Thoughts about Ebola...

1. Wash your hands. Often. Well.
2. Read this.
3. Remain calm. There is money to be made in this slo-mo panic. Don't let it be yours.

We return you to your regularly scheduled crises...

No PSA, please...

I have tried to avoid difficult conversations with friends and family about my conviction we are over-screening for cancer, especially breast and prostate. While I have numbers on my side, people do not want rational discussions - they want to live, and almost always at any cost (which they do not know) or any effort or even if the odds of successful treatment are small.

Mostly they embrace the idea that more screening can only be a good thing. The "Save Just One Life Standard" is a powerful calculus and frankly exploited by our medical industry. What is not understood is that to save that one life other lives are damaged or even sacrificed due to false positives, treatment consequences, and other unadvertised complications.

More evidence continues to pile up to illustrate how unreasonable our expectations from screening are.

The bottom half of this pic shows the actual effect of mammography. If we take 1000 women age 50 and watch them for 10 years, and don’t screen them, 5 will die of breast cancer, 44 will die of other causes, and 951 will be fine. If we do screen them, then 4 women die of breast cancer, 44 or 45 die of other causes, and 951 or 952 are fine. This is why the effects seem to be negligible.But if you ask women to estimate how well mammography works, then you’re in for a whole different ballgame. They think that without screening, of those 1000 women, 160 are going to die from breast cancer in the next 10 years. They way, way, way overestimate the danger. They also overestimate the effectiveness of mammography. They think that it will halve the rate of death, so that only 80 of the 1000 women will die from breast cancer.Therein lies the problem. If you think that breast cancer is going to kill 16% of all 50-year-old women in the next 10 years and that mammography makes a huge difference in the mortality rate, then you’re going to demand a universal screening program. Hell, I’d demand it if that were the case. Until we can change the perception of the public to more closely match reality, and make them realize that the harms may outweigh the benefits, we’re going to get nowhere in trying to make changes. [More]

Along those same lines, someone I know recently was diagnosed with prostate cancer, and promptly underwent a prostatectomy. After the operation, he was told his prostate and the lymph nodes removed showed no trace of cancer. His original biopsy was mixed up with another patient at the lab. While he did have symptoms it could have been benign BPH. I do not know all the facts, but often in these cases the urge to "cut that cancer out of me" is overwhelming and surgeons rarely suggest watchful waiting. (My physician brother always considered a surgeon as a doctor who believed there was nothing wrong with you that an expensive operation couldn't prolong.)

Many things went wrong - no second opinion and biopsy is one obvious fault. But our system refuses to accept that aggressive treatment is not always the answer, so there was no established procedure to slow the rush to surgery. Nor does a hyperactive litigation system offer real compensatory relief, IMHO.

I have always expected to talk a good game, but in the end melt down to a passive victim should I face such a diagnosis. But after simply telling my doctor to not check my PSA because I'm over 60 and have no risk factors or symptoms, I think I will be able to deal with the next level of decisions should the occasion present. Multiple experiences of friends and family with difficult treatments and dubious benefits reinforces my inclinations. Getting older also helps anchor our cost/benefit calculations, I think.

There is something about the process of learning and taking small steps that enables us to gain control of our lives. And we will never control health care costs until we control our own health care.

Are farmers committing suicide more often?...

This is exactly the kind of sloppy statistical writing that drives me nuts.  The topic (farmer suicide) looked (and is) serious, but as I read it became apparent the writers weren't interested in framing the numbers in a way that would be helpful to readers.

Since that crisis, the suicide rate for male farmers has remained high: just under two times that of the general population. And this isn't just a problem in the U.S.; it's an international crisis. India has had more than 270,000 farmer suicides since 1995. In France, a farmer dies by suicide every two days. In China, farmers are killing themselves to protest the government's seizing of their land for urbanization. In Ireland, the number of suicides jumped following an unusually wet winter in 2012 that resulted in trouble growing hay for animal feed. In the U.K., the farmer suicide rate went up by 10 times during the outbreak of foot-and-mouth disease in 2001, when the government required farmers to slaughter their animals. And in Australia, the rate is at an all-time high following two years of drought.Robert Fetsch, a retired professor of human development and family studies at Colorado State University, says there are profound social reasons farmers are reluctant to seek help. "Farmers are extremely self-sufficient and independent," he says, "and tend to work around whatever they have, because they are so determined to keep moving."One factor disputed among agricultural and mental health professionals is the connection between pesticides and depression. A group of researchers published studies on the neurological effects of pesticide exposure in 2002 and 2008. Lorrann Stallones, one of those researchers and a psychology professor at Colorado State University, says she and her colleagues found that farmers who had significant contact with pesticides developed physical symptoms like fatigue, numbness, headaches and blurred vision, as well as psychological symptoms like anxiety, irritability, difficulty concentrating and depression. Those maladies are known to be caused by pesticides interfering with an enzyme that breaks down the neurotransmitter that affects mood and stress responses."A lot of farmers are very familiar with the pesticides, so they sort of take it for granted," Stallones says. "It's an invisible kind of thing, so if you can't actually feel it, taste it, touch it, you might not believe it's an issue."Not everyone is sold on the link between pesticides and depression. "I don't think there's firm data on that yet," says Jill Harkavy-Friedman, senior director of research at the American Foundation for Suicide Prevention. A greater contributor to suicide in rural areas, she says, is the easy access to guns. According to the Centers for Disease Control and Prevention, most suicides in America involve firearms, and more than half of all firearm deaths every year involve suicide. Harkavy-Friedman points to a 1998 study published in The British Journal of Psychiatry that showed the most common means of farmer suicide in England and Wales from 1981 to 1988 was guns. Following firearm legislation in 1989 that reduced access to guns, the total number of farmer suicides went down. [More]

I should have seen it coming from the extravagantly photoshopped cover, but it really begs to be given context.  Which is why God gave us Google.

First off, the article tells a few stories about tragic suicides.  Fair enough, but those anecdotes prime us for interpreting any numbers as pessimistically as possible. The note the comparisons without any total. 

• "the rate for suicide for male farmers has remained high: just under two times that of the general population"  Let's unpack that.  To begin with, the male rate is always higher than the general population - men kill themselves more often.

[Source]

• So if they were talking about the true general rate, male farmers could be expected to have about twice the rate just because they are male - 20:12

• But if they meant twice the rate for other males, let's see what that looks like. Looking at white males in the US, it turns out the rate for farmers is not so out of line. In fact, it's lower than the rate for physicians, dentists, veterinarians, finance workers, chiropractors, heavy contruction operators, urban planners (?), handmolders (??), real estate sellers, electrical assemblers, lawyers, and lathe operators.
• Look at the above numbers from NIOSH on occupational deaths. They cover a period from 1984 to 1998. For farmers that added up to 94 suicides out of 4984 deaths. That's a little over 6 per year. When the numbers get this small annually even one or two deaths can bump the rate up dramatically.

What are the most recent numbers for farmer suicide?  Amazingly enough, it's hard to find out.  I use "The Straight Dope" as a kind of "Snopes" for these questions. Here's what they found out.

Well, it hasn't been easy to track this one, and I'm not sure I've got a definitive answer. Let's start by noting that suicide statistics are questionable at best. Many suicides are classified as "accident" to spare the family from publicity. So the statistics are only a rough indication.I easily found statistics on the Internet about suicides by age, region, gender, and race, but very little about occupation. Actually, since suicide is the second leading cause of death in the U.S. among those age 15 to 24, probably the answer is "student", but I don' t think that's what you're looking for.I called the library of the Society of Actuaries, thinking they'd know. The librarian said she used to work at a large psychiatric library, and that about 8 years ago, the answer was psychiatrists/psychologists/related. However, she couldnt quote me a source or cite a statistic, except what she says she knew. [More]

In fact, I spent an amazing amount of time trying to nail this statistical jello to the wall. And largely failed.  All the articles I found were slanted to assess blame, attack GMO's or Big Ag or pesticides, raise sympathy for (usually) smaller farmers, or persuade readers to support some cause.

Every now and then you would find a real number (I think) like this:

Still, Colorado state health officials recorded 4,012 suicides in the past five years; 53 were farmers, mostly men, who shot themselves. Bankrupt farmers have sought government help as bankers press for payments, often triggering the suicides. [More]

So that would mean about 10 farmers per year in CO alone. But without historical or comparative numbers it doesn't tell us much. And it sure doesn't jibe with the national numbers from NIOSH above.

I'm not going to waste any more time on this since it looks somewhat futile, despite the tragedy it represents. My conclusions:

1. All suicide stories evoke strong empathy, which primes our interpretation of data.
2. Assume any farmer suicide story to be slanted for persuasive purposes unless proven otherwise.
3. Suicide rates are distorted by low numbers, so disregard any claims of drastic rate changes. 
4. If guns are mentioned, remember while guns are a factor, their biggest influence is effectiveness - suicide attempts by firearm have a much higher success rate than other methods. I don't want to be dragged into an NRA rebuttal rant about guns and suicides, so I'm leaving it at that despite my own aversion.
5. What is happening in other countries, especially India, but also France and China, are largely cultural phenomena, and hard to apply to the US.

So when you read, as I did in Kevin Van Trump's daily newsletter, an account like this, note your reaction and don't leap to conclusions.

West Central Iowa - Two weeks ago my best friend and neighbor committed suicide. The whole community is in shock because this was one of the calmest, nicest guys I knew. He was a good farmer who had cattle and row crops. He worked harder than anybody I know. I talked to him almost every day. This past winter with all the snow and bitter cold for so long while having a lot of cattle, I think it just got to be too much. He knew it was going to be a late spring, had a ton of manure to get hauled because he didn't get much done during the winter, plus all the crops - just took a toll on him. So we all need to learn from this. If you feel stressed out, you either need to get more help or let some livestock or rented land go back. Also we need to watch out for each other. As I look back I could tell he was depressed but not in a million years I thought he would do something like this. There has been many times where I have thought instead of me owning the farm, that the Farm owns ME. Money isn't an issue, just too much work to get done, especially if you farm alone. Farming has changed so much since I started. Seems like the seasons were longer or something. People were more laid back. A lot more rush rush now. Anxiety can sure set in this time of year with looking ahead and so much to do.

Each event is a tragedy of its own, and thankfully, suicide is still rare enough to shock us each time. I don't think the link between suicide and farming is precisely enumerated nor well explained, just frequently spun. 

[A good (albeit troubling) thread on the aftermath of suicide is here.]

Hard to take seriously, but...

The gluten-free trend seemed to me to be a fad with natural limits and a definite lifespan, but like my belief GMOS's would eventually win the day, I seem to be badly mistaken. Proof: marketing vodka as gluten-free.

It's not just alcohol, of course. The new FDA label guidelines allow bottled water, vegetables and fruits to be labeled gluten-free even though these products do not naturally contain gluten. The FDA says gluten-free labeled products cannot contain any type of wheat, rye, barley or crossbreeds of these grains. The regulation also requires that the food does not contain an ingredient derived from these grains.The new labeling has created a marketing frenzy that may become a $6.2-billion gluten-free product industry by 2018, according to a 2013 report from research firm MarketsandMarkets. Some say the risk of cross-contamination warrants such broad labeling; others claim the FDA just made gluten-free living much more complicated.Although she is pleased with an FDA formal definition of gluten-free in labeling, Schluckebier notes the less than 20-ppm gluten allowance is likely to create an artificial sense of labeling security. A 2011 FDA report, “Health Hazard Assessment for Gluten Exposure in Individuals with Celiac Disease,” recommended the “most sensitive individuals with CD” eat foods with less than one-ppm gluten levels to protect them from “from experiencing any detrimental health effects from extended to long-term exposure to gluten.”But Taylor, for one, defends the FDA’s 20-ppm measure and assures celiac disease sufferers that there’s no risk in drinking distilled spirits. As he says: “the FDA and other public health agencies around the world have reviewed the evidence and concluded that products with less than 20-ppm gluten are safe for the vast majority of celiac sufferers.” [More]

The other lesson I learned is my skepticism that the complaints have any medical basis wither in the face of first-person confrontation with friends and family who have found their lives measurably improved by eliminating  gluten. Hard to argue with that kind of data. Not socially smart either (see, I am learning).

While $6.2B is a big number, the total food and beverage market is a $1.4T market, so some context helps. But the range of gluten-free-products continues to grow.

Why has gluten-free eating gotten easier? The Food and Drug Administration recently defined what it takes for a food to qualify as gluten-free. Before their ruling, there were no federal standards or definitions for the food industry to use in labeling products "gluten-free." As one of the criteria for using the claim "gluten-free," FDA set a gluten limit of less than 20 ppm (parts per million) in foods that carry this label. This is the lowest level that can be consistently detected in foods using valid scientific analytical tools. Also, most people with celiac disease can tolerate foods with very small amounts of gluten. In addition to limiting the unavoidable presence of gluten to less than 20 ppm, FDA allows manufacturers to label a food "gluten-free" if the food inherently doesn’t have any gluten such as bottled water, fruit, vegetables and eggs.This level is consistent with those set by other countries and international bodies that set food safety standards. While most products are accurately labeled, there is an estimated 5 percent of foods currently labeled "gluten-free" that contain 20 ppm or more of gluten. These manufacturers that want to use the phrase on their products must adhere to the strict guidelines. They will have until August 2014 to comply with the new regulations. [More]

The bigger issue here could be the impetus this gives to good labeling of all kinds. It's not hard to see a kind of "if it's good for gluten, then why not X" becoming the norm as retailers and manufacturers find there is market share gold in the fine print.

All this reinforces my feeling that GMO labeling will happen in some way or other eventually. That's a pretty vague prediction, of course, but it would take a popular tide reversal to change the inevitability of disclosure. I don't think Monsanto, et al, can spend enough to prevent it occurring.

In case you know someone...  

Who suffers from Parkinson's disease. At my age it's almost a certainty you will.

   

We can only hope, but evidence likes this undergirds those hopes.

This keeps popping up...  

No wonder the food industry is a tough market - consumers are a restless bunch. One particular idea that keeps popping up in new forms is the anti-carb concept. Three anecdotes:

1. A former NCGA president is dropping white carbs from his diet.  When I raised my eyebrows he ascribed it lamely to his wife, but did say he felt better and had lost weight. The better mental attitude was the claim that struck me.
2. At dinner the other night in a slightly too-trendy-for-me restaurant in the Chicago suburbs, I had to ask what the abbreviation "gf" stood for. (Gluten-free) The waiter explained it wasn't that people were gluten-sensitive, but rather a range of reasons why they wanted to avoid it.
3. Then there was this hidden note in an article about the most-highlighted passages in Kindle books. [For those who don't use a Kindle, it shows you how many people have highlighted a given passage, and of course, Amazon keeps track of such things. I have always been mystified by most of the selections]:

The bleakness of the worldview suggested by those passages is striking. It’s no surprise then, to find self-help passages appearing alongside them: They help us cope with our inherently flawed human selves. Stephen Covey’s The Seven Habits of Highly Effective People appears several times—“It’s not what happens to us, but our response to what happens to us that hurts us”—as does Dale Carnegie’s How To Win Friends and Influence People. Quotes about the healing power of God also make a strong showing, as do musings on the nature of marriage, and work, and leadership, and white carbohydrates. [More] [My emphasis]

Really? Carbs are one of the existential questions of our day? The fact this curious aversion has been around now since the Adkins diet suggests it may have enough penetration and longevity to seriously affect the American diet. Jan has decreased our potato/bread/rice intake surreptitiously enough I haven't really noticed anything except a deeper apprecation for French fries at the occasional meal out.

Like other seemingly hopeless trends in the US, perhaps a series of relatively small adjustments, rather than a massive campaign can actually affect a curve bending change. The last thing anyone expects is for people to solve the obesity problem on their own, but it's not impossible, I guess.

Not feeling well?...  

Move to Argentina. Seriously.

To show how astoundingly high our medical prices are compared to other first-world countries, WaPo put together a string of graphs. (Hint: The US average is the middle number)

[Many more here]

The US is shown as a range because unlike other countries, the prices paid here can vary wildly.

It's hard not to notice which two countries bookend the field. And to spot a singular problem with our system. While you can argue our health care is more advanced, why does that make the same prescription price so much higher here? The pills are identical.

There are two strategies emerging for dealing with this problem, and they don't overlap much. First, is the idea more free market action at the consumer level will empower them to bargain with medical providers. The second is using a matching large force - Medicare to face up to providers.

There is a sense in which the fundamental health-cost theories of Republicans and Democrats have become perfectly contradictory. Republicans believe Medicare is the singular problem contributing to the relentless growth in health-care costs, and the only way to truly fix our health-care system is to turn Medicare into a voucher system, breaking it up among private and public options and letting competition work its will.
Democrats look at the lower prices paid in single-payer countries as well as the lower prices paid by Medicare in this country and come away with a very different conclusion: We could be paying much less and getting much more, but the insurance industry, at the moment, doesn’t have enough power via-a-vis hospitals and other providers.
Medicare, as the nation’s largest payer, is thus the most promising solution to health-care costs, and Medicare should be using its bargaining power to lead the private market — in particular, by persuading hospitals and other providers to make overdue, but difficult, reforms to how they deliver care.
One ongoing example is electronic health records, which were long resisted by providers, but are coming into wide use now not just because the federal government helped providers pay for them, but because Medicare is going to start docking the pay of providers who don’t use them.
Therefore, for Democrats, breaking Medicare up into a mass of competing insurers removes one of the most powerful levers available for controlling health costs. “Medicare has enormous financial leverage to drive changes in medical practice,” Sebelius said. It’s not just that they think premium support won’t work. It’s that they think it would be actively harmful to the cause of cost control, and to do it right now, when medical costs are falling and the Affordable Care Act and all its Medicare-connected cost controls is just going into full effect, would be perverse. [More]

There is some evidence Medicare-like programs can reduce costs by lowering payments. One reason other countries have lower costs are the single payer power of their health systems.

Personally, I don't see much evidence individuals will bargain effectively with hospitals, etc. given the responsibility to do so. When I have done that and talked about it, people around me were horrified at my impudence. "How can you put a price on health?" they gasp. Well, we do it all the time, only we're not the ones with much say in the number.  Perhaps if it really comes out of our pockets we might shop around, but generally we're not in much condition, mentally or physically, to engage in commercial tactics.

Health care is not your usual consumer good, and I'm not sure applying the usual retail economics will take us to a place we want to be.
 

 

Meat eating is just the tip...  

Of the iceberg. While I support moderation in meat consumption...I guess...I have always been slightly skeptical of the more hysterical warnings. It seems science has plodded along as usual to moderate our most alarming suspicions.

The government, public health advocates, and the American Heart Association have long warned Americans that overconsumption of red meat can lead to heart disease and other ailments. Yet the scientific evidence supporting this hypothesis has always been weak. And in fact, this month's study isn't the first to fly in the face of these assumptions. A large study in Japan also found no increase in heart disease deaths from moderate meat consumption as well.
And last year, Harvard researchers published another similar large study. The media reporting on the study declared that researchers had found that "adding an extra portion of unprocessed red meat to someone's daily diet would increase the risk of death by 13%. The figures for processed meat were higher, 20% for overall mortality." But the Harvard data also showed that meat consumption had a protective effect for a lot of people. Up to a certain point, people who ate more of it fared better than those who ate little or none. The source of some of this confusion is simple: People who eat junk food are unhealthy in myriad ways that make it nearly impossible to zero in on a single food item as the source of their health woes.
To see what I mean, let's take a closer look at the EU study. Known as the European Prospective Investigation in Cancer and Nutrition (EPIC), it included more than half a million people from 10 European countries who were queried on a host of different factors, from how much and what they ate to their levels of education, their age, their weight, and whether they'd ever smoked. The study indicated that people who eat a lot of processed meats are also more likely to smoke, eat few fruits and vegetables, and have lower levels of education. They're much fatter and exercise less than the rest of the sample. And men in this category are also serious boozers. Oh, and the heavy meat eaters were older, too—so many of them were well into their 70s by the time they suffered the consequences of too many sausage rolls.
And the people who ate the most processed meat—which the study qualifies as more than 160 grams per day (about six sausage links' worth)—didn't only die of cardiovascular diseases and cancer, the things we associate with a bad diet; they also died of lots of "other causes," a category that includes car crashes, accidental injuries, and other non-food-related causes. (The study's big chicken eaters, on the other hand, were the Girl Scouts of the data pool: They don't smoke much, they eat lots of vegetables, exercise, go to college, and no doubt brush their teeth, wear seatbelts, and get regular checkups.) [More]

For some reason, this discovery reassures me of the self-righting feature of good research. It also supports my view that people tend not have a few bad habits, but many. I have no real backup evidence, and maybe we just don't notice the behaviors of those we like. 

And yes - this is from what many farmers would consider a "liberal" media outlet. But that's the beauty of being liberal or moderate - you can change your mind if the facts warrant it.

What if Obamacare...  

Has a positive effect on unemployment? While I have speculated that a whole bunch of farm wives in their 50's would tell some bosses where to put their job once they had access to the insurance market, this phenomenon might be more widespread than just ag.

 

The Employee Benefits Research Institute recently surveyed workers and retirees on how health care benefits factored into the timing of their retirement. The short answer is: A lot.
Three-quarters of retirees said they worked longer than they would have otherwise in order to maintain access to their health plan. A majority of current workers agreed with a statement that said they “planned to work longer than you would like in order to continue receiving health insurance through your employer.” [More from chart source]

Should retirement become an easier option for Boomers, some holes should open up for those currently unemployed or starting out. While I doubt those will be at the same salary, they at least are possible job opportunities.

Of course, access to health insurance is not the same as getting it free. And folks, especially conservatives bitterly opposed to and largely clueless about Obamacare are starting to realize how expensive coverage is, especially top-tier plans.

It turns out that the IRS published some final regs related to Obamacare recently, and in an effort to be helpful they provided some worked-out examples that include some assumptions about how much health coverage is likely to cost for various kinds of families. In one example, they assume that a worker can buy coverage for himself for $5,000 and coverage for his entire family of four for $20,000. They then work out the tax implications of all this.
So is this unusual? Not really. The average cost of healthcare coverage for a family is currently about $16,000, and by 2015 (the base year for the IRS examples) that will probably be around $18,000 or so. And that's for employer-sponsored plans. Individual plans are generally steeper, so $20,000 isn't a bad guess. It might be a little high, but not by much. And the family in question will, of course, be eligible for generous subsidies that bring this cost down substantially, thanks to the Affordable Care Act. They won't actually pay $20,000 per year.
So is this outrageous? An example of Obamacare run amok? Hardly. It's just an example of how damn much healthcare coverage costs in America and why we needed Obamacare in the first place. Apparently a lot of conservatives are shocked when they find this out. [More]

The main reason is pretty simple - we pay a lot more than other OECD countries for all kinds of care, from operations to prescriptions.

Similarly, if you compare U.S. health care spending to health care spending in foreign countries you see that again the main issue is just paying higher prices for the same services. It's not that Americans are unusually sick or that Americans use an unusually large amount of health care, it's that foreign countries engage in more nationwide price-setting to ensure low per unit prices for health care services. Sarah Kliff has a post making the same point in a new super-clever way. She's got this chart from the National Center for Health Care Reform where they looked just at America's unionized auto workers. That's a large and geographically dispersed population and it lets you compare high-cost regions to low-cost regions. And this is what you get:

 [More]

This is the relatively unknown upside to Obamacare: more Americans will get some first-hand knowledge of what their coverage costs, instead of a number on their pay stub.

Once this market knowledge is widely available, not only will the employment-insurance link be broken, but consumer choice will start taking effect. By opting for larger deductibles, for example families could take home more pay and make better choices about health issues.  We already suspect co-pays are changing how often we visit doctors.

And I think the medical industry will suddenly face a need to justify frankly insane prices. Consumers will make better choices about lifestyles as it becomes a financial decision as well as well-being. Everything we can do, such as exercising, eating more kale (blecch), or curbing some bad consumption habits (cough - drinking) will mean real savings to us, not our employer. The pieces will be in place for good market signals and economic nudges.

In other words, the much derided "socialist" nature of Obamacare could be a giant step toward a freer market in healthcare.

How weird is that?

Coffee vs. Coke...  

I think the HFCS market is slip-sliding away, but I did not see the downtrend in soda consumption becoming as pronounced as it has.

 Now look where we are: Soda is in a free fall, with domestic revenue down 40%. Coffee culture is ascendant, up 50% in ten years. In another decade, the United States could easily spend more on coffee than soda -- something utterly unthinkable at the turn of the century (industry data via IBISWorld) [More]

Like so much else, it is driven in part at least, by generational differences. And when Coke tried to staunch the bleeding with a 2-minute commercial, it did not impress much - in fact. it may have hardened anti-sugar positions.

This explains why the reaction to the commercial was immediate and derogatory, even in the advertising community. “Critics Jeer Coke’s Entrance Into Obesity Discussion” read a headline in a MediaPost blog. “The soda giant makes an awkward first stab at addressing obesity,” said AdWeek, which called the video  “shameless.” Among food and health writers, the response was mocking, perhaps best represented by Marion Nestle’s “Coca-Cola Fights Obesity? Oh, Please.”
...There is virtual consensus that drinking too much soda is bad for you, and it’s not hard to understand the evidence. I asked Rob Lustig, a pediatric endocrinologist at the University of California, San Francisco, and the author of “Fat Chance: Beating the Odds Against Sugar, Processed Food, Obesity, and Disease,” if he’d sum it up for me. His response: “A calorie is NOT a calorie. Different calories have different metabolic fates in the body.
Those from fructose overwhelm the liver, forcing the pancreas to make more insulin and driving more energy into fat cells. And soda is nothing but a fructose delivery system.”[2]
Soda is a fructose delivery system as tobacco is a nicotine delivery system. (And if it’s not “truly” addictive but only habit forming, so much the better; it’ll be that much easier to get people to cut back.) That’s why added sugar, especially in liquid form, is rapidly becoming the focus of savvy public health officials, scientists, physicians, journalists, parents and even politicians. And the ridiculous notion that government has no role in public health — the blind “nanny-statism” argument, which ignores everything from seat belts to tobacco to guns — is being overwhelmed by the tide of evidence, as demonstrated by a recent poll by The New England Journal of Medicine, in which 68 percent of nearly 1,300 respondents worldwide “favored government regulation of sugar-sweetened beverages." [More]

These are charges that may be more definitely proven, but if we have learned nothing else from GMO's, climate change, etc., it's that public perception doesn't wait for replicated studies or respect scientific consensus when it suits them.

 There is some kind of synergy I think developing with social media, search engines, economic discontent, and anti-consumerism that could rebuild our food system. From meat to drink, a growing number of people aren't just eating what's set in front of them.

The "survival rate" scam...  

As you wearily know, I am in the camp with those who think we are over-diagnoed, and over-treated especially when it comes to cancer. (I'm also recently dubious about hypertension). More and better ways of explaining this fundamental logic error are being found. Here's a good one:

Mortality rates define the number of people who die of a certain cause in a year divided by the total number of people.  For instance, the mortality rate for people with lung cancer in the United States is 53.4 per 100,000 people.
Survival rates are something else entirely.  They calculate the percentage of people with a disease who are still alive a set amount of time after diagnosis.  The five year survival rate for people with lung cancer in the US is 15.6%.
But here’s the thing.  You can only decrease the mortality rate by preventing death, or curing the disease.  That’s really it.  That’s a cure or a life extension, and both are unequivocally good.  Survival rate, however, can be increased by preventing death, curing the disease, or making the diagnosis earlier.
And there’s the rub.  Let’s say there’s a new cancer of the thumb killing people.  From the time the first cancer cell appears, you have nine  years to live, with chemo.  From the time you can feel a lump, you have four years to live, with chemo.  Let’s say we have no way to detect the disease until you feel a lump.  The five year survival rate for this cancer is about 0, because within five years of detection, everyone dies, even on therapy.
Now I invent a new scanner that can detect thumb cancer when only one cell is there.  Because it’s the United States, we invest heavily in those scanners.  Early detection is everything, right?  We have protests and lawsuits and now everyone is getting scanned like crazy.  Not only that, but people are getting chemo earlier and earlier for the cancer.  Sure, the side effects are terrible, but we want to live.
We made no improvements to the treatment.  Everyone is still dying four years after they feel the lump.  But since we are making the diagnosis five years earlier, our five year survival rate is now approaching 100%!  Everyone is living nine years with the disease.  Meanwhile, in England, they say that the scanner doesn’t extend life and won’t pay for it.  Rationing!  That’s why their five year survival rate is still 0%.
The mortality rate is unchanged.  The same number of people are dying every year.  We have just moved the time of diagnosis up and subjected people to five more years of side-effects and reduced quality of life.  We haven’t done any good at all.  We haven’t extended life, we’ve just lengthened the time you have a diagnosis.
Think this is far fetched?  In England women are screened by mammography every three years starting at age 50, yet in the United States the American Cancer Society recommends women are screened by mammography every year starting at age 40.  For a woman diagnosed with breast cancer in 2001, the five year survival rate in the US was 89.1%; in England it was 80.3%.
The mortality rates?  The American Cancer Society’s Cancer Facts & Figures 2009 reports it’s 25.0 per 100,000 women in the US and Cancer Research UK reports it’s 26.7 per 100,000 women in England.  That’s not as big a difference.  Hard to believe we’re spending almost two and a half times per person for health care what they do over there. [More]

Or to put it in picures:

[Source]

We are going to do some dumb, well-intentioned things to deal with health care costs. We have to. But there are better ways of making these decisions. Dealing with real numbers would be a start.

The explosive topic...  

Of over-screening, especially for breast cancer, just got some more evidence of misuse.

The reason is that no other medical test has been as aggressively promoted as mammograms — efforts that have gone beyond persuasion to guilt and even coercion (“I can’t be your doctor if you don’t get one”). And proponents have used the most misleading screening statistic there is: survival rates. A recent Komen foundation campaign typifies the approach: “Early detection saves lives. The five-year survival rate for breast cancer when caught early is 98 percent. When it’s not? It decreases to 23 percent.”

Survival rates always go up with early diagnosis: people who get a diagnosis earlier in life will live longer with their diagnosis, even if it doesn’t change their time of death by one iota. And diagnosing cancer in people whose “cancer” was never destined to kill them will inflate survival rates — even if the number of deaths stays exactly the same. In short, tell everyone they have cancer, and survival will skyrocket.

Screening proponents have also encouraged the public to believe two things that are patently untrue. First, that every woman who has a cancer diagnosed by mammography has had her life saved (consider those “Mammograms save lives. I’m the proof” T-shirts for breast cancer survivors). The truth is, those survivors are much more likely to have been victims of overdiagnosis. Second, that a woman who died from breast cancer “could have been saved” had her cancer been detected early. The truth is, a few breast cancers are destined to kill no matter what we do. [More]

As we grapple with health care costs, over-screening must be tackled. I don't think individuals are prepared enough to objectively make these decisions (although that can change slowly, perhaps) and it isn't in the medical industry's interest to find ways to decrease services rendered yet. So despite all the railing about some government body deciding when and whether to treat, that seems the most practical method. We already are habitual bureaucrat haters, so not much to lose there.

The other minefield to be cleared is late-life care. With about 25% of all medial expense paid out in the last year, something has to change there as well. Feeding tubes are one example.

The benefits of a feeding tube -- helping elders who have forgotten how to eat -- seem so obvious that it is used on one-third of demented nursing home residents, contributing to a growing device market worth $1.64 billion annually.
Except it does little to help. And it can hurt.
Decades after the tube achieved widespread use for people with irreversible dementia, some families are beginning to say no to them, as emerging research shows that artificial feeding prolongs, complicates and isolates dying.
The tale of the feeding tube, known as percutaneous endoscopic gastrostomy (PEG), is the latest installment of "Cost of Dying," a series exploring how our technological ability to stave off death creates dilemmas unimaginable decades ago, when we died younger and more quickly.
Food is how we comfort those we love; when all other forms of communication have vanished, feeding remains a final act of devotion. So the easy availability of feeding tubes forces a wrenching choice upon families: Do we say yes, condemning a loved one to dependency on a small plastic tube in their stomach? Or do we say no, consenting to their death?  [More]

We are losing any familiarity with the death process, and our fears of death simply override reason. Too much medical treatment complicates impending death.

Almost all dying patients, even those who are hand-fed, lose their interest in eating and drinking; this is the body's signal that death is coming, according to palliative care providers. If food is not artificially provided, patients typically die within two weeks, although exceptions are common. Lack of food triggers a biochemical process called ketosis, which actually blunts hunger and eases discomfort due to the release of natural morphine-like agents.
"We are putting in feeding tubes much too quickly," concluded Dr. Joan M. Teno of the Center for Gerontology and Health Care Research at Brown University Medical School.
"We're thinking: It's nourishment," said Teno, author of some of the field's most influential studies. "We don't think of the myriad reasons they cause problems." [Same as above]

Updating our medical POA's is clearly a necessary process to make sure those who care for us have emotional backup to make seemingly harsh decisions. Telling our children/spouse/etc. exactly what we think about our death process may seem gruesome and awkward, but the alternatives keep getting grimmer.

Sleep well?...  

You may never know. 

A number of studies have shown that drugs like Ambien and Lunesta offer no significant improvement in the quality of sleep that a person gets. They give only a tiny bit more in the quantity department, too. In one study financed by the National Institutes of Health, patients taking popular prescription sleeping pills fell asleep just twelve minutes faster than those given a sugar pill, and slept for a grand total of only eleven minutes longer throughout the night.

If popular sleeping pills don’t offer a major boost in sleep time or quality, then why do so many people take them? Part of the answer is the well-known placebo effect. Taking any pill, even one filled with sugar, can give some measure of comfort. But sleeping pills do something more than that. Drugs like Ambien have the curious effect of causing what is known as anterograde amnesia. In other words, ingesting the drug essentially makes it temporarily harder for the brain to form new short-term memories. This explains why those who take a pill may toss and turn in the middle of the night but say the next day that they slept soundly. Their brains simply weren’t recording all those fleeting minutes of wakefulness, allowing them to face each morning with a clean slate, unaware of anything that happened over the last six or seven hours. [More]

I always liked Steven Wright's answer: "No, I made a couple of mistakes."

The separation...  

Of Church and Plate. Agriculture has watched bemused as celebrities and the occasional real human embrace, umm...alternative diets.  But popular pastor Rick Warren takes it up a notch when he brings scripture to the menu.

This is a story about weight loss. Four young men are kidnapped by an invading army, forced against their will to their enemy’s teeming capital, into the heart of the palace of the enemy king. Their old names are taken away. Their clothing is stripped off, and they are dressed up in the stiff, stifling robes of the foreign court. They are kept under watch, instructed in a new language, forbidden the worship of their fathers’ god. They are offered riches and power in the king’s service, if only they give themselves over to the life of the court, sit at the king’s banquet table and eat his rich, strange food, answer to new names in a new language—if only they forget who they were. 

Did I say this is a story about weight loss? Excuse me: Pastor Rick Warren says this is a story about weight loss. The story is the Hebrew Bible’s Book of Daniel, and out of the wealth of details in this two-and-a-half-millennia-old book, Pastor Warren has plucked one in particular as the centerpiece of his church-sanctioned diet.
Daniel, one of the four kidnapped Jewish youths, “resolved not to defile himself with the royal food and wine,” and chose to subsist on vegetables instead, ending up as healthy as anyone in his captors’ court. So, as Time magazine recently reported, Warren has “launched the Daniel Plan, a comprehensive health-and-fitness program.” [More]

Actually, I have no problem with preaching against carbs, for example. But I think this is just one more example of ways fundamentalist orthodoxy can create conflicts with American ideals of freedom. Which is why we have wisely tried to keep as much daylight between government and religion as we have.

Bible-literalists in rural America may have to swallow hard to embrace this latest self-help interpretation from the same guy who launched a thousand study groups with "The Purpose-Driven Life".

• EAT Delicious Whole Foods
  Have 70% of your daily diet consist of whole, living foods including raw or lightly cooked vegetables, fruit, raw nuts and seeds. The other 30% can include lean protein, whole grains and starchy vegetables.
  Don’t drink your calories (sodas, juices, alcohol). Drink water instead.
  Read the label: Avoid high fructose corn syrup, hydrogenated oils, nitrates, food coloring.
  Avoid the “white menaces,” flour, rice, potatoes and sugar (bread, pasta, cookies, cakes).
  Supplement your diet with high quality vitamins Omega-3, Vit. D, and a multi-vitamin.
  Eat nutritious breakfast that includes protein. Add healthy snacks throughout the day. Low fat lunches. Light dinners (don’t eat within three hours of bedtime).

MOVE Your Way to Health
Stay active daily. Find ways to enjoy exercise. God made our bodies for movement.

• Begin improving your posture, flexibility and cardiovascular/aerobicconditioning.Lose weight faster with “burst” (interval) training. Read “How to Exercise” to guide you.
• Burn calories, gain strength using resistance training.

THINK Sharper and Smarter
Your decisions about the way you eat, move and think are results of your brain health.

• Get 7-8 hours of sleep per night. Stress less with deep breathing and exercise.
• Reverse risk of dementia and Alzheimer’s by learning something new: language, scripture.
• Avoid brain robbers like; alcohol, drugs, smoking, and sports that can cause concussions.
• Don’t believe the automatic negative thoughts in your head. Challenge and replace them with the truth! 

[More]

Aside from the admonitions against HFCS, rice, potatoes, etc., the warning about football will doubtless cause some controversy.  On the whole, the recommendations are in the mainstream of medical advice.

The problem for me is the same as the above writer: since when did Scripture devolve into a glorified self-help book? While it has always offered guidance for life, I don't find it to be the end authority on health any more than on science.

Strict "Biblical living" seems to have an attraction that reappears every so often in modern cultures. And time and again, the impracticality of its misuse reduces its power in areas where it can truly work miracles.

The Daniel diet is a good enough idea. Selling with a theological endorsement is inappropriate and unhelpful to both health and religion.

It's not just feed costs...  

There's the cage issue and now this:

 A new study suggests eating egg yolks can accelerate heart disease almost as much as smoking.

The study published online in the journal Atherosclerosis found eating egg yolks regularly increases plaque buildup about two-thirds as much as smoking does. Specifically, patients who ate three or more yolks a week showed significantly more plaque than those who ate two or less yolks per week.
It may seem harsh to compare smoking with eating egg yolks, but lead study author Dr. David Spence says researchers needed a way to put it into perspective since both eating cholesterol and smoking increase cardiovascular risks - but the general public believes smoking is far worse for your health.

The issue is with the yolk, not the egg, says Spence, who is also a professor of neurology at the University of Western Ontario's Schulich School of Medicine & Dentistry. "One jumbo chicken egg yolk has about 237 milligrams of cholesterol."[More]

Now throw into the mix news that long-range studies are sifting out some myths about cholesterol in general. For example, maybe there is no such thing as "good" cholesterol.

Cholesterol in the blood is carried by particles called lipoproteins, which come in different sizes and densities, according to the researchers. There is a well-established connection between elevated LDL levels and heart attack, and decades of research - including genetic studies similar to the new study - paved the way for the development of lipid-lowering drugs known as statins.
But research has been less clear on HDL, since a study more than 30 years ago found the higher levels of HDL a person had, the least likely they were to have a heart attack. Mouse studies since then have reported similar findings, but researchers haven't been able to prove the link conclusively. The new study may provide the clearest evidence yet of the role HDL plays, the researchers said.
"Through our research, we have found that all roads that raise HDL do not always lead to the promise land of reduced risk of heart attack," said study co-author Dr. Benjamin F. Voight, an assistant professor of pharmacology at the University of Pennsylvania, said in a university written statement. [More]

Even more alarming (to Big Pharma) is the heretical idea that statins aren't the panacea.

Statins such as Lipitor and Crestor are among the most widely prescribed drugs in the world. Their effectiveness in lowering LDL cholesterol has been firmly established; however, the overall impact upon the health of those using statins is questionable. Serious side effects such as liver damage, cataracts, muscle pain and renal failure have been known for some time, but thought to be rare; however recent evaluation of statin use outcomes reveals that the risks may in fact outweigh the benefits. Is the practice of prescribing statins as a preventative measure for individuals with borderline LDL likely to cause more harm than good? Perhaps, exercise, good diet and plant sterol supplements should be the vigorously endorsed as the frontline treatment, prior to any consideration of statin therapy. [More]

The egg yolk study strikes me as a little narrow and solitary in the research literature, but it was large enough to be respected. After having outlived a mound of bad press a few years ago, this cannot be helpful to the egg industry. If egg producers are infighting over cages, they may miss this health broadside that could really lose them some market share.

By the way, Doctor...  

Does treating for mild hypertension do any good?

Hoffman, of UCLA, says that it is always possible to dismiss “inconveniently negative” evidence, like that in the Cochrane review, because no study can test every possible dosage or combination of medicines or duration of treatment. Thus it is always technically possible that some untested formula might work. But he calls the Cochrane review “the best evidence currently available” about the effects of drug treatment on patients with mild hypertension and says that its results fit with what is known about diminishing returns—and the potential for dangerous side effects—when treating people with less severe disease. He also objects to the idea of treating “unless and until we know for sure that it’s a bad idea,” suggesting instead that “we shouldn’t subject patients to possible harm unless and until we have reasonably good evidence that it’s worth doing.”

Given the possibility that future trials will identify at best a small, currently nonapparent benefit, it seems clear that the best thing for doctors to do would be simply to tell patients the truth—that while the best current evidence doesn’t support routine treatment of mild hypertension, we really don’t know for sure. But we do know this: Emphasizing far more effective—and evidence-based—approaches, such as exercising, quitting smoking, and following a Mediterranean diet, seems to be a very good idea. And besides, they work. [More]

Another conversation I will be having at my annual physical.

Since House has been cancelled...  

We're gonna need something like this.

(Sorry lost the link and the point...)

I think it is fatuous to think this won't change the status and need for doctors. Moreover, this is one response to one part of the problem of healthcare costs.

But I think it would also reduce the spending on unneeded procedures and tests. That is ONE big issue for bending the curve.

Let's see, it's three hours...  

And nine minutes to South Bend (best ever). Slightly over 210 miles. So is this the equivalent of commuting 42 miles each way, 5 days a week?

That may explain my new suits and blood pressure meds...

In other words, a long commute is definitely bad for your blood pressure but it's positively disastrous if it ends up eating into your physical activity time. So a longish walk or bike ride to work probably isn't that bad, but a long drive is disastrous. I really firmly believe that the existence of persistent regular traffic jams is just about the most underrated problem in American public policy, especially because it's a problem we could almost certainly solve relatively easily with a mix of congestion pricing, demand-responsive pricing of street parking, and more bus service.  [More]

I can assume I'll drop 20# and 20 points on the diastolic when I retire, right?

It's officially out...  

The PSA test for prostate cancer, which IMHO, has been a Full Employment Act for Urologists, as well as a sales brochure for daVinci robotic surgery machines, is no longer recommended for any man.

The task force said it conducted a review of clinical studies of PSA testing, including a large U.S. study and a European one. The U.S. study didn't find a mortality benefit. The task force said the European study suggested a small benefit of no more than 1 in 1,000 men screened.
"Many men are harmed by prostate-cancer screening" with a PSA test, said Michael LeFevre, the task force's co-chairman and a professor at the University of Missouri School of Medicine. "Very few will benefit." The task force is made up of 16 nonfederal, primary-care providers who review preventative health services and make recommendations, primarily for primary-care doctors.
Dr. LeFevre said the task force recommended doctors could still offer the PSA test if men are informed about the risks and benefits of the test. The blood test is meant to detect a substance found normally in the prostate that is also made by cancer cells. Men with higher PSA scores typically have a higher risk of developing prostate cancer. But the test isn't perfect, and in some cases follow-up biopsies find no cancer. [More]

Arguing against this test is like arguing against breast cancer screening. That too, has failed to show any true benefit. What we cannot handle intuitively is the false positive problem. Our "better safe than sorry" mentality should be replaced with "worse likely harmed than rarely sorry". Neither popular screening generates any good for the vast majority as well as much harm for way too many.

Just say no, amigos.

The president, ctd...  

Thanks for the great comments. I'll respond in this separate post, as linking is a bear in the comments.

First:

"From VA":
1. For most objectors I know, it is more about the appropriate role and size of government. Not withstanding the many previous encroachments, if Obamacare stands, there is nothing in my life that the feds cannot dictate. The concept of limited government is gone completely and many of us find this a travesty.

2, Your own source says "The number of significant federal rules, defined as those costing more than $100 million, has gone up under Obama, with 129 approved so far, compared with 90 for Bush, 115 for President Bill Clinton and 127 for the first President Bush over the same period in their first terms." This is more than a 40% increase in the most burdensome regulations. Also, for aggies, think GIPSA, dust, child labor, and TMDL. I very definite pattern of increasing regulation impacting agriculture.

3. I have witnessed this administration "vetting" of very routine, perfunctory, commodity board appointments where they have indeed used Chicago tactics, and have confronted the most minor appointee with their record of campaign contributions.

4.I agree, no jamming.

5. I think it is not Obama as a person many aggies find repugnant, but it is his view of government and his belief that government always knows best that most of us reject.

Okay, in similar order:

1. Your objection to the mandate as THE line in the governmental size stand is typical.  It has been nicknamed the "broccoli argument"  as it requires an affirmative commercial action. There are two answers to this. First, we said the same thing about Kelo and imminent domain. I thought that was dumb decision as it trampled private property rights, but so far we haven't seen cities, etc. seizing land will-nilly. Second,

 The law’s critics, for instance, do not challenge rulings like Wickard vs. Filburn, which allowed Congress to forbid a farmer from growing his own wheat that he did not plan to sell. Of course, growing wheat for personal consumption is an elemental act of human civilization, a definitive act of a person who wishes to provide for himself and be left alone. Not coincidentally, some of history’s most monstrous tyrannies denied individuals the right to grow their own food unmolested – think of Stalin’s Russia, inducing a famine among the productive farmers of the Ukraine, who were forbidden from using their own time to grow their own food.

Indeed, if we imagine a reverse situation – in which conservatives were conceding the government the right to regulate “inactivity” but not “activity” – their hyperventilations over the perilous state of freedom in America would be more persuasive. The line between the laws legitimized by Wickard and real communist tyranny is actually quite thin. Instead they have managed to whip themselves into a frenzy by painting fantastical, concocted stories about the government forcing people to eat broccoli – as if they truly cannot imagine a legal or philosophical principle that would allow the government to enforce a health care mandate (that conservatives invented!) and not allow the government to force-feed broccoli to its population. [More]

2. Note the source (thanks for reading the link, BTW) does not compute any benefits, only costs. What does preventing another well blow-out count? The EPA and other regulators tackled some hard problems like finance reform that have already cost us billions. We can complain regulations cost us but as ethanol supporters like to shout, "Look at all the benefits!"  Regardless, I simply disagree with the perception there has been a "tsunami" of regulation. More, perhaps, but it is a matter of degree.
3. I think those type of tactics are now pretty standard across both parties, Look at how slow the Senate has been to confirm appointees.
4. N/A
5. I'm glad you are on a different e-mail spam list than me, VA. You might visit ag talk blogs or listen to Rush. I appreciate your objection is based on policy, but after three years of bad jokes when with other farmers, my opinion is as I stated.

But a truly insightful comment with which I agree followed (albeit mislocated):

Ed Arndt Rich. Co ND said...
John,

On Obama. I didn't vote for Obama but was willing to give him the benefit of the doubt. I had hoped he would stop the shredding of the constitution started by George W. Bush with the Patriot Act. However,under Obama and his attorney general Eric Holder, the process has been accelerated. Under sections 1021 and 1022 of the National Defense Authorization Act the government can indefinitely detain terrorist suspects. The suspect has no right or opportunity to defend himself or make an attempt to refute the governments action. Are we to believe the government will never make a mistake? Think about that for a bit.

Now consider this. On Mar. 5th, in a speech at Northwestern University, Attorney General Eric Holder made the astounding statement (astounding to me at least)that the constitution guarantees due process of law, but it does not guarantee judicial process. For all of my adult life I had always believed that due process of law included a public trial before judge and jury. Not according to Holder. Under Holder's version due process becomes whatever the government says it is, not open to public or even congressional scrutiny. Holder's remarks were referring to the killing of Anwar al Awliki by drone strike, and various arguments can be made in defense of this action. However, the precedents set by Holder's speech are terrifying. How long until some other branch of government decides that it is not obligated to provide judicial process and instead provides whatever due process the government decides will suffice? Under this scenario, what we have commonly held to be constitutional guarantees become null and void.

These things have not been much reported in the mainstream media. Why? Is the media keeping it a secret? Or does the media think(I fear correctly) that the public is not interested?

You can google "Eric Holder's speech at Northwestern University" for background on this subject.

I was irate when habeus corpus was decimated under Bush, and am dumbfounded that Obama has doubled down on this insidious attack on personal liberty. What is more profoundly troubling is this is still not invasive enough for the Republican party excepting the sane voice of Ron Paul. They are cheering him [Obama] on!

This matter is far and away more devastating to me than Obamacare, but that is the issue that the public wants to debate. In fact, the public seems OK with killing suspected terrorists, even if they are American citizens, under the thinking I guess it wouldn't happen to someone named Phipps, of course.

Until you are targeted by the president to be killed (as just a suspect), I suppose.