, private moments of remembrance.

One of the loveliest tributes is a special military tradition of remembering those who aren’t here to eat with us, but remain in our hearts. The Missing Man Table. While each ceremony is slightly different depending on where it is held, each is a solumn, prayerful memorial....

A special table is set with an empty place to represent the missing brave men and women who answered our nation’s call to serve. It is a table set for one, symbolizing the frailty of a single prisoner alone against oppressors. The table is round to show our everlasting concern for our missing. The tablecloth is white, symbolizing the purity of their intentions to respond to their nation’s call to arms so that their children could remain free.

A single red rose in a vase signifies the blood they may have shed and to remind us of the family and friends of our missing comrades who keep the faith awaiting their return. A yellow ribbon around the vase symbolizes the everlasting hope for a joyous reunion with those yet unaccounted.

A folded American Flag may be rest on the table to represent those who’ve given the ultimate sacrifice.

A slice of lemon sits on a bread plate to recognize the bitter fate of those captured and missing in a foreign land. A sprinkling of salt symbolizes the countless fallen tears of the missing and their families who seek answers.

The wineglass is inverted, reminding us that the missing cannot be here to drink a toast or join in the festivities today. A candle is lit, signifying the light of hope which lives in our hearts to illuminate their way home to the open arms of a grateful nation.

The chair remains empty for they are not here with us today, but their place at the table is saved for their hoped return.

Let us remember and never forget their sacrifices. As we raise our glasses in a toast to honor America’s POWs and MIAs, may all who serve return home safe.


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May 27, 2007

Acomplia update: Holy Cow!

Since the Junkfood Science Exclusive posted here in December, which examined the clinical trial evidence for Acomplia and revealed troubling complications that weren’t being reported in the news, I’ve been following the Acomplia story. As you’ll remember, it’s the new diet pill that Sanofi-Aventis has been seeking FDA approval to sell here in the United States. Just days after that Exclusive, the FDA made a surprising move and put it on a slow track and deferred decision on whether to approve it until concerns over its side effects were reviewed by an FDA advisory panel on June 13, 2007.

But a few noteworthy things have happened since then that necessitate an update before the June decision.

In January, the German Ministry of Health reported Germany’s health insurance, European Union’s largest market, refused to cover Acomplia for reimbursement based on the evidence. This month, widespread denial of insurance coverage across Europe has been reported. The recent Avandia scare has sparked analysts to predict Acomplia may work against the FDA approving it next month. As Acomplia Report just reported: “[T]ogether with recent publicity about safety issues involving top-selling anemia drugs Aranesp, Epogen and Procrit, have refocused attention on drug safety, rekindling memories of the stunning 2004 withdrawal of painkiller Vioxx from the market.”

An incredible report just published today and written by St. Petersburg Times (Florida) business news reporter, Kris Hundley, may put the breaks on the FDA’s readiness to grant Sanofi-Aventis’ petition. She investigated recent clinical trials conducted for FDA approval of Ketek, a new antibiotic for which the company stood to make hundreds of millions of dollars. Sanofi-Aventis paid a contract research organization $20 million to conduct the trials and it offered doctors $400 per patient to test the new antibiotic. The rest of the story is here:

Drug’s chilling path to market

Anne Kirkman Campbell, a family practice doctor in Gadsden, AL, signed up 400 patients, more than any other doctor in the country. When one patient backed out, Campbell forged the consent form and faked the data. A company hired to oversee the study caught the doctor's forgery, along with unmistakable signs of fraud involving dozens of other patients, and alerted the drugmaker. But the pharmaceutical company, which stood to make hundreds of millions of dollars on Ketek, didn't stop Campbell or report her crime to the Food and Drug Administration. Instead, it included her dubious data in its submission to the agency. Even after federal regulators stumbled on Campbell's fraud and uncovered problems at several other study sites, the FDA approved Ketek....

...Combing patient files, Cisneros found that the doctor had enrolled her entire staff and several family members in the study. Patient consent forms had been signed every few minutes and at times when the office was closed. Medical records had been edited, with notations of “sinusitis" and “bronchitis" added so patients would qualify for the trial....Dr. Campbell ended up with 407 people."...In July 2002, the drugmaker submitted the trial results to the FDA - including data from all 407 patients at Campbell's site....

While the FDA's drug approval division reviewed the Ketek data, its inspectors were conducting routine audits of the biggest study sites. Their first stop was Campbell's office, where they found such flagrant violations that they immediately called in the agency's criminal division. FDA investigators visited nine other high-enrolling sites and discovered serious problems at every one....

The story gets even more incredible and is well worth reading in its entirety. She goes on to reveal discrepancies in other drug approvals and share concerns about the FDA drug approval process:

Last year drugmakers paid the FDA more than $300-million in user fees, accounting for more than half of the agency's drug review budget. “Even if a product doesn't work or we don't know how it works, there is pressure on managers that gets transmitted down to reviewers to find some way of approving it," Ross said. “There's been a cultural shift at the FDA, and the pharmaceutical industry is now viewed as the client."

Ross, an infectious disease specialist, stressed that Ketek was being marketed for common ailments that often get better over time without the use of antibiotics. “This was not a drug that anybody thought was necessary in terms of public health. But it was important for the company financially."... In mid December, an FDA advisory committee discussed the growing evidence linking Ketek to liver failure: 53 reported cases, including two people who needed liver transplants and five deaths.... On Feb. 12, the day before the congressional hearing on Ketek, the FDA sharply curbed the drug's use. With health risks outweighing the benefits of using the drug for common colds, the agency limited Ketek's use to treatment of community-acquired pneumonia. Until then, Ketek had been one of the most successful antibiotic launches in history, bringing Sanofi-Aventis nearly $400-million in U.S. sales.

Clearly, not all medications are bad and there are drugs that have proven lifesaving for countless Americans. And it's never safe to just discontinue any prescription without talking with your doctor. But these black eyes are more than troubling and remind us that when our doctor says we don’t need a medication or antibiotic, don’t be in a rush for a prescription. And take just a moment to consider: Do you really want a prescription to lose a few pounds, or treat restless legs, dry eye, irritable bowel, to get it up, or fuss with minor variations in risk factor numbers?


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Another example of cognitive disconnect

A reader from Australia sent in this wonderful example of cognitive disconnect surrounding news there that the “Obesity epidemic is spinning out of control.” Despite increasingly more Australians over the past ten years eating their fruits and vegetables, getting regular exercise, and not smoking or drinking, it has made no difference in rates of overweight or obesity.

But, but... “everyone knows” that eating “badly” and not exercising cause obesity.

So, even though the evidence continues to demonstrate that eating right and exercising don't impact obestiy rates, the proposed solution is: do it more!

Yup, that’ll work.

The Sidney Morning Herald reported this morning:

A report card on the state's health released by NSW Health today shows more than half the state's adult population is overweight or obese, up from 41.8 per cent 10 years ago. Data collated for the 2006 NSW Population Health Survey shows messages about the importance of regular exercise, adequate fruit and vegetable intake and the dangers of smoking are getting through...

More than half of all adults now eat the recommended minimum of two serves of fruit a day, jumping from 46.1 per cent a decade ago to 53.4 per cent. And more than 40 per cent now eat three or more vegetables a day, up from 34 per cent. Almost 55 per cent exercise enough and the number of people drinking at risky levels is down 10 per cent to 32.8 per cent....

[Adrian Bauman, professor of public health at Sydney University] said: “We need societal change - we've got to get serious about portion size, junk food advertising to kids and food labelling - so we can engineer the choices we make."

Health Minister Reba Meagher said the Government had launched a series of major initiatives in recent years to tackle obesity and promote better health, including the Live Life Well campaign, an interactive website providing tips and practical advice on smoking, exercise and good nutrition. “Individuals need to take responsibility for their lifestyle choices ....

Just weeks ago, we reported the results of the clinical trial conducted in 29 medical clinics across Melbourne to teach healthy eating and lifestyles to overweight children and their families. This intervention program proved ineffective. In February, we posted the results of the NSW Health report which found that “children are more active today than they were in 1997, while the incidence of overweight and obese children continues to climb.” Today’s kids are bigger and more active.

Just where is this crisis? The biggest disconnect came in January, when the Australian Bureau of Statistics released its findings that Australians are among the longest-living people in the world, even though according to the International Obesity Task Force, they’re supposedly the fattest in the world, too. So much for the “obesity shortens life” theory!

The facts continue to be so inconvenient to government agendas to “engineer” lifestyle choices. :)


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May 26, 2007

Speaking up

Most of us stopped believing a long time ago that politicians will ever follow good science. I guess that’s why it’s called politics. :)

When Montgomery County, Maryland, became the first county in the nation to totally ban trans fats this week, people who may not have believed before that any public official would actually take the junk science seriously, have been speaking out. The public reaction has been one of outrage and incredulity.

We’ve examined here how the trans fat scare campaign has tried to convince lawmakers and the public that this “unnatural fat” is deadly and even the tiny amount in our diet is a “risk factor” for everything from heart disease, cancer to infertility. The trouble is, there isn’t even a credible association they can hang their hat on. Not a single population study has been able to show even a link between trans fats or any other dietary fat and heart disease. Not only has our consumption of trans fats not changed in half a century, while we’ve been eating all of this supposedly bad stuff, the actual health of Americans has improved enormously, we’ve gained more than seven years in life expectancy; and heart disease and most cancers have dropped.

This isn't just opinion. The FDA, after spending years reviewing all available evidence on trans fats, said in its July 9, 2003, 260-page ruling (Docket No. 94P-0036), that any fears of a public health concern from the small amounts of trans fats in our diets were not supported by the evidence. These fatty acids haven’t been shown to be better or worse than any other dietary fat. The FDA expert panel specifically stated that trans fats needn’t be eliminated from the diet and they refused to establish a daily recommended intake due to lack of evidence. They agreed to add trans fats to food labels, but only after explaining it was only in response to a relentless, decade-long activist campaign. But those labels are being used by certain interests as proof that trans fats hold some health danger that’s imperative to control.

The government invading private lives to the point of telling people what they can and can’t eat, purportedly to protect us from ourselves, especially given it’s been demonstrated to be unsupportable, has resulted in an especially vehement public outcry.

“Becoming the first county in the nation to ban trans fats probably resulted in backslapping and high-fives in the council chambers in Rockville,” one resident opinioned. “Is creation of another county agency, the Trans Fat Inspection and Enforcement Division, just around the corner?

Another wrote this: “Guns or margarine? Trans fat is banned in Montgomery County. A bill to ban assault weapons never made it out of committee. Trans fat vs. assault weapons. Which would you rather not face on the street? Does something seem wrong here?”

The trans fat hysteria is spreading across the country — fears will do that when people let them. But Phil Maymin wrote a poignant commentary in the Hartford Courant, calling for some sanity and critical thinking. Speaking to those who might have gotten taken into believing the move to bans trans fats has merit, he said that by letting the government take away this choice, when they take on other personal choices, you won’t be able to argue later that it’s none of their business. And the next thing they decide to control or take away might be something you like. It’s well worth reading.

Keep the government out of my clogged arteries!

Do you think lawmakers in Hartford should decide what you can eat ...[and] keep unhealthy options away from you? They’ve taken one step closer to banning trans fats from being used in any restaurant in the state, not because the production of trans fats uses child labor, not to reduce our dependence on foreign trans fats, and not even because trans fats deplete the ozone. None of those tired excuses for interfering in your life were even trotted out.

This was pure paternalism. They think it’s bad for you. Therefore, you shouldn’t have the option to decide otherwise. Can’t a guy even eat a nice, greasy basket of fries anymore without the nanny state slapping his hand? Eating trans fat does not cause more crime or put pushers on school grounds (“Hey, buddy, want some trans fat?” is not a commonly heard schoolyard expression).

...Who gets to make decisions about your life and the amount of risk you can take? Can you go skydiving? Rock climbing? Can you attempt to hike Mount Everest, or should we file papers for permission from Connecticut’s Senate Deputy Minority Leader ...Perhaps you are okay with this legislation, even though it was underhandedly tacked on as an amendment to a bill to repair a swimming pool....

The real issue isn’t even about the trans fat. It’s about who runs your life when not a single other person is even remotely involved. As an aside, if you think the government should make this decision for you because otherwise you would be eating up public funds with health-care costs, then that same logic applies to the government deciding your friends, job, dates, hobbies, etc., because otherwise you might be depressed or hospitalized and take up public funds again....


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"Figure flaws"

It is simple to make impressionable, vulnerable young people feel self-conscious, inadequate and bad about themselves. Cruel, but easy to do. Young girls, who are held to higher standards and expected to be beautiful in our culture, are especially easy prey. Pointing out a natural feature that makes them unique or is different from a cultural ideal of beauty, and convincing them the “flaw” is so ugly that because of it they will never be loved or successful in life, is pretty much the marketing tactic used by the weight loss industry for the past century. Lovely, healthy girls around the world have been made to feel they are "too fat" and their bodies are all wrong. Over recent decades, weight loss interests have added another dimension to the body angst by frightening people into believing their “figure flaws” are evidence of bad behavior and nothing short of an anomalous disease that’s sure to spell disability and early demise.

Creating a desperate willingness to do anything necessary to be acceptable and “fit in” has sadly become so common and unquestioned, it’s not only led to unprecedented dieting behaviors and eating disorders, it’s made even recreational surgery a source of entertainment, with make-over shows going to any extreme to transform everyone into look-alikes. There’s lots of talk about how media influences young people, but few talk about the harmful effects on girls of having their confidence stripped when they’re given the message that only one idealized vision of beauty is acceptable and "fit": tall, thin, blond, white and young.

The Onion wrote a satirical piece a few years ago about a children’s book promoting plastic surgery for little girls — nose jobs, breast implants and lipo-suction. As satire often does, it hits very close to home.

New Children’s Book Helps Kids Deal With Pain And Isolation Of Plastic Surgery

...As the book opens, Norah, a little girl who inherited her father's "generous" nose, is peering out her bedroom window at the moon. “‘Good night!' Miss Moon said to Norah," the book reads. “But although the beautiful Miss Moon said good night to Norah, she said it the same way Mommy says good night to homely Miss Crabgrass or creepy old Mr. Kratch. Norah became very sad." ... “It isn't Miss Moon's fault she can't see your inner beauty," Mommy gently tells Norah. “Miss Moon may be very special, but she isn't all powerful." Using an enchanted mirror, Mommy shows Norah the difference between her own perfect nose and her daughter's “big, broad, bulky bird beak." Norah starts to cry, but Mommy assures her that doctors at the hospital can solve her problem, just like they solved Mommy's.

“I wanted to show these kids that the changes they go through in the plastic-surgery ward are normal and natural,"[pediatric plastic surgeon, Dr. Jessica] Krieg said. “It's not like getting your tonsils out. It's something to make you even better instead of just barely good enough."...

... “I like the part where Lissa The Thin-Lipped Butterfly changes from a butterfly into a beautiful betterfly," said Amanda Robles, 8, a collagen-therapy patient from Long Beach, CA. “She'll win all the butterfly pageants now. And even though Matt R. Pillar now pays attention to her, she realizes she's way too good for him."

... “It's just like what Miss Moon tells Norah at the end, after she comes back home with her beautiful new nose: 'My dear, now that you are as beautiful as a little girl can possibly be, all those people are just jealous.'"

Creating shame about being fat — feelings of being mortified, rejected and desperate to fit in — has proven immensely profitable for the weight loss industry. More recently, an intense marketing campaign has ensued to promote bariatric surgery for young teens, at a time in their lives when every one feels the most insecure and vulnerable. You can’t miss all of the television specials and “documentaries.” Last month, Cincinnati Children’s Hospital Medical Center, was awarded a $3.9 million grant from the National Institutes of Health for an “observational study” — Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) — to evaluate the effectiveness of bariatric surgeries in teens. However, it will be too short in duration, as needed for any credible weight loss intervention to determine long-term effectiveness or clinical outcomes. It has been designed to end while the patients are still in the well-recognized “honeymoon” period — before the inevitable weight regain and long-term health problems are fully evidenced. Instead of health, it will have to rely on false surrogate endpoints (“risk factor numbers”).

As Dr. Paul Ernsberger, Ph.D., an associate professor of nutrition at Case Western Reserve University in Cleveland and bariatric expert, explained in a March Bloomberg article, when it comes to surgeries, there isn’t anything like the FDA to make sure something has been shown to be safe and effective. “The only limit is malpractice suits. In the case of weight loss surgery, doctors are insulated by an NIH panel, a panel mostly made up of people doing the surgery.” The results of this NIH study won’t be published until 2012 or later. Meanwhile, even before this semblance of evidence is available, the industry is actively promoting bariatrics and lap bands among teens and young women.

Today’s news brought a troubling story revealing the marketing of bariatric surgeries in India by targeting poor, underprivileged girls in small towns and playing on their fears and those of their families that they’ll never be matched up with a suitable husband unless they are slim. The industry appears to have found a unique venue by appealing to matchmakers, nayans. Arranged marriages have been part of Indian culture since the fourth century and 95% of today’s marriages there are arranged, according to Emory College. As Express India reported today, this marketing tactic has resulted in a surge of bariatric surgeries among poor and young girls:

Honey, I shrunk the fat for you...

...[S]mall town girls too, seem to have been hit by a ‘get slim’ syndrome. Considered a privilege of the rich and the famous — with Bollywood leading the brigade — now, young girls from small cities and dusty towns have no qualms about going under the surgeon’s knife to get rid of those extra pounds. Sample this: Last 11 months saw a sudden jump in number of people ready to take physical and monetary pains for a more ‘presentable’ look. Of the 100 bariatric surgeries or gastric bypass done at Ahmedabad, 50 per cent of the patients were females. And, the bulk of them comprised young girls from small cities like Rajkot, Mehsana, Jamnagar and towns such as Surendranagar and Lathi.

Three months ago, on a husband-hunting mission, 22-year-old Shruti Dholakia from Rajkot underwent the gastric bypass surgery at the Asian Institute of Gastroenterology Surgery at Ahmedabad — one of the three centres in India....“It was becoming difficult to even arrange a meeting with prospective grooms. I seriously had to consider the option for surgery,” [her father] said.

The case of a 21-year-old from Lathi in Surendranagar district is no different, with worried parents ready to shell out a few lakhs to help their daughter cut a fine figure. And, with advanced technology and surgical facility calling, girls are all for the famed nose job or liposuction. Parents too, do not cringe at doling out Rs 1 to 3.5 lakh [about $9,000], for getting the right groom....


In Taking Up Space, psychologist, Dr. Pattie Thomas, Ph.D., writes about the need for a powerful voice of truth in a world that keeps women in their place with pressures to be thin and disenfranchises those who don’t measure up — not just by being fat, but also a poor, working-class, aging, minority or disabled.

“Fat people are the first line of defense in a political economy designed to make all people feel dissatisfied with their bodies and then exploit that dissatisfaction for profit,” she wrote. It’s not just a fight of fat people, but those of all sizes, because the starving of an entire population in the name of health threatens everyone. “What is at stake is nothing less than the freedom for all of us to be what our bodies are meant to be. We are fighting for our beings, our lives.”

The private has become public. The government, medical professionals, public health officials, insurance companies, pharmaceutical companies, employers, managed care providers, media and researchers have made our weights a social problem and are making money off what should be a private matter, she writes. Public initiatives over our bodies under the guise of an "obesity crisis" have become widespread and have targeted every aspect of our lives. "I believe telling people what to do with their bodies is the ultimate in limitation of the freedom of individuals." And when we blindly accept authoritative statements, rather than look to good science ourselves, we give them the power to oppress us.

Coming to appreciate our differences and the beauty of whatever body nature gave us, she writes, is to say that I get to decide what I value, what I enjoy and what I want. “A fat woman happy with her body is a dangerous thing in the current culture.” In fact, any woman happy with her body is a liberated woman...free to take up space.


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