The city of New York is at it again…they were the first to ban trans fat and lead the fight for restaurant labeling of calories on menus. Now they have an ad campaign that is grossing some people out. Read more »
This post, Pouring on the Pounds: NYC’s New Anti-Obesity Campaign, was originally published on Healthine.com by Brian Westphal.
This week’s New England Journal of Medicine contained a very, very interesting proposal put forth by a few prominent physicians and researchers working on the obesity crisis in America.
They propose that beverages loaded with sugar should be considered a public health hazard (much like cigarettes) and should be taxes. The proposal calls for an excise tax of “a penny an ounce” for beverages like sugar sweetened soft drinks that have added sugars. They cite research that links obesity to heart disease, diabetes, cancers, and other health problems. They say sugar sweetened beverages should be taxed in order to curb consumption and help pay for the increasing health care costs of obesity.
They estimate that the tax would generate about $14.9 billion in the first year alone and would increase prices of soft drinks by about 15-20%. That is big money, but at what cost?
My personal opinion is that while the tax would generate a lot of money that could be put to good use on anti-obesity programs, it is singling out one industry when obesity has numerous contributing factors. Calories Americans are getting from beverages have actually gone down in the past decade, but obesity rates still climb. Soft drinks alone are not making us fatter.
Americans need to pay closer attention to portion sizes and overall calories coming into their bodies from all sources. We know that Americans also eat too much fried food, candy, ice cream, etc. Should we tax everything that is “bad” for us? Absolutely not! And these foods are not “bad” when consumed in reasonable quantities in reasonable frequency.
We also need to learn how to move our bodies more to burn off some of the sweet treats that we love to indulge in. Weight loss is a simple equation that I don’t get tired of explaining again and again: Move more and eat less.
Taxing soft drinks will not decrease heart disease risk…exercising more and losing body fat by consuming less calories definitely will!
This post, Will Taxing Soft Drinks Solve The Obesity Problem?, was originally published on Healthine.com by Brian Westphal.
With news reports about the H1N1 flu all over the place, you may not think about the old “stomach flu” right now. Did you know that there really is no such thing as the stomach flu? If you have diarrhea or vomiting, it is usually not from influenza virus, but rather from another bug that got you. Often these bugs get us from not properly handling our food or from unsanitary conditions in our kitchens. Don’t go blaming the restaurant so quickly because studies show our homes are a breeding ground for bacteria that make us sick, too!
Top places germs reside
Tips to prevent getting sick
Check out this research from the USDA:
Best Ways To Clean Your Kitchen Sponge
Your microwave or dishwasher can make sponges safer to reuse in today’s kitchens.
Heating your used kitchen sponges in your microwave for one minute, or washing them in your dishwasher and leaving them there through a drying cycle, are the most effective household ways to inactivate harmful bacteria, yeasts and molds.
ARS food safety experts who specialize in research on foodborne pathogens, like E. coli O157:H7, looked at several simple, convenient and often-recommended ways of cleaning reusable kitchen sponges. Techniques included soaking sponges for three minutes in a 10-percent chlorine bleach solution, soaking in lemon juice or sterile water for one minute, heating in a microwave at full power for one minute, or washing in a dishwasher—including through a drying cycle.
At the outset of the experiment, they soaked all the sponges for 48 hours at room temperature in a slurry of ground beef and laboratory compounds which allow bacteria, yeasts and molds naturally present in the beef to grow on the sponges.
Microwaving and dishwashing each killed nearly 100 percent of the bacteria, with dishwashing being only slightly (0.0001 percent) less effective.
And, microwaving and dishwashing each killed nearly all yeasts and molds; less than 1 percent (only 0.00001 percent) survived.
This post, H1N1 Flu: Where Germs Are Hiding, was originally published on Healthine.com by Brian Westphal.
An emergency physician, like me, may be the worst possible person to discuss relationships with patients. I mean, one of the reasons I chose this specialty was that I didn’t want long-term relationships with my patients. I see, now, that God has a great sense of humor.
See, the county I landed in after residency is small enough that I do know many of my patients, and I do see them more often than you might imagine. After all, our hospital is ‘the only game in town.’
There are some patients I know quite well, and thus I know with reasonable accuracy who is sick and who isn’t, based on how they looked or behaved before. It doesn’t always work, but frequently it does.
Which brings me to trends in primary care. I don’t know if I’m really a primary care provider or not. Some years we are, some years we’re considered specialists. Whatever. It doesn’t really change the work. It might change the pay, as administrations place different emphasis from time to time. But I do see a lot of primary care. I watch internists and pediatricians, family physicians and ob/gyns do their work. And what I see, from the standpoint of the emergency room, is a drift away from relationship.
The thing that brings it up most poignantly is the trend towards hospitalists. For those of you not acquainted, the hospitalist is a physician whose practice is focused on admitting patients to the hospital, caring for them, and discharging them back to their regular physicians (if they have one) when the acute situation is over.
Now, I know some great hospitalists. And I understand the need for them. As hospital care becomes more complex, as offices suffer when their docs are at the hospital, as the goal becomes ‘discharge as soon as possible,’ wherein utilization review committees are prime-movers, the idea of the hospitalists makes great sense, and probably bears much fruit.
However, a relationship is severed. We have many community physicians who do not do hospital work. And more now that the hospitalist option exists. So let’s say I have patient X in the evening or on the weekend. His physician doesn’t admit. I call the hospitalist. ‘Patient X is having chest pain. His cardiac labs and EKG look alright, but it just seems concerning to me. Can we admit him?’ Hospitalist: ‘well, he doesn’t have risk factors and everything looks OK, what are we going to do? Do a second set of labs and let him see his doc tomorrow.’
Now, that was a technically correct encounter. But if his own doc had been on call, as in the past, he might have said ‘I’ve known him for years. He doesn’t complain. That isn’t like him. Let’s keep him overnight.’ Scientific? Maybe not. Possibly useful? Absolutely.
See, the hospitalist is driven by admissions and discharges. And he or she has no abiding relationship with these patients. In the same way, the family physician who won’t admit has severed his relationship. ‘So, I see you were admitted last week!’ He’ll get a report. But the next serious illness that comes around will still be a situation in which the patient is admitted to a stranger with a lack of personal interest (I don’t mean that they don’t care, just that they aren’t personally connected over a long period of time).
I see both sides. The hospitalist has a focused mission and a busy service. The family doc has a focused mission and a struggling office to run. But somewhere in between is the patient, who has been left afloat between two continents. I guess the ER is the ‘desert island’ in between.
I don’t know the answer. But I know that when they come to my emergency department, I have
Doctor and boy looking at thermometer, Norman Rockwell
to put together the pieces and do the right thing. I don’t have all of the information. But before you scream ‘EMR,’ remember that medicine is more than data points. Even if I have the data, I don’t have the sense of the patient. The knowledge his or her physician has from personal, repeated interaction.
So I have to put the data together, decide if it heralds something perilous, and then I have to be a salesman…just to get someone else to look at the patient. I am, in a sense, a voice-activated robotic surrogate for everyone; from family physician to hospitalist, obstetrician to urologist, ENT to general surgeon. But then, that’s another post altogether.
What I mean to say is, when we lose relationship, we lose some of the most important bits of information in all of medicine. Humans are complex, and in order for us to care for them, at least in the setting of being hospitalized or discharged, it’s remarkably useful to know them.
What do we do to fix it? I have no idea. I don’t believe it’s a thing that can be repaired with compensation schemes. Perhaps only philosophically, as we teach young physicians the value of relating to their patients more than scientifically. Or if it works better, to explain to them that science is more than labs, stress-tests, x-rays and biopsies. Science is the pursuit of knowledge.
And patients are best known by…knowing them.
How’s that for a koan?
Edwin
I was reading a very interesting study in this month’s issue of the Journal of the American Dietetic Association the other day. The study was on sugar consumption and looked at different populations in the US and compared on average how much sugar they ate.
The first statistic that shocked me was that the average intake of added sugar is 17% of our daily calories per day. This is added sugar, meaning it doesn’t count the sugar found naturally in fruit and milk, but rather just the sugars added to the foods we consume. 17% of our calories?!?!? That is a lot, in my opinion. It is not a secret that I have a sweet tooth especially when it comes to chocolate, but the sweets do not add up to almost 20% of my calories for the day!
The study broke down race/ethnicity, education, and income to see how these factors influenced how much sugar they ate. Check out some of the findings:
Trying to identify added sugars? Look for these terms:
Common foods with added sugars:
This post, Sugar, Sugar Everywhere…, was originally published on Healthine.com by Brian Westphal.
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