"Getting There from Here: How should Obama reform health care?" by Atul Gawande

Stolen from Hend :)

I <3 Atul Gawande, even if I have no idea how in the world he manages to find the time to research and write these amazing articles on health and healthcare in between his inevitably busy life as a surgeon.

In this piece, he (briefly) explores how other industrialized nations happened upon their own universal healthcare programs, revealing that the change was rarely a sharp policy or ideology shift but rather a transition (often caused by a national catastrophe) which build on a country's existing system. In doing so, he urges us to realize that if universal healthcare is going to be a reality in the US, we have to follow a similar example by building on or expanding our current policies, regardless of how haphazardly put together they may seem. "The [new] system," he says, "will undoubtedly be messier than anything an idealist would devise. But the results would almost certainly be better."

Article

Highlights:

"Every industrialized nation in the world except the United States has a national system that guarantees affordable health care for all its citizens. Nearly all have been popular and successful. But each has taken a drastically different form, and the reason has rarely been ideology. Rather, each country has built on its own history, however imperfect, unusual, and untidy."

"Social scientists have a name for this pattern of evolution based on past experience. They call it “path-dependence.” In the battles between Betamax and VHS video recorders, Mac and P.C. computers, the QWERTY typewriter keyboard and alternative designs, they found that small, early events played a far more critical role in the market outcome than did the question of which design was better."

Hm. Makes me think of The Tipping Point...

"Yes, American health care is an appallingly patched-together ship, with rotting timbers, water leaking in, mercenaries on board, and fifteen per cent of the passengers thrown over the rails just to keep it afloat. But hundreds of millions of people depend on it. The system provides more than thirty-five million hospital stays a year, sixty-four million surgical procedures, nine hundred million office visits, three and a half billion prescriptions. It represents a sixth of our economy. There is no dry-docking health care for a few months, or even for an afternoon, while we rebuild it. Grand plans admit no possibility of mistakes or failures, or the chance to learn from them. If we get things wrong, people will die. This doesn’t mean that ambitious reform is beyond us. But we have to start with what we have."

"It will be no utopia. People will still face co-payments and premiums. There may still be agonizing disputes over coverage for non-standard treatments. Whatever the system’s contours, we will still find it exasperating, even disappointing. We’re not going to get perfection. But we can have transformation—which is to say, a health-care system that works. And there are ways to get there that start from where we are. "

Can You Become a Creature of New Habits? by Janet Rae-Dupree (NYT)

Apparently,

... brain researchers have discovered that when we consciously develop new habits, we create parallel synaptic paths, and even entirely new brain cells, that can jump our trains of thought onto new, innovative tracks.

Definitely interesting, not to mention helpful if you're trying to get over old habits (or form new ones). Read more here, or highlights below.

But don’t bother trying to kill off old habits; once those ruts of procedure are worn into the hippocampus, they’re there to stay. Instead, the new habits we deliberately ingrain into ourselves create parallel pathways that can bypass those old roads.

Good to know!

Researchers in the late 1960s discovered that humans are born with the capacity to approach challenges in four primary ways: analytically, procedurally, relationally (or collaboratively) and innovatively. At puberty, however, the brain shuts down half of that capacity, preserving only those modes of thought that have seemed most valuable during the first decade or so of life.

If you’re an analytical or procedural thinker, you learn in different ways than someone who is inherently innovative or collaborative. Figure out what has worked for you when you’ve learned in the past, and you can draw your own map for developing additional skills and behaviors for the future.

"If you have a pathway to learning, use it because that’s going to be easier than creating an entirely new pathway in your brain.”

We tend to believe that those who think the way we do are smarter than those who don’t. ... If seniority and promotion are based on similarity to those at the top, chances are strong that the company lacks intellectual diversity.

One Country’s Table Scraps, Another Country’s Meal by Andrew Martin (NYT)

Sad, how much food we waste.

Highlights:

...the Department of Agriculture estimated that two years before, 96.4 billion pounds of the 356 billion pounds of edible food in the United States was never eaten. Fresh produce, milk, grain products and sweeteners made up two-thirds of the waste. An update is under way.

A more recent study by the Environmental Protection Agency estimated that Americans generate roughly 30 million tons of food waste each year, which is about 12 percent of the total waste stream. All but about 2 percent of that food waste ends up in landfills; by comparison, 62 percent of yard waste is composted.

America's Second Harvest — The Nation's Food Bank Network, a group of more than 200 food banks, reports that donations of food are down 9 percent, but the number of people showing up for food has increased 20 percent. The group distributes more than two billion pounds of donated and recovered food and consumer products each year.

In England, a recent study revealed that Britons toss away a third of the food they purchase, including more than four million whole apples, 1.2 million sausages and 2.8 million tomatoes. In Sweden, families with small children threw out about a quarter of the food they bought, a recent study there found.

And most distressing, perhaps, is that in some parts of Africa a quarter or more of the crops go bad before they can be eaten. A study presented last week to the United Nations Commission on Sustainable Development found that the high losses in developing nations "are mainly due to a lack of technology and infrastructure" as well as insect infestations, microbial growth, damage and high temperatures and humidity.

Of course, eliminating food waste won't solve the problems of world hunger and greenhouse-gas pollution. But it could make a dent in this country and wouldn't require a huge amount of effort or money. The Department of Agriculture estimated that recovering just 5 percent of the food that is wasted could feed four million people a day; recovering 25 percent would feed 20 million people.

The City of San Francisco is turning food waste from residents and restaurants into tons of compost a day. The city has structured its garbage collection system so that it provides incentives for recycling and composting.

The federal government tried once before, during the Clinton administration, to get the nation fired up about food waste, but the effort was discontinued by the Bush administration. The secretary of agriculture at the time, Dan Glickman, created a program to encourage food recovery and gleaning, which means collecting leftover crops from farm fields.

He assigned a member of his staff, Mr. Berg, to oversee the program, and Mr. Berg spent the next several years encouraging farmers, schools, hospitals and companies to donate extra crops and food to feeding charities. A Good Samaritan law was passed by Congress that protected food donors from liability for donating food and groceries, spurring more donations.

"We made a dent," said Mr. Berg, now at the New York City hunger group. "We reduced waste and increased the amount of people being fed. It wasn't a panacea, but it helped."

Poverty is Poison by Paul Krugman (NYT)

Busy/at work. Article

Highlights:

...neuroscientists have found that “many children growing up in very poor families with low social status experience unhealthy levels of stress hormones, which impair their neural development.” The effect is to impair language development and memory

In 2006, 17.4 percent of children in America lived below the poverty line, substantially more than in 1969.

But the distance between the poor and the rest of us is much greater than it was 40 years ago, because most American incomes have risen in real terms while the official poverty line has not.

According to one recent estimate, American children born to parents in the bottom fourth of the income distribution have almost a 50 percent chance of staying there — and almost a two-thirds chance of remaining stuck if they’re black.

That’s not surprising. Growing up in poverty puts you at a disadvantage at every step.

The study found, roughly speaking, that in modern America parental status trumps ability: students who did very well on a standardized test but came from low-status families were slightly less likely to get through college than students who tested poorly but had well-off parents.

None of this is inevitable.

The Revolution Will Not Be Pasteurized: Inside the raw-milk underground By Nathanael Johnson

Not sure how much of this to believe, but it's definitely interesting. The hippy side of me is intrigued.

"The very thing that makes raw milk dangerous, its dirtiness, may make people healthier, and pasteurization could be cleansing beneficial bacteria from milk."

Read more.

"A balance must be struck between health and yield" seems to be the take-home message, along with

"Although American consumers are periodically outraged by the realities of modern agriculture, they never stop demanding cheaper food. Stoker doesn't mind playing the hand he's been dealt. He's good at producing cheap food. But, he acknowledged, "cheap food makes for expensive health care." "

11 Odd but Simple Ways to Improve Your Health

Unconventional ways to improve your health

I'm down with all but 6 and 8 (they seem to product oriented and I know little about them); on the fence about 2 (only cuz I've never heard of that before).

A lot of it seemed focused on helping us detoxify gunk that builds up in our bodies.

i really need to fix my posture. again.

"You Walk Wrong" by Adam Sternbergh (New Yorker)

An article discussing how walking in shoes - any shoes - could be hurting our feet and knees.

Read here

Highlights:

"Brennan was an avid tennis player who suffered from chronic knee and ankle injuries. His father taught the Alexander Technique, a discipline that studies the links between kinetics and behavior; basically, the connection between how we move and how we act. Brennan's father encouraged Tim to try playing tennis barefoot. Tim was skeptical at first, but tried it, and found that his injuries disappeared."

For decades, the guiding principle of shoe design has been to compensate for the perceived deficiencies of the human foot. Since it hurts to strike your heel on the ground, nearly all shoes provide a structure to lift the heel. And because walking on hard surfaces can be painful, we wrap our feet in padding. Many people suffer from flat feet or fallen arches, so we wear shoes with built-in arch supports, to help hold our arches up.

"Here's another example: If you wear high heels for a long time, your tendons shorten—and then it's only comfortable for you to wear high heels. One saleswoman I spoke to at a running-shoe store described how, each summer, the store is flooded with young women complaining of a painful tingling in the soles of their feet—what she calls "flip-flop-itis," which is the result of women's suddenly switching from heeled winter boots to summer flip-flops. This is the shoe paradox: We've come to believe that shoes, not bare feet, are natural and comfortable, when in fact wearing shoes simply creates the need for wearing shoes."

^^ Totally happens to me when I work out in flat sneakers. Weeird.

"Consider a paper titled "Athletic Footwear: Unsafe Due to Perceptual Illusions," published in a 1991 issue of Medicine and Science in Sports and Exercise. "Wearers of expensive running shoes that are promoted as having additional features that protect (e.g., more cushioning, 'pronation correction') are injured significantly more frequently than runners wearing inexpensive shoes (costing less than $40)." According to another study, people in expensive cushioned running shoes were twice as likely to suffer an injury—31.9 injuries per 1,000 kilometers, as compared with 14.3—than were people who went running in hard-soled shoes."

... the impact on the knees was 12 percent less when people walked barefoot than it was when people wore the padded shoes.

In effect, we instinctively plant our feet harder to cancel out the shock absorption of the padding. (The study found the same thing holds true when gymnasts land on soft mats—they actually land harder.) We do this, apparently, because we need to feel the ground in order to feel balanced. And barefoot, we can feel the ground—and we can naturally absorb the impact of each step with our bodies.

"In one of the Rush Medical College knee-adduction experiments, barefoot walking yielded the lowest knee load, but a flat sneaker, like a pair of Pumas, also offered significantly less load than the overly padded walking shoes."

"South Asians face increased heart risk"

Damn. More motivation to work out?

The same yellow fat that hugs Ashok's heart also surrounds his other organs. This abdominal, or visceral fat, is much more active – and dangerous – than the fat found under your skin. It acts like a furnace to produce toxic fumes in the body, decreasing insulin sensitivity, reducing good cholesterol levels and raising blood pressure, all of which are risk factors for heart disease.

Sonia Anand, an associate professor of medicine at McMaster University and an international expert on the links between ethnicity and heart disease and diabetes, says South Asians are more likely to get visceral fat than any other ethnic group, even if they eat and exercise the same. People of South Asian descent are also more apt to have the same array of risk factors for heart disease as Caucasians, but at about 45 pounds lighter, she says.

"MN Health System Purges Its Hospitals and Clinics of Drug Company Trinkets"

Farah approved.

MINNEAPOLIS (AP) -- When a Duluth-based operator of hospitals and clinics purged the pens, notepads, coffee mugs and other promotional trinkets drug companies had given its doctors over the years, it took 20 shopping carts to haul the loot away.

The operator, SMDC Health System, intends to ship the 18,718 items to the west African nation of Cameroon.

The purge underscored SMDC's decision to join the growing movement to ban gifts to doctors from drug companies.

"I've never seen nor heard of a systematic roundup of pens and coffee mugs before," Johnson said. "It's a bit draconian. But the onus is on us now to do a better job of explaining the job and the importance of marketing representatives. Unfortunately there are a lot of cynics in America who want to think the worst."


SDMC's effort was motivated by a desire to show patients that its 450 doctors were serious about keeping prescription drug costs down and making unbiased medical decisions, Irons said.

The backlash against the cozy relationships between doctors and drug makers gained steam from article in the Journal of the American Medical Association in 2006. It said research had shown that even cheap gifts, such as pens, can affect doctors' prescribing decisions.

"The Checklist" by Atul Gawande (The New Yorker)

Lengthy highlights for a simple concept article. Irony? Check.

Article

Highlights:

Consider a case report in The Annals of Thoracic Surgery of a three-year-old girl who fell into an icy fishpond in a small Austrian town in the Alps. She was lost beneath the surface for thirty minutes before her parents found her on the pond bottom and pulled her up. Following instructions from an emergency physician on the phone, they began cardiopulmonary resuscitation. A rescue team arrived eight minutes later. The girl had a body temperature of sixty-six degrees, and no pulse. Her pupils were dilated and did not react to light, indicating that her brain was no longer working.

But the emergency technicians continued CPR anyway. A helicopter took her to a nearby hospital, where she was wheeled directly to an operating room. A surgical team put her on a heart-lung bypass machine. Between the transport time and the time it took to plug the inflow and outflow lines into the femoral vessels of her right leg, she had been lifeless for an hour and a half. By the two-hour mark, however, her body temperature had risen almost ten degrees, and her heart began to beat. It was her first organ to come back.

After six hours, her core temperature reached 98.6 degrees. The team tried to put her on a breathing machine, but the pond water had damaged her lungs too severely for oxygen to reach her blood. So they switched her to an artificial-lung system known as ECMO—extracorporeal membrane oxygenation. The surgeons opened her chest down the middle with a power saw and sewed lines to and from the ECMO unit into her aorta and her beating heart. The team moved the girl into intensive care, with her chest still open and covered with plastic foil. A day later, her lungs had recovered sufficiently for the team to switch her from ECMO to a mechanical ventilator and close her chest. Over the next two days, all her organs recovered except her brain. A CT scan showed global brain swelling, which is a sign of diffuse damage, but no actual dead zones. So the team drilled a hole into the girl’s skull, threaded in a probe to monitor her cerebral pressure, and kept that pressure tightly controlled by constantly adjusting her fluids and medications. For more than a week, she lay comatose. Then, slowly, she came back to life.

First, her pupils started to react to light. Next, she began to breathe on her own. And, one day, she simply awoke. Two weeks after her accident, she went home. Her right leg and left arm were partially paralyzed. Her speech was thick and slurry. But by age five, after extensive outpatient therapy, she had recovered her faculties completely. She was like any little girl again.

A decade ago, Israeli scientists published a study in which engineers observed patient care in I.C.U.s for twenty-four-hour stretches. They found that the average patient required a hundred and seventy-eight individual actions per day, ranging from administering a drug to suctioning the lungs, and every one of them posed risks. Remarkably, the nurses and doctors were observed to make an error in just one per cent of these actions—but that still amounted to an average of two errors a day with every patient. Intensive care succeeds only when we hold the odds of doing harm low enough for the odds of doing good to prevail.

This is the reality of intensive care: at any point, we are as apt to harm as we are to heal. Line infections are so common that they are considered a routine complication. I.C.U.s put five million lines into patients each year, and national statistics show that, after ten days, four per cent of those lines become infected. Line infections occur in eighty thousand people a year in the United States, and are fatal between five and twenty-eight per cent of the time, depending on how sick one is at the start. Those who survive line infections spend on average a week longer in intensive care. And this is just one of many risks. After ten days with a urinary catheter, four per cent of American I.C.U. patients develop a bladder infection. After ten days on a ventilator, six per cent develop bacterial pneumonia, resulting in death forty to fifty-five per cent of the time. All in all, about half of I.C.U. patients end up experiencing a serious complication, and, once a complication occurs, the chances of survival drop sharply.

Here, then, is the puzzle of I.C.U. care: you have a desperately sick patient, and in order to have a chance of saving him you have to make sure that a hundred and seventy-eight daily tasks are done right—despite some monitor's alarm going off for God knows what reason, despite the patient in the next bed crashing, despite a nurse poking his head around the curtain to ask whether someone could help "get this lady's chest open." So how do you actually manage all this complexity? The solution that the medical profession has favored is specialization.

Expertise is the mantra of modern medicine. In the early twentieth century, you needed only a high-school diploma and a one-year medical degree to practice medicine. By the century's end, all doctors had to have a college degree, a four-year medical degree, and an additional three to seven years of residency training in an individual field of practice—pediatrics, surgery, neurology, or the like. Already, though, this level of preparation has seemed inadequate to the new complexity of medicine. After their residencies, most young doctors today are going on to do fellowships, adding one to three further years of training in, say, laparoscopic surgery, or pediatric metabolic disorders, or breast radiology—or critical care. A young doctor is not so young nowadays; you typically don't start in independent practice until your mid-thirties.

Expertise is the mantra of modern medicine. In the early twentieth century, you needed only a high-school diploma and a one-year medical degree to practice medicine. By the century's end, all doctors had to have a college degree, a four-year medical degree, and an additional three to seven years of residency training in an individual field of practice—pediatrics, surgery, neurology, or the like. Already, though, this level of preparation has seemed inadequate to the new complexity of medicine. After their residencies, most young doctors today are going on to do fellowships, adding one to three further years of training in, say, laparoscopic surgery, or pediatric metabolic disorders, or breast radiology—or critical care. A young doctor is not so young nowadays; you typically don't start in independent practice until your mid-thirties.

In 2001, though, a critical-care specialist at Johns Hopkins Hospital named Peter Pronovost decided to give it a try. He didn't attempt to make the checklist cover everything; he designed it to tackle just one problem, the one that nearly killed Anthony DeFilippo: line infections. On a sheet of plain paper, he plotted out the steps to take in order to avoid infections when putting a line in.

These [5] steps are no-brainers; they have been known and taught for years. So it seemed silly to make a checklist just for them. Still, Pronovost asked the nurses in his I.C.U. to observe the doctors for a month as they put lines into patients, and record how often they completed each step. In more than a third of patients, they skipped at least one.

The next month, he and his team persuaded the hospital administration to authorize nurses to stop doctors if they saw them skipping a step on the checklist; nurses were also to ask them each day whether any lines ought to be removed, so as not to leave them in longer than necessary. This was revolutionary.

The new rule made it clear: if doctors didn't follow every step on the checklist, the nurses would have backup from the administration to intervene.

Pronovost and his colleagues monitored what happened for a year afterward. The results were so dramatic that they weren't sure whether to believe them: the ten-day line-infection rate went from eleven per cent to zero. So they followed patients for fifteen more months. Only two line infections occurred during the entire period. They calculated that, in this one hospital, the checklist had prevented forty-three infections and eight deaths, and saved two million dollars in costs.

The researchers found that simply having the doctors and nurses in the I.C.U. make their own checklists for what they thought should be done each day improved the consistency of care to the point that, within a few weeks, the average length of patient stay in intensive care dropped by half.

The checklists provided two main benefits, Pronovost observed. First, they helped with memory recall, especially with mundane matters that are easily overlooked in patients undergoing more drastic events.

...

A second effect was to make explicit the minimum, expected steps in complex processes. Pronovost was surprised to discover how often even experienced personnel failed to grasp the importance of certain precautions.

...

Checklists established a higher standard of baseline performance.

For his doctoral thesis, he examined intensive-care units in Maryland, and he discovered that putting an intensivist on staff reduced death rates by a third. It was the first time that someone had demonstrated the public-health value of using intensivists. He wasn't satisfied with having proved his case, though; he wanted hospitals to change accordingly. After his study was published, in 1999, he met with a coalition of large employers known as the Leapfrog Group. It included companies like General Motors and Verizon, which were seeking to improve the standards of hospitals where their employees obtain care. Within weeks, the coalition announced that its members expected the hospitals they contracted with to staff their I.C.U.s with intensivists. These employers pay for health care for thirty-seven million employees, retirees, and dependents nationwide. So although hospitals protested that there weren't enough intensivists to go around, and that the cost could be prohibitive, Pronovost's idea effectively became an instant national standard.

The scientist in him has always made room for the campaigner. People say he is the kind of guy who, even as a trainee, could make you feel you'd saved the world every time you washed your hands properly.

In 2003, however, the Michigan Health and Hospital Association asked Pronovost to try out three of his checklists in Michigan's I.C.U.s.

...

Sinai-Grace is a classic urban hospital. It has eight hundred physicians, seven hundred nurses, and two thousand other medical personnel to care for a population with the lowest median income of any city in the country. More than a quarter of a million residents are uninsured; three hundred thousand are on state assistance. That has meant chronic financial problems. Sinai-Grace is not the most cash-strapped hospital in the city—that would be Detroit Receiving Hospital, where a fifth of the patients have no means of payment. But between 2000 and 2003 Sinai-Grace and eight other Detroit hospitals were forced to cut a third of their staff, and the state had to come forward with a fifty-million-dollar bailout to avert their bankruptcy.

...

Meanwhile, the teams faced an even heavier workload because of new rules limiting how long the residents could work at a stretch. Now Pronovost was telling them to find the time to fill out some daily checklists?

Tom Piskorowski, one of the I.C.U. physicians, told me his reaction: "Forget the paperwork. Take care of the patient."

Pronovost had been canny when he started. In his first conversations with hospital administrators, he didn't order them to use the checklists. Instead, he asked them simply to gather data on their own infection rates. In early 2004, they found, the infection rates for I.C.U. patients in Michigan hospitals were higher than the national average, and in some hospitals dramatically so. Sinai-Grace experienced more line infections than seventy-five per cent of American hospitals. Meanwhile, Blue Cross Blue Shield of Michigan agreed to give hospitals small bonus payments for participating in Pronovost's program. A checklist suddenly seemed an easy and logical thing to try.

In December, 2006, the Keystone Initiative published its findings in a landmark article in The New England Journal of Medicine. Within the first three months of the project, the infection rate in Michigan's I.C.U.s decreased by sixty-six per cent. The typical I.C.U.—including the ones at Sinai-Grace Hospital—cut its quarterly infection rate to zero. Michigan's infection rates fell so low that its average I.C.U. outperformed ninety per cent of I.C.U.s nationwide. In the Keystone Initiative's first eighteen months, the hospitals saved an estimated hundred and seventy-five million dollars in costs and more than fifteen hundred lives. The successes have been sustained for almost four years—all because of a stupid little checklist.

Tom Wolfe's "The Right Stuff" tells the story of our first astronauts, and charts the demise of the maverick, Chuck Yeager test-pilot culture of the nineteen-fifties. It was a culture defined by how unbelievably dangerous the job was. Test pilots strapped themselves into machines of barely controlled power and complexity, and a quarter of them were killed on the job. The pilots had to have focus, daring, wits, and an ability to improvise—the right stuff. But as knowledge of how to control the risks of flying accumulated—as checklists and flight simulators became more prevalent and sophisticated—the danger diminished, values of safety and conscientiousness prevailed, and the rock-star status of the test pilots was gone.

Something like this is going on in medicine. We have the means to make some of the most complex and dangerous work we do—in surgery, emergency care, and I.C.U. medicine—more effective than we ever thought possible. But the prospect pushes against the traditional culture of medicine, with its central belief that in situations of high risk and complexity what you want is a kind of expert audacity—the right stuff, again. Checklists and standard operating procedures feel like exactly the opposite, and that's what rankles many people.

Pronovost remains, in a way, an odd bird in medical research. He does not have the multimillion-dollar grants that his colleagues in bench science have. He has no swarm of doctoral students and lab animals. He's focussed on work that is not normally considered a significant contribution in academic medicine. As a result, few other researchers are venturing to extend his achievements. Yet his work has already saved more lives than that of any laboratory scientist in the past decade.

I called Pronovost recently at Johns Hopkins, where he was on duty in an I.C.U. I asked him how long it would be before the average doctor or nurse is as apt to have a checklist in hand as a stethoscope (which, unlike checklists, has never been proved to make a difference to patient care).

"At the current rate, it will never happen," he said, as monitors beeped in the background. "The fundamental problem with the quality of American medicine is that we've failed to view delivery of health care as a science. The tasks of medical science fall into three buckets. One is understanding disease biology. One is finding effective therapies. And one is insuring those therapies are delivered effectively. That third bucket has been almost totally ignored by research funders, government, and academia. It's viewed as the art of medicine. That's a mistake, a huge mistake. And from a taxpayer's perspective it's outrageous ."

I asked him how much it would cost for him to do for the whole country what he did for Michigan. About two million dollars, he said, maybe three.

He's already devised a plan to do it in all of Spain for less.

"We could get I.C.U. checklists in use throughout the United States within two years, if the country wanted it," he said.

So far, it seems, we don't. The United States could have been the first to adopt medical checklists nationwide, but, instead, Spain will beat us. "I at least hope we're not the last," Pronovost said.

A High Price for Healthy Food by Tara Parker-Pope (NYT)

Article

Highlights:

The survey also showed that low-calorie foods were more likely to increase in price, surging 19.5 percent over the two-year study period. High-calorie foods remained a relative bargain, dropping in price by 1.8 percent.

Based on his findings, a 2,000-calorie diet would cost just $3.52 a day if it consisted of junk food, compared with $36.32 a day for a diet of low-energy dense foods. However, most people eat a mix of foods. The average American spends about $7 a day on food, although low-income people spend about $4, says Dr. Drewnowski.

How to Boost Your Willpower by Tara Parker-Pope (NYT)

So many links. Let's fly through them.

Article

Highlights:

Studies now show that self-control is a limited resource that may be strengthened by the foods we eat. Laughter and conjuring up powerful memories may also help boost a person’s self-control. And, some research suggests, we can improve self-control through practice, testing ourselves on small tasks in order to strengthen our willpower for bigger challenges.

By the foods we eat, eh? Perfect. PERFECT.

Last month, Dr. Baumeister reported on laboratory studies that showed a relationship between self-control and blood glucose levels. In one study, participants watched a video, but some were asked to suppress smiles and other facial reactions. After the film, blood glucose levels had dropped among those who had exerted self-control to stifle their reactions, but stayed the same among the film watchers who were free to react, according to the report in Personality and Social Psychology Review.

But the researchers also found that restoring glucose levels appears to replenish self-control. Study subjects who drank sugar-sweetened lemonade, which raises glucose levels quickly, performed better on self-control tests than those who drank artificially-sweetened beverages, which have no effect on glucose.

The findings make sense because it’s long been known that glucose fuels many brain functions. Having a bite to eat appears to help boost a person’s willpower, and may explain why smokers trying to quit or students trying to focus on studying often turn to food to sustain themselves.

“Self-control is a limited resource. People make all these different New Year’s resolutions, but they are all pulling off from the same pool of your willpower. It’s better to make one resolution and stick to it than make five.'’

Patients Per Doctor Map of the World

http://strangemaps.wordpress.com/2007/10/17/185-the-doctorspatients-map-of-the-world/

Countries with the highest ratio of patients to doctors:

Burundi 33,500
Ethiopia 33,500
Liberia 33,500
Mozambique 33,500
Malawi 50,000
Tanzania 50,000

The scariest part of that list is comparing it to countries with the highest prevalence of HIV/AIDS in the world:

http://en.wikipedia.org/wiki/List_of_countries_by_HIV/AIDS_adult_prevalence_rate

Tanzania, Malawai and Mozambique are among the countries with the highest AIDS prevalence/populations (# 12, 8, 10 by prevalence; # 5, 12, 7 by population size).

Snooze or Lose by Po Bronson (NY Magazine)

Sleep is for the weak! *shakes fist at bed* or for the... week. I prefer the latter, but usually end up abiding by the former.

Article stole from Chen. Lots of highlights because I need motivation to move my laptop out of my room (and there, hopefully, sleep more).

Highlights:

According to surveys by the National Sleep Foundation, 90 percent of American parents think their child is getting enough sleep. The kids themselves say otherwise. In those same surveys, 60 percent of high schoolers report extreme daytime sleepiness. In another study, a quarter admit their grades have dropped because of it. Over 25 percent fall asleep in class at least once a week.

sleep scientists have recently been able to isolate and measure the impact of this single lost hour. Because children’s brains are a work-in-progress until the age of 21, and because much of that work is done while a child is asleep, this lost hour appears to have an exponential impact on children that it simply doesn’t have on adults.

The performance gap caused by an hour’s difference in sleep was bigger than the normal gap between a fourth-grader and a sixth-grader. Which is another way of saying that a slightly sleepy sixth-grader will perform in class like a mere fourth-grader.

Dr. Kyla Wahlstrom of the University of Minnesota surveyed more than 7,000 high schoolers in Minnesota about their sleep habits and grades. Teens who received A’s averaged about fifteen more minutes sleep than the B students, who in turn averaged eleven more minutes than the C’s, and the C’s had ten more minutes than the D’s.

Tired children can’t remember what they just learned, for instance, because neurons lose their plasticity, becoming incapable of forming the synaptic connections necessary to encode a memory.

The best known of these is in Edina, Minnesota, an affluent suburb of Minneapolis, where the high school start time was changed from 7:25 a.m. to 8:30. The results were startling. In the year preceding the time change, math and verbal SAT scores for the top 10 percent of Edina’s students averaged 1288. A year later, the top 10 percent averaged 1500, an increase that couldn’t be attributed to any other variable.

After the time change, teenage car accidents in Lexington were down 16 percent. The rest of the state showed a 9 percent rise.

Dr. Matthew Walker of UC Berkeley explains that during sleep, the brain shifts what it learned that day to more efficient storage regions of the brain. ... The more you learned during the day, the more you need to sleep that night.

Perhaps most fascinating, the emotional context of a memory affects where it gets processed. Negative stimuli get processed by the amygdala; positive or neutral memories get processed by the hippocampus. Sleep deprivation hits the hippocampus harder than the amygdala. The result is that sleep-deprived people fail to recall pleasant memories yet recall gloomy memories just fine.

Dr. Eve Van Cauter at the University of Chicago discovered a “neuroendocrine cascade” that links sleep to obesity.

Sleep loss increases the hormone ghrelin, which signals hunger, and decreases its metabolic opposite, leptin, which suppresses appetite. Sleep loss also elevates the stress hormone cortisol. Cortisol is lipogenic, meaning it stimulates your body to make fat. Human growth hormone is also disrupted. Normally secreted as a big pulse at the beginning of sleep, growth hormone is essential for the breakdown of fat.

Vandewater analyzed the best large data set available, the Panel Study of Income Dynamics, which has extensively surveyed 8,000 families since 1968. She found that obese kids watch no more television than kids who aren’t obese. All the thin kids watch massive amounts of television, too. There was no statistical correlation between obesity and media use, period. “It’s just not the smoking gun we assumed it to be.”

Vandewater examined the children’s time diaries, and she realized why the earlier research had got it wrong. “Children trade functionally equivalent things. If the television’s off, they don’t go play soccer,” she says. “They do some other sedentary behavior.”

Sleep is a biological imperative for every species on Earth. But humans alone try to resist its pull. Instead, we see sleep not as a physical need but a statement of character. It’s considered a sign of weakness to admit fatigue, and it’s a sign of strength to refuse to succumb to slumber. Sleep is for wusses.

The University of Pennsylvania’s David Dinges did an experiment shortening adults’ sleep to six hours a night. After two weeks, they reported they were doing okay. Yet on a battery of tests, they proved to be just as impaired as someone who has stayed awake for 24 hours straight.

Caring for Your Introvert by Jonathan Rauch

I didn't really consider myself an introvert until I read this (these?) article(s). I'm not highlighting, as I am very, very lazy.

Caring for Your Introvert by Jonathan Rauch

There's another article (Top 5 Things Every Extrovert Should Know About Introverts) that I actually preferred. This one I will highlight cuz I enjoyed it a little more and because I already highlighted in an email.

Extroverts on the other hand tend to have more activity in the back of their brain, areas that deal with processing sensory information from the external world, so they tend to search for external stimuli in the form of interacting with other people and the outside world to energize them.

There's a deeper science to this that involves differences in the levels of brain chemicals such as acetylcholine and dopamine in extroverts and introverts, but I won't get into that.

But I wanted to know more about that :-/

Because extroverts notice that introverts don't talk that much with other people. Therefore, extroverts assume that introverts think they're too good to talk to others, hence arrogant and that's hardly the case.

And what's more, introverts can do a lot of things extroverts are naturally good at - give great speeches, schmooze with everyone, be the life of the party, charm the socks off of total strangers - but only for a short period of time. After that, they need time for themselves

4. Introverts need time alone to recharge.

And for those interested in sports, Michael Jordan and Tiger Woods come to mind as athletes who are introverts as well.

Introverts have a lot to bring to the table. They have an amazing ability to discover new thoughts, an uncanny ability to focus, to concentrate, to connect the dots, to observe and note things that most people miss, to listen extremely well and are often found having a rich and vivid imagination as well.

Dove's "Onslaught"

Video

Via Debbie Millman:

Dove's "Onslaught" features a close-up of a cute red-haired preteen girl to musical refrains of "Here it comes" from U.K. group Simian's "La Breeze," followed by a barrage of beauty-industry images and ads featuring booty-shaking lingerie models, cheesy direct-response-style pitches promising cosmetic miracles, scenes of plastic surgery, time-lapse effects of yo-yo dieting and bulimia, all leading up to the tagline: "Talk to your daughter before the beauty industry does." The video, like "Evolution," comes from WPP Group's Ogilvy & Mather Worldwide, Toronto. And it directly supports the Dove Self-Esteem Fund, which has set a goal to reach 5 million girls globally with programs by 2010. To that end, Unilever this year also will enlist yet-unnamed celebrities to appear at events to reveal how stylists, makeup artists, photographers and computer technicians produce their onscreen and on-page looks."

Via Kottke:

BTW, Dove's parent company makes all sorts of products that may contibute to the problem that Dove is attacking here.

"You Are What You Grow" - NYT

New York Times journalist Michael Pollen examines the clandestine connection between federal farm subsidies and the nation's obesity epidemic.

Interesting read, particularly because I had no idea wtf they were talking about. I' be way more likely to have full faith in the article if he, you know, cited his sources (books, studies, research, etc). Further investigation will have to be done (links and recommendations on the subject are greatly appreciated). Regardless, it's a bit depressing how the lowest tier of society is kinda effed over in every aspect of their life.

Article in New York Times
and if you don't have a subscription to NYT (though you really should), that same article is found elsewhere.

Drewnowski gave himself a hypothetical dollar to spend, using it to purchase as many calories as he possibly could.
...
Drewnowski found that a dollar could buy 1,200 calories of cookies or potato chips but only 250 calories of carrots. Looking for something to wash down those chips, he discovered that his dollar bought 875 calories of soda but only 170 calories of orange juice.

As a rule, processed foods are more "energy dense" than fresh foods: they contain less water and fiber but more added fat and sugar, which makes them both less filling and more fattening. These particular calories also happen to be the least healthful ones in the marketplace

Like most processed foods, the Twinkie is basically a clever arrangement of carbohydrates and fats teased out of corn, soybeans and wheat--three of the five commodity crops that the farm bill supports, to the tune of some $25 billion a year. (Rice and cotton are the others.) For the last several decades--indeed, for about as long as the American waistline has been ballooning--U.S. agricultural policy has been designed in such a way as to promote the overproduction of these five commodities, especially corn and soy.

That's because the current farm bill helps commodity farmers by cutting them a check based on how many bushels they can grow, rather than, say, by supporting prices and limiting production, as farm bills once did. The result? A food system awash in added sugars (derived from corn) and added fats (derived mainly from soy), as well as dirt-cheap meat and milk (derived from both). By comparison, the farm bill does almost nothing to support farmers growing fresh produce.

The farm bill helps determine what sort of food your children will have for lunch in school tomorrow. The school-lunch program began at a time when the public-health problem of America's children was undernourishment, so feeding surplus agricultural commodities to kids seemed like a win-win strategy. Today the problem is overnutrition, but a school lunch lady trying to prepare healthful fresh food is apt to get dinged by U.S.D.A. inspectors for failing to serve enough calories; if she dishes up a lunch that includes chicken nuggets and Tater Tots, however, the inspector smiles and the reimbursements flow.

By making it possible for American farmers to sell their crops abroad for considerably less than it costs to grow them, the farm bill helps determine the price of corn in Mexico and the price of cotton in Nigeria and therefore whether farmers in those places will survive or be forced off the land, to migrate to the cities--or to the United States. The flow of immigrants north from Mexico since Nafta is inextricably linked to the flow of American corn in the opposite direction, a flood of subsidized grain that the Mexican government estimates has thrown two million Mexican farmers and other agricultural workers off the land since the mid-90s.

The smorgasbord of incentives and disincentives built into the farm bill helps decide what happens on nearly half of the private land in America: whether it will be farmed or left wild, whether it will be managed to maximize productivity (and therefore doused with chemicals) or to promote environmental stewardship. The health of the American soil, the purity of its water, the biodiversity and the very look of its landscape owe in no small part to impenetrable titles, programs and formulae buried deep in the farm bill.

"The devil is in the details, no doubt. Simply eliminating support for farmers won’t solve these problems; overproduction has afflicted agriculture since long before modern subsidies. It will take some imaginative policy making to figure out how to encourage farmers to focus on taking care of the land rather than all-out production, on growing real food for eaters rather than industrial raw materials for food processors and on rebuilding local food economies, which the current farm bill hobbles. But the guiding principle behind an eater’s farm bill could not be more straightforward: it’s one that changes the rules of the game so as to promote the quality of our food (and farming) over and above its quantity."