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50 Percent Of Physicians Disagree With AMA’s Soda Tax Endorsement

The American Medical Association (AMA) voted today to endorse taxation of sugary beverages as a means to raise money for anti-obesity programs. Interestingly, a recent physician survey at Medpage Today suggests that only 50% of physicians think that a soda tax is an effective public health strategy.

I am one of the 50% who feels that this policy will not be effective. In short, this is why:

1. You can become obese by eating and drinking almost anything in excess. Targeting sugary beverages is reductio ad absurdum. Did America become fat simply because of an excess supply of sugary fluids on grocery shelves? What about the super-sizing of our food portions, the change in workforce physical requirements, the advent of cars, escalators, healthy food “deserts” in poor neighborhoods, video games, and cutting gym class from schools?

Holding Coca Cola, et al. responsible  for our own over-consumption of  calories is both unfair and tantamount to spitting into the wind – something bad is going to come back at us. Consumers can easily get around the soda tax by buying sweet alternatives – which may have even more calories than soda. (Caramel latte anyone?) And then what? Are we really going to play public policy, food and beverage whack-a-mole?

Carmelita Jeter's Shopping Cart

2.  You can be thin and fit while eating and drinking almost anything. Obviously nutrition science has shown that a diet rich in fresh fruits and veggies, lean meats, low-fat dairy, whole grains, and healthy fats is the best for our health. However, please consider that the world’s fastest woman, Olympian Carmelita Jeter, eats Hostess cup cakes, Teddy Grahams, Welch’s grape juice, whole milk, and Gatorade. How do I know? Because she posted a photo of her shopping cart on Twitter (see image to the left). I obviously have no idea how much of this she eats – or when she eats it – but if the world’s fastest woman is powered (to some degree) by “Twinkies” then I think we should all think twice about demonizing certain foods/beverages in our anti-obesity fervor.

3. You can’t regulate good behavior. Human behaviors that may lead to obesity are simply too complex to regulate. Who would want to live in a world where government becomes the de facto “Nutrisystem” for its citizens, mailing out pre-packaged, ingredient-controlled meals to 312 million people per day, three times a day, seven days a week?  While that may save the post office from its imminent demise, we can neither afford to do that, nor do we need to.

People who believe that policy should drive behavior point to smoking bans that have cut down on smoking rates. While I agree that small improvements have been made in reducing smoking rates, roughly one in four people still smoke (depending on your source, this number could be as low as one-in-five), and one in every five deaths is still attributed to cigarette smoking. Hardly a resounding victory, alas.

But beyond the fact that policy changes (and the billions we’ve spent enacting and enforcing them) have resulted in a disappointing decrease in smoking rates, is the issue that cigarettes and food ingredients (such as sugar) are not analogous substances. While there is no safe minimum amount of cigarette smoke, our bodies need salt, glucose, and fat to survive. They cannot be cut out of our diet completely – nor should they. And the only way to force people to optimize their intake is to enact Draconian measures.

So instead of starting a food-fight, it’s important to accept the complexities associated with this particular health scourge and promote a broader, more-nuanced approach to wellness incentives. We have to attack this problem from the ground up, because a top-down approach requires our government to become an invasive, food and exercise nanny.

The good news is that one-third of Americans are not overweight or obese, despite our current “toxic” food/inactive lifestyle environment. Perhaps these thinner folks can be ambassadors for the rest of us, and reveal their secrets of healthy living despite our current limitations. Even with our best efforts, we need to understand that (like smokers) we will always have a segment of the population that is overweight or obese.

And as for the Olympians among us – they help to illustrate that obsessing over every morsel of food or cup of soda that we consume is not the way forward. Sorry AMA, I’m with Carmelita on this one.

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Can Price Transparency In The Insurance Industry Fix Healthcare?

Truthful information (Price Transparency) is a huge issue in the healthcare system. Hospital systems, physicians, drug companies, pharmacies, the healthcare insurance industry and the government hide behind the opacity of information.

There is a mutual distrust among stakeholders.

This mutual distrust must be overcome and price transparency achieved before any progress can occur in Repairing The Healthcare System.

In order to achieve Pareto efficiency in the healthcare system all the stakeholders must agree to price transparency. The advantage of Pareto efficiency is that Read more »

*This blog post was originally published at Repairing the Healthcare System*

Affordable Prenatal Fitness For Pregnant Women

Low cost, prenatal fitness classes. What a progressive thought. The New York City Prenatal Fitness Initiative is a community model that should be replicated on a national scale. A nurse midwife, Marilinda Pascoe and Andrea Bachrach Mata, an aquatic fitness instructor founded a program that offers prenatal water exercise and yoga to low-income pregnant women in North Manhattan and the Bronx at an affordable cost. For 7 weeks, pregnant women will be able to do light aerobics, swim, dance, gentle stretching and exercise for a total cost of $60.00 in a community pool. Not only will these women have fun by releasing endorphins (substances released by the brain that make you feel happy) but they will also be reducing their risks of developing gestational diabetes, obesity and other potential complications. Three weeks ago the program sponsored a community walk and invited pregnant women to participate. Read more »

*This blog post was originally published at Dr. Linda Burke-Galloway*

An iPhone App With “Skinsight”

photo 5.PNGBedbugs are back. For many people, this is only slightly curious, since their understanding of bedbugs stops at the second half of the bedtime admonition: “Sleep tight, don’t let the bedbugs bite.” But, for those others who have experienced a home bedbug infestation, it is a modern nightmare.

The tiny critters can hide in any furniture crevice or fabric fold and come out only in the wee hours of the night in search of their favorite food: human blood. Their bites cause intense itching which can last days to weeks and they can remain dormant and hide for months.

The cause of the recent resurgence is unknown. It does not seem to be paying any great regard to socioeconomic status nor to cleanliness. In metropolitan New York, it seems to have caused a minor panic, with families having to temporarily move out of their homes for toxic fumigation and thousands of dollars of clothes and artifacts being disposed of for fear of contamination. For a chilling recounting, check out this article in the UK Guardian: “How bedbugs invaded New York.”

Since so many skin afflictions are related to insect bites, the folks at Logical Images have just released Bedbugs ‘n Things, an iPhone app that describes the most common perpetrators of insect bites, identification by the appearance of the bite marks and recommended treatment. For bedbugs in particular, it goes further and gives a thorough set of guidelines for concerned traveler so they avoid bringing home uninvited travelers inside their luggage or clothes. Read more »

*This blog post was originally published at iMedicalApps*

What’s Your Poison? Science And Medicine Vs. Chemical Poisoning

The Poisoner's HandbookThis is going to be a quick welcome to Deborah Blum who has just moved her blog, Speakeasy Science, to ScienceBlogs.

Why quick?

Because I am only 22 pages away from finishing her latest book, The Poisoner’s Handbook: Murder and the Birth of Forensic Medicine in Jazz Age New York.

This engaging tale of the race of science and medicine against chemical poisonings for profit and punishment features the true story of NYC chief medical examiner Charles Norris and toxicologist Alexander Gettler.

Of course, the other actors are arsenic, methanol, chloroform, thallium, and radium, among others. In the teens through the mid-1930s, long before benchtop atomic absorption spectrophotometry and LC/MS instruments, Norris and Gettler devised methods to detect poisons in human tissues with high sensitivity. These advances led to the prosecution of some, the absolution of the wrongly-accused, and revealed that our own government poisoned citizens who dared to challenge Prohibition. Read more »

*This blog post was originally published at Terra Sigillata*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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