Coca-Cola's Obesity Research Ends: Ethical True Science Wins

After FOUR years of not posting a single post (a very full time career and three very young children being the reason for the long sabbatical), I'm BACK!  I just couldn't help but post after reading about the retirement of Coca-Cola's Chief Scientist.

Rhona Applebaum, who was Coke's chief science and health officer, helped lead the creation of a nonprofit obesity working group, the Global Energy Balance Network (G.E.B.N.) last year. Coke spent $1.5 million last year on starting this group and nearly $4 million since 2008 supporting projects for two of G.E.B.N's founding members, academics who study obesity. Interestingly, the funding and direction from Coke was to focus the group's work on exercise and physical activity to reduce obesity, and to reduce and minimize the emphasis on calories and sugar's role in obesity (to improve Coke's image, and dropping sales, of course).

And as described in an earlier (August) NY Times blog post, the Global Energy Balance Network's (G.E.B.N.)  website is registered to Coca-Cola and they are the site administrator, because the other team members "didn't know how to set it up."  And in email communication between the G.E.B.N. University of Colorado researcher Dr. James Hill and Coke execs, "...provide a strong rationale for why a company selling sugar water should focus on promoting physical activity. This would be a very large and expensive study, but could be a game changer. We need this study to be done.”  Riiiiight; of course they need it to be done, because it means lots of [unethical] funding. 

 This is definitely a case of true, valid, ethically-produced science versus large corporations and profits. May science always win, science that is backed with ethical monies anyway. As shown in one of this post's images, "Honesty is the best policy." To give Coke some credit, there is more to the obesity problem than well, Coca-Cola, sugar, and calories. However, to shift (and fund) research 100% away from dietary intake and to other aspects (physical inactivity) is immoral, unethical, and flat-out wrong. It misleads the public and average consumer. What do you think about this controversy? What do you think are primary drivers of the obesity epidemic; and more importantly, what sources did you draw on to develop those opinions?  Also, do you drink Coca-Cola?

For More, Visit:

NY Times Blog

Bloomberg

Baby in Bed with Butcher Knife Ad Generates National Reactions

We've all heard that sleeping with your baby in bed with you is somewhat risky.  Soft blankets, a soft mattress, parents rolling on top of their babies...there are plenty of ways a child could suffocate and die by co-sleeping (and many children have).  Sudden Infant Death Syndrome (SIDS) is more common in co-sleeping families (babies in same bed as parents).

The city of Milwaukee is taking it one step further by scaring the $#% out of people by releasing these ads.  Equating a child sleeping in an adult bed to sleeping with a butcher knife.  Wow.

I'll admit it, as a breastfeeding-on-demand Mom, I sometimes lay my son next to me in bed in the middle of the night and we fall asleep together.  Call me an insane demon if you want, Milwaukee.  (Note--I do move pillows away from his face, he is not covered or twisted in our sheets, and our mattress is pretty firm--love our Tempur-pedic.  But I digress).

Here's the press release.  And here is CNN's video story about it.

What do you think?  Appropriate?  Too extreme?

Supreme Court on Health Care Reform: History in the Making

Today the Supreme Court announced they will make a ruling on whether or not health care reform is constitutional.  The arguments will be heard in February or March and a ruling will come in late June, just a few months before election time.  This is serious history in the making, people.

This follows the ruling from Florida and 25 other states where the appeals courts struck down the law (the only one of 4 cases).

Roughly speaking, the Supreme Court will decide on two main things: 1) if the individual mandate portion is constitutional and 2) whether the rest of the reform legislation should also be scrapped.

Stay tuned.

More detail can be read on CNN, NPR, Kaiser Health News, or NYTimes.

Eat Organic & Improve I.Q.

Are you eating organic?  If you're not and you are pregnant or planning on having a baby, you might want to consider it.  Three new studies have independently come out with results showing that babies exposed to pesticides in the womb have lower IQs than non-exposed babies.  Children with the highest levels of exposure scored 7 IQ points lower than children with the lowest levels of exposure.  Wow.

All three of these studies were published in the latest issue of the Environmental Health Perspectives Journal.

Read more about it at the NYTimes.  Or, read each of the three studies themselves.
1) Prenatal Exposure to Organophosphates, Paraoxonase 1, and Cognitive Development in Childhood.
2) 7-Year Neurodevelopmental Scores and Prenatal Exposure to Chlorpyrifos, a Common Agricultural Pesticide.
3) Prenatal Exposure to Organophosphate Pesticides and IQ in 7-Year Old Children.

If you're not able to go 100% organic, be sure to look at the Environmental Working Group's Shopper's Guide and at least eat the "dirty dozen" organic!

USDA's Releases New Guidelines

Yesterday, the United States Department of Agriculture (USDA) and the Department of Health and Human Services (HHS) released the new "Dietary Guidelines for Americans: 2010."  The guidelines come at an important time--when one of every three Americans is overweight or obese.  The main focus of the guidelines is to describe the need to balance calories, in terms of food and exercise, to manage weight appropriately and keep your health in check.

Some of the new food guidelines include:
1) Limit salt for healthy people to 2,300 milligrams.  For those with hypertension, diabetes, or kidney disease, or those over the age of 51, or African Americans of any age, salt should be restricted to 1,500 milligrams per day.
2) Alcohol should only be consumed in moderation, meaning: 1 drink a day for women, 2 drinks a day for men.
3) Make half of your plate fruits and vegetables.  Avoid over-sized portions of all foods.
4) Drink water instead of sugary drinks.
5) Less than 10% of your daily fats should be saturated and eat more polyunsaturated and monounsaturated (think nuts, olive oil, etc).

These guidelines are not extremely surprising, but important to take note of nonetheless.  Americans need to limit their daily intake of salt, sugar, bad fats, and alcohol.  Additionally, watch your portions.   Some of the messages for consumers can be found here.

The USDA will also be releasing a new food pyramid within the next month or two, so be on the lookout!

Meditation, Memory, & Stress

According to a study published yesterday in Psychiatry Research: Neuroimaging, meditation might alter your brain for the better.

A group of participants who underwent mindfulness meditation had increased gray matter in the hippocampus, which is where your learning and memory takes place, when compared to a control group.   They also had reduced gray matter in the amygdala, or the area where stress and anxiety occur.

The meditation was called Mindfulness-Based Stress Reduction (MBSR) and has origins in Buddhism, where one is supposed to focus on the here and now, being conscious of their breathing, body, and the here and now.  Basically, it involves getting to a place where you are not thinking of the past or the future (e.g. to-do list etc), but being completely focused on yourself in the present.  The lead author of the paper, Britta Holzel, discusses it in the NYTimes article on the topic.

This meditation has also been shown to reduce blood pressure and improve your attention span.  Although more research is needed to understand the mechanisms by which meditation impacts the brain (and larger studies, as this study only had 16 participants and 17 controls), it certainly is promising to improve one's health.

Have you ever tried it?  It certainly takes practice.  But it might be more practice I decide to do.  Will you?

Dime a Drink, What do you Think?

The state of Maryland is proposing a new tax on all alcoholic beverages.

There are a few reasons for this.  One is to reduce the amount of alcohol consumption.  Research has shown that as the price of alcohol rises, consumption decreases.  Supporters of the tax argue the tax could potentially reduce the number of alcohol-related deaths by 33 each year and reduce those with alcohol-related dependency by 13,000, according to a study done at Johns Hopkins..  This would save the state of Maryland $225 million in health care costs during its first year.

The second reason for the proposed tax is to fund the Medicaid expansion and mental health services for those with developmental disabilities or those needing drug abuse treatment.  The bill is expected to raise about $215 million per year for the state of Maryland.

The tax would be a 10 cent tax per alcoholic beverage, which translates to an extra $2.40 per case of beer.  The last time taxes were raised on alcohol in Maryland was in 1972.  The same bill was introduced in the last session of the Maryland assembly, but failed.  A 5-cent tax was proposed the year before that, also failing.  There are so far 54/141 state delegates who have signed on to the current bill.

Will it pass?  If so, will the funds be administered as they are proposed?

Happy New Year! New Health Law Changes In Effect.

With the start of 2011, a number of health law provisions are now in place. These include

1) Shrinking the "doughnut hole," meaning that seniors who fall into the doughnut hole (those who have spent between $2,840-$6,448 on medications, including what insurers pay) will now get a 50% discount on brand-name medications.  This compares to a $250 rebate they received in 2010.
2) Health insurers can use incentives (such as reduced premiums) for employees who join wellness programs or meet certain health targets. The discounts can be up to 30% of employee-related health insurance costs.  More info here.
3) Health insurance companies must now spend 80% (for small-group plans) on improving patient care, as opposed to spending on general profits/salaries, and admin costs.  If they fail to do so, they must give rebates to customers (starting in 2012).  This percent is 85% for large group plans.
4) Primary care physicians and general surgeons receive 10% more in reimbursements from Medicare.

5) Medicare will pay 100% of preventive care, meaning seniors on Medicare receive free health screenings (e.g. colorectal cancer, mammograms, etc) and other services (e.g. smoking cessation programs).
6) Medicare beneficiaries with annual incomes $85,000+ (for individual) or $170,000+ (for couples) will get smaller subsidies from Medicare Part D (prescription drug coverage)...and the start of higher premiums.
7) Holders of flexible-spending accounts will no longer be able to pay for most over-the-counter supplies with their accounts and will now require a prescription.
8) Community-Based Care Transition Program is underway, which is a Centers for Medicare and Medicaid Services (CMS) Demonstration project designed to put evidence-based care transition services into place for Medicare beneficiaries to reduce the risk of hospital readmissions and improve the quality of care for seniors.  Hospitals and community-based organizations apply to the Department of Health and Human Services to implement this program, based on other successful care transition models, which have eased the transition from hospital to home and reduced hospital re-admission rates.  More information found here.  .
9) Certified Nurse Midwives will now receive the same rate as physicians by Medicare.  They were previously only paid 65% of the physician rate.

Mandatory health insurance doesn't come into play until 2014.

For more information, check out: Kaiser Health News

Health Reform is Happening!

It's been 6 months since the health reform bill was passed.  Confused about what is in the health reform bill?  Confused about what it means for you?  About when things will occur?  Then, a great resource to check out is: Health Reform Hits Main Street, a short animated "YouToons" video by the Kaiser Family Foundation.

Last week (Thursday, Sept 23rd)  a number of provisions of the bill went into effect.  Six of them are as follows:   One, insurance companies (for employer plans) are no longer able to deny health insurance coverage to children with pre-existing conditions, such as diabetes or asthma.  Two, lifetime limits on coverage are dropped, meaning there is no lifetime limit on what you spend on hospital stays or other medical costs.  Three, free preventive care must be given by new health insurance policies purchased.  These things include preventive screenings, immunizations, and other preventive tests cannot have a copay.  Four, insurance companies are not allowed to drop you from coverage when you get sick and additionally, they can't look for an error on your application form and then deny coverage based on that.  Five, there is an expanded appeal process for denied claims, meaning you can do an external appeal to an independent third party (instead of just to your insurer directly).   Six, dependent children under the age of 26 can remain on their parent's health insurance policy, as long as their job doesn't offer insurance.  The under-26 population are currently one of the most likely to be uninsured groups, and allowing them to be on their parent's plan will generally save money (to pay for other provisions above) by allowing younger and healthier into the insurance pool to reduce the overall risk and thus, premium costs.  Go to Getting Covered.org if you have questions about how the dependent coverage rules work in your state.

Pop Quiz: What Disease Costs $600 Billion a Year and Has NO Cure?

The Answer:  Alzheimer's Disease.

According to the World Alzheimer's Report, released today, Alzheimer's Disease costs $600 billion, or 1% of the world's GDP.

Today is World Alzheimer's Day, a day to recognize this tremendous public health problem, create awareness, and to take action. To find events occurring world-wide, click here.

To tell your Congressional representative to vote for the National Alzheimer's Project Act (NAPA), click here. The goal of NAPA is to create a national inter-Agency group within the Department of Health and Human Services to come up with a national plan for fighting Alzheimer's Disease.

War Against McDonalds

The Physicians Committee for Responsible Medicine, a nonprofit advocacy group with a mission of promoting preventive medicine and conducting clinical research, released a controversial advertisement two days ago.  This ad shows a man on a gurney with his death grip (pun intended) on a fast food hamburger.  The end shows the McDonald's logo (the largest fast food chain and producer of high-fat, high-sodium, & high-cholesterol meals) with "I Was Loving It."

You can watch the ad by clicking here and can view the NYTimes story by clicking here.

What are your reactions?  Mine?  Finally someone is educating the television-viewing public about potential dangers and consequences of eating unhealthy.

UnMoral Minds

Wow, not even peer-reviewed journal articles are safe from false information.  Apparently a Harvard researcher, Marc Hauser, may have provided false, made-up data (at least for the control condition of the study) for a 2002 article published in the journal Cognition.  Although extremely rare something like this would happen, it's worth taking note of.  Sad to say, but this man will likely be looking for a new career. Ironically, he published a book called Moral Minds. It looks like someone teaching others about right and wrong has a few things to learn.

Read the story here.  And because I know you're interested (obviously I was), here is the man behind the story and his photo is at right.

Will You Develop Alzheimer's Disease? Do a Spinal Tap and You May Find Out.

I had to share this extremely interesting study.  It is one of the many findings found from the Alzheimer's Disease Neuroimaging Initiative (ADNI), of which I worked a research coordinator for at the University of Kansas Medical Center site.  One of the large $60 million study's goals was to look for biomarkers for Alzheimer's Disease.  Previously, the only definitive confirmation of an Alzheimer's Disease diagnosis was autopsy, whereupon one could see plaques and tangles in the brain.  


Published on Tuesday in the Archives of Neurology, was an article using results from ADNI to predict who with memory loss would go on to develop Alzheimer's Disease.  The authors were 100% accurate in using spinal fluid to make this prediction.  The article is titled, "Diagnosis-Independent Alzheimer Disease Biomarker Signature in Cognitively Normal Elderly People."  


Also interesting was the fact that the authors found this Alzheimer's Disease "signature" biomarker (presence of beta-amyloid plaques and tau tangles) in 36% of people who were cognitively "normal," or healthy people with no signs of memory loss.  Would you want to find out if you were going to develop Alzheimer's Disease or not?  It might be possible very soon.  


A cure though?  Not yet possible.  The current treatments for Alzheimer's Disease only treat symptoms, not the underlying disease.  This means the current medications will ease some of the disease's side effects, but the plaques and tangles will continue to build up in your brain and the disease will progress.  


Click here to read a NYTimes news article written about this same study.  

Real Men Go To The Doctor

Recent research shows than men are 24% less likely to visit a doctor than women are.  And they are more likely to be hospitalized for health conditions that could have been prevented.  

Thus, the Agency for Healthcare Research and Quality (AHRQ--where I am currently employed) released their public service advertising campaign yesterday to promote men's preventive health.  The timing coincides with Men's Health Week, which, for 2010, is June 14th through 20th.  Laura Landro covered the story in an excellent video for the Wall Street Journal (WSJ), which you can watch here.

Please encourage your friends and family to visit the doctor.  Simple preventive tests can detect diseases early, when treatment is easier and your health outcomes will be better.  Here is a list of preventive medical tests men should have completed. Immunizations and screening tests for body mass index, cholesterol, blood pressure, depression, sexually transmitted diseases, and colerectal cancer are just a few of the preventive tests that should be done. 

There are a number of campaign materials here, including television, radio, and print.  I highly suggest checking them out--they are effective, well-crafted, and really interesting!  I've included a couple of the print materials and an outdoor banner as the images for this story.

Attention Nonsmokers: Your Mental Health

According to a recent study published in the Archives of General Psychiatry, second-hand smoke could potentially be causing mental illness.  Yep, we know how bad smoke and second-hand smoke are for our physical health, including cancer risks, but it may also affect our mental health.  The risk of mental distress is higher among exposed nonsmokers than exposed smokers, 1.5 times higher for psychological distress and 3 times higher for psychological hospitalizations. Mental illness was defined as psychological distress, mainly meaning symptoms of depression and anxiety, and was measured with the General Health Questionnaire.  The authors additionally found the risk of psychiatric hospital admissions was higher for people exposed to second-hand smoke.  This study provides more reason to encourage your loved ones, coworkers, friends, and the public to quit the lethal habit.

Happy Birthday! Peel an Orange

A number of nurseries in the UK are trying something new for kids--no more birthday cake, or any sweets for that matter.  The elimination of the the age-old tradition of birthday cake is removed from children's diets as part of a program called the "Pre-school Nutrition Project," which is basically a program geared toward encouraging healthy eating.  It was set up by the Knowsley Borough Council and Chester University.  


I love this.  Stick a candle in an apple and I'm happy.  


But don't worry, birthday cakes and sweets are still allowed on the kids' birthdays--they just can't be eaten on-site.  The sweets will get sent home with parents, who can them decide on their own whether to allow their kids to indulge or not.  


Is this taking it too far?  Or is this a great idea to combat our overwhelmingly growing obesity problem and teach children healthy eating habits?  

Curative+Palliative=New Hospice?

Prior to health reform, Medicare (federal program for 65+ and disabled) only covered palliative (non-curative) care for individuals on Hospice care.  Hospice is both a type of care and a philosophy for terminally ill patients, focused on management and alleviation of pain symptoms and spending the end of one's life with friends and family in a manner of dignity and peace.  The focus is on quality of life, rather than lengthening duration of life, or providing cures, and occurs on one's home or a hospice facility.   


With health reform becoming law, Medicaid (state-federal program for the poor) must now provide both palliative care and curative care for children with terminal health conditions.  Additionally, Medicare is instructed to start approximately 15 demonstration projects around the US (rural/urban mix) to test this palliative and curative combination.  Basically, the demonstration projects will be 3-year programs allowing individuals to receive all currently covered Medicare services while simultaneously receiving hospice care.  If the demonstration projects show benefits (defined as the impact on patient care and quality of life) without increasing costs, this could become a new policy for Medicare.  It is listed as Section 3140 of the Patient Protection and Affordable Care Act (PPACA) (and its reconciled Healthcare and Education Reconciliation Act) and is called the Medicare Hospice Concurrent Care Demonstration Program.  


What do you think the outcome will be?  Will this combination of therapies work?  Will costs increase?  Does the addition of curative therapies confuse the point of hospice care (to end life peacefully and with dignity)? Will this make the end of life easier or more difficult for families? 

Robots & Quality Health Care

In yesterday's Wall Street Journal, John Carreyou talks about da Vinci (the robot, not the artist).  The da Vinci is a robot used to perform minimally invasive surgeries.  The machine costs between $1.4 million and $2.2 million and is manufactured by Intuitive Surgical.  It's operated by surgeons with joystick controls with the purpose of providing better visibility and greater flexibility and ease in surgeries.  

Tha da Vinci then is argued to be good for patients because leads to: less blood loss, smaller scars, and less infection.  Additionally, one study found da Vinci surgeries to cut hospital stays, thus reducing hospital costs by a third.  Sounds great, but what are the potential problems?


For one, if unexperienced doctors are performing these procedures, there could be harmful outcomes for patients.     


The da Vinci has been marketed as a technological advantage for small hospitals to be competitive with other hospitals.  One such hospital, Wentworth-Douglas Hospital, in Dover, New Hampshire, has been using the da Vinci for years.   The hospital has performed about 300 surgeries in 4 years.  As a comparison, individual robotic surgery experts, like Dr. David Samadi at Mt. Sinai, average 400-600 per year.  Now, Wentworth-Douglas hospital is under investigation for quality concerns with the robotic surgeries.  There have been some complications in surgeries, but the hospital also notes their da Vinci complication rates are below some recently published rates.


There isn't current data to compare the rates of complications across hospitals, comparing high-volume (high number of procedures in a year) to low-volume.  However, there is data on number of procedures and offsetting cots.  One recent study in the Journal of Urology said that doctors need to perform over 500 per year to offset costs of traditional surgery.


So how can we ensure that we can allow for technological innovation while ensuring consistently high quality medical care delivered to patients and keeping costs down?  If it takes continuous experience (i.e. high volume hospitals, specifically the physicians in the hospitals, performing the procedures frequently) to ensure top-notch quality, how do we ensure access to top quality to less-resourced areas?  Can we ensure equality in quality geographically?

The Skinny on Childhood Obesity

Yesterday, Michelle Obama led the White House Childhood Obesity Summit.  The meeting was a follow-up to her (much-needed) Let's Move Campaign she announced in February.  We all know childhood obesity is a problem and the first lady is getting some national discussions started on how to combat this public health epidemic within the next generation.  Both Health and Human Services (HHS) Secretary Kathleen Sebelius and Surgeon General Regina Benjamin have also stated their plans to help Americans stop the obesity epidemic.

One of the leading health policy journals, Health Affairs, released their special March 2010 issue (Vol 29, No 3), with the theme: Child Obesity: The Way Forward. In this issue, there are a number of great articles discussing implications of childhood obesity and potential next steps to combat it.


Regarding costs, John Cawley's article on "The Economics of Childhood Obesity," mentioned two interventions shown to be not just effective, but cost-effective in youth.  One is the Coordinated Approach to Child Health (CATCH) and the other is Planet Health (cost-effective for females).  He argues that we need to use policies and incentives to promote cost-effective interventions and to find other cost-effective measures to stop this problem costing us $14.1 billion in outpatient care and $237.6 billion in inpatient care each year (direct costs).  


So, what can we do and what's being done? Thomas Frieden, director of the Centers for Disease Control and Prevention (CDC) was the lead author on an action agenda, "Reducing Childhood Obesity Through Policy Change: Acting Now To Prevent Obesity," in the Health Affairs issue.  Recommendations include: food and beverage taxes, zoning policies, banning ads, counterads, increasing exposure to healthy foods, increasing physical activity, and decreasing sedentary behavior.  However, the food and beverage taxes would likely need to be pretty high as a study released last week in Health Affairs revealed soda taxes at 4% have no effect on consumption.  However, if the tax revenues are used to fund cost-effective interventions for childhood obesity, there is still potential benefit in these increased taxes, also noted by the authors.    The authors also called to duty: federal, state, and local governments, parents, the food industry, and businesses to act.


Additionally, issue and policy briefs were released in Washington DC.  The Senate Health, Education, Labor and Pensions (HELP) Committee started a series of hearings on child obesity and how to address the epidemic, with the first in the series being the Health Affairs hearing on March 2.  A number of stakeholders convened to begin discussions on what can be done, the built environment, and food policy. You can view the Health Affairs Issue Briefing here.  Aside:  One of the speakers was Debbie Chang, Vice President of Policy & Prevention for Nemours.  I consulted with Dr. Cynthia Minkovitz and the Johns Hopkins Women & Child Health Policy Center (WCHPC) on a policy scan last year regarding current policies practiced by youth-serving organizations to promote healthy eating and physical activity.  It's exciting to be a part of positive change for our nation.


What are your thoughts on the best way to fight childhood obesity?  What is the largest barrier to stopping the epidemic?

Health Affairs, 29, no. 3 (2010): 357-363

The theme issue for Health Affairs was supported by the Robert Wood Johnson Foundation.
Photo of Michelle Obama courtesy of Evan Vucci/Associated Press.

It's National Public Health Week!

We are halfway through National Public Health Week, which runs from April 5th-11th!! I thought I better get a quick post in to promote public health myself!

So what does Public Health do? Click here to find out!

Click here to view the Statement by Assistant Secretary for Health Howard Koh, MD, MPH.