Category Archives: Health care

Americans Need to Drive Less, Walk More

by James A. Bacon

WEST PALM BEACH, FLA.–Something is very wrong with America’s health, Dr. Richard Jackson, professor of environmental health sciences at the University of California-Los Angeles, told the Congress for the New Urbanism today. Rates of depression, obesity and diabetes are soaring. “We’re looking at the first generation in American history that will have a shorter life span than their parents.”

There is no single villain behind the deterioration in public health. But from a big-picture perspective, the problem is easy to explain. Americans are eating more than they did 30 years ago, and they’re getting less exercise. And a major reason they’re getting less exercise can be traced to changes in the built environment. “The environment is rigged against the child and rigged against the doctor,” he said. “We have medicalized what is an environmental health challenge.”

Jackson was preaching to the converted. New Urbanists have long fought the auto-centric design of the American suburbs and preached the virtues of compact, walkable, mixed use communities. Originally, walkable communities were seen mainly as an antidote to traffic congestion, the high cost of automobile ownership and the erosion of community. But in recent years, New Urbanists have been touting the health advantages of urban design that make it practicable for people to walk and ride bicycles.

Jackson blasted the contribution of automobiles to mortality and illness at many levels. Automobile crashes are the number one cause of death for Americans between the ages of three and 33, he said. Air pollution from cars and trucks causes an ever larger number of deaths. Children living in communities with high levels of pollution have 3.3 times the risk of asthma than children living in communities with low levels. But the greatest health threat of all is the lack of physical exercise. Children enjoy little mobility in suburban communities. They cannot walk to school, visit their friends or engage in scheduled activities unless driven by an adult.

Children are out of shape, and obesity rates are surging, Jackson said. Only 37% of California kids can meet a fitness standard of running/walking a mile in 12 minutes. Two out of seven volunteers get rejected by the military because they don’t meet minimal fitness standards. By 2030, obesity rates for adults are projected to reach 42%.

Physicians have found they can’t treat obesity with medication, and counseling doesn’t seem to work. The environmental factors reinforcing over-eating and under-exercising are too strong. It may be possible to reduce caloric intake by such measures as taxing soft drinks, Jackson said, but Americans need to re-build their communities to get them out of cars and onto sidewalks and bicycles. The nation needs to “make physical activity a routine and integral part of life.”

Bacon’s bottom line: I don’t agree with all of Jackson’s prescriptions (like raising taxes on sugar), but there’s no denying that he’s diagnosed the problem. For what it’s worth, obesity seems to be a particular problem in Virginia. Hampton Roads is the 4th fattest region in the country, according to a recent Newsweek tally, and Richmond is the 2nd fattest! Holy moly! No wonder the Bon Secours Virginia Health System sponsored Jackson’s presentation.

As Jackson said, this is a “code blue” emergency. Obesity and the health complications arising from it, particularly hypertension and diabetes, will cost the health care system hundreds of billions of dollars that will cost even the healthy among us. Time to get cracking!

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Sugar Shock

Food activists proved wrong about fat are now setting their sights on sugar.

Image credit: Washington Times

by James A. Bacon

Once upon a time, there was a medical “consensus” that fat and cholesterol in the diet were major causes of heart disease. Armed with this “settled science,” the public health establishment moved in the 1970s to expunge the offending substances, beyond a basic minimum deemed to be necessary, from Americans’ diets. Food bureaucrats established dietary guidelines. Physicians ordered billions of dollars of blood tests. Pharmaceutical companies made tens of billions of dollars on drugs that suppressed cholesterol levels. Food companies, castigated in some quarters as soulless merchants of dietary corruption, were compelled to report the nutritional breakdown of their packaged products. Badgered by public officialdom and the media over the decades, Americans slowly, grudgingly changed their eating habits.

What good did it do them? Americans are more overweight, more prone to diabetes and more at risk of heart disease than ever before. Now, it transpires, the public health consensus and settled science might not have gotten it right. A new wave of scientific research finds that the worst culprit of all is sugar. CBS‘ “60 Minutes” hit the highlights of that research in a show broadcast April 1, “Is Sugar Toxic?”

In that segment, Dr. Sanjay Gupta interviewed Dr. Robert Lustig, a pediatric endocrinologist who was for years the proverbial voice in the wilderness.

Gupta: “What are all these diseases that you say are linked to sugar?”

Lustig: “Obesity, Type 2 diabetes, hypertension and heart disease itself.”

Gupta: “So, with the best of intentions, they said, it’s time to reduce fat in the American diet.”

Lustig: “And we did. And guess what? Heart disease, metabolic syndrome, diabetes and death are skyrocketing.”

Gupta: “Dr. Lustig believes that’s primarily because we replaced a lot of that fat with added sugars.”

Lustig: “When you take the fat out of the food, it tastes like cardboard. The food industry knew that. So they replaced it with sugar.”

Prediction 1: Often wrong but never in doubt, the progressives and do-gooders will develop amnesia about the past 40 years of regulatory activism. The old “settled science” will go down the memory hole, to be replaced with a new “settled science.” With new demons to castigate and a new cause to justify meddling in peoples’ lives on the grounds that they are too ignorant, slothful or obstinate to do what’s good for them, progressives will embark joyfully upon a new crusade. Soon we’ll be hearing how sugar is as addictive as cocaine. (Oh, wait, Dr. Gupta quoted a different scientist saying exactly that.) Sugar companies will replace the fat peddlers at McDonald’s as the new villains du jour. (Dr. Gupta also interviewed a sugar-industry lobbyist.)

Prediction 2: Progressives will not engage in the slightest bit of introspection. It will never occur to them to think, “Gee, if the science wasn’t really settled about heart disease, could the science really be settled about, say, global warming?”

Prediction 3: The American public will grow ever more distrustful of the way science is presented to them by the do-gooders and media, which in turn will lead do-gooders and the media to demean the intelligence of the American public.

Glenn Reynolds recently pointed out in the New York Post that conservatives are no more distrustful of science than liberals and progressives, despite the conceit of liberals and progressives that they represent the “evidence-based” school of thought in contrast to creationists, global-warming deniers and other assorted Neanderthals. Conservative distrust, Mr. Reynolds suggests, stems from “the increasing use of science as ammunition for big-government schemes.”

I concur. In my experience, conservatives do not quibble with the scientific method as a way to advance knowledge. But they distrust the intermediaries between the scientists and the public – the journalists and good-government activists who purport to interpret the findings of the “scientific community” – who frequently minimize the uncertainties in the science and extrapolate to policy conclusions not supported by science.

Prediction 4: It’s just a matter of time before we start hearing, “Hey, we knew a sugar tax was a good idea!”

As for me, I’m stockpiling KitKats, Oreos and Eskimo bars. If the goo-goos want to take my confections away from me, they’ll have to pry them from my warm, sticky fingers.

This column was originally published in the Washington Times.

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IG of the Day: Virginia’s Healthiest Counties

The healthiest jurisdictions in Virginia (shown in white) are concentrated in Northern Virginia, the Shenandoah Valley, Roanoke/Blacksburg, Charlottesville and exurban counties surrounding Richmond… oh, and Virginia Beach. The least healthiest counties? Pretty much where you’d expect, in Southside and Southwest.

Source: County Health Rankings & Roadmaps. Visit the website for details by county: premature death, poor physical health days, low birthweight, smoking, obesity, excessive drinking, STDs and a whole lot more.

Hat tip: LarryG

– JAB

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Quote of the Day: John H. Cochrane

John H. Cochrane

PeterG. often belittles me for scabbing material from the Cato Institute, which, in fact, I almost never do. (Just search “Cato” on this blog to see for yourself — all “Cato” references originate with my old Wonk Salon squibs or PeterG, accusing me of something I don’t do!) Thus, it is with some trepidation that I reproduce a quote from John H. Cochrane, a University of Chicago finance professor who actually is an adjunct scholar at the Cato Institute.

This column in today’s Wall Street Journal, “What to Do on the Day after Obamacare,” addresses an issue frequently discussed in the comments relating to health care (my bold face):

Most pathologies in the current system are creatures of previous laws and regulations. Solicitor General Donald Verrilli explained as much in his opening statement to the Supreme Court: “The individual market does not provide affordable health insurance,” he noted, “because the multibillion dollar subsidies that are available” for the “employer market are not available in the individual market.”

Start with the tax deduction employers can take for their contributions to group health-insurance policies—but which they cannot take for making contributions to employees for individual, portable insurance policies. This is why you have insurance only so long as you stay with one employer, and why you face pre-existing conditions exclusions if you change jobs.

Continue with the endless mandates (both state and federal) on insurance companies to provide all sorts of benefits people would otherwise not choose to buy. It sounds great to “make insurance companies pay” for acupuncture. But that raises the premiums, and then people choose not to buy the insurance. Instead of these mandates, at least allow people to buy insurance that only covers the big expenses. …

If we had a deregulated, competitive market in individual catastrophic insurance, that market would be so much cheaper than what’s offered today that we would likely not even need the mandate.

– JAB

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Another Private-Sector Initiative to Salvage Health Care

Back in 2006 an estimated 2.2 million Virginians were living with chronic diseases, running up $24.6 billion in health care costs. The numbers are far higher today. One reason costs are so high is that care is so fragmented. Patients often have multiple providers, treatment plans and prescriptions. Physicians, hospitals and other providers operate in silos, providing care without complete information about what others are doing. The lack of communication leads to unnecessary emergency room and hospital admissions.

The au current idea for dealing with this mess is the Patient Centered Medical Home (PCMH), in which the “home” is not a physical place but a personal physician who leads a team of providers to plan and deliver ongoing care for the “whole person.” The idea is catching on, and a General Assembly report, “Chronic Health Care Homes,” describes what’s happening in Virginia.

The Family Medicine Group in Vinton was the first practice in Virginia to be certified as a PCMH. Now, 18 Carillion physician practices in the Roanoke and New River Valley areas are recognized as NCQA Level-3 (highest) PCMHs. Additionally, an increasing number of practices in the Hampton Roads area are transforming themselves into PCMHs. Physicians and faculty of Eastern Virginia Medical School and several Sentara practices are in the application process for recognition as a medical home.

In the meantime, a Virginia Innovation Center, established as a nonprofit center hosted by the Virginia Chamber of Commerce, “will serve as a resource” in Virginia by (1) researching and disseminating knowledge about innovative models of health promotion and health care; (2)  developing demonstration projects to test innovative delivery models; and (3) helping Virginia employers, providers, purchasers, health plans, and communities accelerate their pace of innovation. (That information was based upon a 2010 communication to JCHC staff but I can find no indication from a Google search or a search of the Chamber website that this center exists yet.)

Based on the study findings, the Joint Commission on Health Care resolved to continue monitoring the progress of the concept.

– JAB

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Richmond’s Arab Spring


By Peter Galuszka

What seems one of the wildest General Assembly sessions that ended on Saturday was actually a healthy display of democracy in action. It could presage a fundamental way that things are done in Richmond.

True, a new Republican and conservative majority in the House of Delegates pushed odious wedge issues at the General Assembly that made Virginia the laughingstock of national late night television. These include attempts to force women to have transvaginal ultrasound exams before they have abortions. In a slap at gay and transgender citizens, it made it harder for them to adopt children.

It pushed back needed health exchanges to get insurance as the Obamacare deadline approaches. Keeping our priorities skewed, public school kids still will have their start-date dictated by huge, profitable theme parts like King’s Dominion and Busch Gardens. Legislators came up with an empty tank when it came to funding transportation projects. And the legislature set up the repeal of the one-handgun-a-month law that could revive Virginia’s key role in pistol trading by East Coast criminals.

That said, a lot of other mayhem was thankfully put to rest. Racist immigration-based citizen checks got nowhere as did a law to burden public school teachers with extra and unneeded reviews. Amazon will be forced to pay sales taxes like everyone else, torpedoing a sweet-heart deal used to attract the digital retailer by Gov. Robert F. McDonnell and the Virginia Economic Development Partnership. The Senate killed a bill that would have singled out poor women by forbidding them from having abortions if the fetus has gross abnormalities.

With all this social agenda nonsense, the General Assembly didn’t get on with its most important task p-p- passing a budget –, but it will meet again to do so. Not to first time this has happened.

What has happened, and is very encouraging, is that this is the first time in years that the average public actually gave a damn about their rights to be heard in the legislative process. The State Capitol’s bucolic lawns saw thousands of protestors, including the arrests of 30 or more by state police SWAT teams armed with nightsticks and machine pistols and dressed in protective armor that made them look like fearsome Michelin Men.

What made the scenes so unusual was that most of the participants were middle aged women outraged that McDonnell and the hard-right Republicans would suddenly start dictating some extremely private parts of a woman’s life and deny her what the U.S. Supreme Court says she can do. We’re not talking the long-haired types of my Vietnam generation or more recent Occupy Richmond (or Wall Street or Seattle) people.

For far too long, state politics has been a good old boys’ club run by big corporations who bankroll think tanks and legislators led by the hand by lobbyists. Bill wording can be cut and paste jobs from national right wing outfits. People with opposite points of view are usually sliced out of the loop.

When McDonnell appointed a subcommittee within a state mining department to study the highly controversial notion of uranium mining in Southside, he picked as its head a former natural gas lobbyist with no experience with radioactive issues. She announced there will be no public hearings before her group sends its recommendations about whether or not lift a near 30-year-old ban on uranium mining. This is typical of the way Bob McDonnell and people like him see the world and regard their voters. They are not to be seen. Not to be heard.

While it is doubtful that McDonnell and his ilk will get the message, the outrage over the behavior of the General Assembly by everyday people shows that the old, behind-closed-door way of doing business is over. McDonnell and his spokesman Tucker Martin, can blame the news media. The State Capitol Police, with McDonnell’s acquiescence, can call out the SWAT teams all they want.

One thing they can’t do is kill the spirit of the man who actually designed the State Capitol building that was the locus of so much outrage. That spirit will outlive them all.

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¡Viva la Revolución!

Estimado Jefe!

Usted nunca debe salir de la ciudad, señor! Ahora que usted está ausente, la revolución comienza! Amados lectores de ya no ver los artículos que glorifican a los ricos y privilegiados. Vamos a ayudar a la tierra y los pobres y redistribuir los fondos de cobertura. ¡Viva la Revolución!

 

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That Danged News Media!

By Peter Galuszka

After a deluge of negative national publicity in recent weeks over a number of socially conservative and highly controversial bills that he originally endorsed, Virginia Gov. Robert F. McDonnell has complained on a WTOP radio interview that he’s disappointed with the news media.

“All we ever ask from the media is to be fair, cover what’s actually going on,” McDonnell told listeners.

Oddly, the news media has been covering exactly what has been going on. Virginia has suddenly become the tip of a spear in a hard right-wing agenda. The General Assembly has been flooded with bills to force women to have a transvaginal ultrasound exams before they get an abortion, to repeal laws restricting monthly handgun sales, to deny poor women abortion money in special cases, to force police to check the citizenship of anyone they arrest, among other legislation.

McDonnell whines that the media should be looking at 100 other bills, such as adjusting the state pension system, boosting education and easing traffic congestion.

He must want the good old days a while back when he was being touted as a modern and responsible new type of Republican governor who can cut budgets while attracting jobs.

Too bad for the governor. It may not be his fault in the most recent elections that a number of socially conservative Republicans gained enough legislature seats to push laws that had been held in check for years. Just after those elections. But he backed these people. He basked in media attention that his enlightened leadership was somehow responsible for their victories.

Yet once these fledglings got into power, they went so crazy with a multi-front socially conservative offensive that the national media could not help but notice. Nor was the humor (if any) of the situation lost on scriptwriters at “The Daily Show” and “Saturday Night Live.”

McDonnell wants to be ready for prime time. His WTOP complaints show that he isn’t.

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“Our Bodies; “Our Idiot Selves”

By Peter Galuszka

Forty two years ago, a feminist group titled “the Boston Women’s Health Book Collective” got together to start researching their own books about female health since they distrusted what they considered the male-dominated medical establishment.

A substantial part of their research had to deal with birth control since the pill had been out for several years although the Roe vs. Wade U.S. Supreme Court decision, allowing limited abortion, was still three years away. Their book “Our Bodies, Ourselves” became a best-seller.

Flash forward 42 years to Virginia. The General Assembly is embroiled in a fiasco over conservative attempts to force-introduce state power into the sexual lives of women through laws that would force women exercising their legal right to an abortion to have ultrasound exams in their first trimester of pregnancy to somehow shame them into not going through with the procedure. Another would declare “personhood” as being that point when an egg is fertilizer and a human life is created.

The result, of course, has been one of the biggest legislative disasters in years. Virginia is the butt of jokes on Saturday Night Live and the Daily Show. Republican Gov. Robert F. McDonnell’s multi-year-young effort to recast himself from social to moderate conservative is in shambles, his future in national politics in doubt.

So, how did we get here? The story appears to be one of ignorance and incompetence, so very unlike what happened in Boston four decades ago. The key issue is that legislators apparently didn’t understand that to determine the age of a fetus accurately, the use of a probe that is put inside a woman’s vagina is needed. They had apparently assumed that the ultrasound could be achieved in a less upsetting way by smearing the pregnant woman’s abdomen with a jell and then using a sound wand. According to The Washington Post, Sen. George Baker, a Fairfax Democrat had doubts and asked fellow Democrat, Sen. Ralph S. Northam, a doctor from Norfolk, who said he’d check. It turned out that yes, an invasive vaginal probe was needed.

The news completely changed the politics of the bill. But one wonders why legislators didn’t know this from the beginning. If they did, they weren’t exactly forthcoming about it.

One answer could be by studying the background of Del. Kathy Bryon, a Lynchburg Republican, who has been a legislator since the late 1990s. She introduced one of the bills that would require the transvaginal ultrasound. Ms. Bryon is a grandmother whose personal education did not go beyond high school. She worships at Thomas Road Baptist Church, home base for the late and controversial televangelist Jerry Falwell. When not working on public matters, she and her husband run a small telemarketing company.

Bryon was also an official of the Tobacco Indemnification and Community Revitalization Commission, a body set up back in the late 1990s to handle hundreds of millions of dollars in funding the state is receiving from a 1996 lawsuit with 45 other states against four big tobacco firms, including Phillip Morris USA. The Commission was supposed to use some of its funds to help out tobacco belt towns with economic development projects.

It did get a black eye when its former executive director, John Forbes II was convicted and sentenced to 10 years in prison for diverting $4 million from an alleged educational program to his own use. Although Bryon was not been linked to the Forbes scandal, she has been criticized for helping arrange a $12 million grant in public, tobacco fund money to help build the “Center for Health and Medical Sciences.” It is part of Lynchburg’s  Liberty University, which, of course, is a religious school affiliated with the late Jerry Falwell’s church.

Thus, Byron’s involvement seems one of  local political logrolling, Lynchburg-style, than a sophisticated understanding of women’s health issues. A case in point: the ultra-conservatives pushing the ultrasound idea didn’t get the difference between a transvaginal probe and a sticky abdominal jell and just how the former presented an even more profound violation to a woman’s rights. The fact that the U.S. Supreme Court says she has a right to an abortion in limited cases makes Bryon’s ignorance and activism even more disturbing.

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Bad Days for Mickey D.

By Peter Galuszka

There must be considerable gnashing of teeth in the Governor’s Mansion. Robert F. McDonnell had been working so hard to distance himself from his social conservative past, notably that nettlesome and Neanderthal anti-gay and anti-female graduate thesis.

He had worked hard to remake himself as a reasonable moderate, thus setting himself up for the Big Time, namely a vice presidential slot. Up to now, things had been looking good. True, his plans to privatize state liquor stores and erect offshore oil platforms have gone nowhere, but McDonnell has enjoyed strong popularity ratings and has received a fair number of invites on national TV talk shows.

This Republican-dominated General Assembly, however, is helping destroy a lot of his hard work. Virginia is getting negative national attention for such mindless, hard right policies such as lifting sales restrictions on handguns and forcing women seeking a legal abortion to pay for a trans-vaginal ultrasound test. Legislators have slapped gay couples across their cheeks by making it harder for them to adopt children. ”Foreign” looking people must go through citizenship checks if they are stopped by police who don’t who don’t have the time, money or will to do so.

Virginia has already made the “Really” segment of Saturday Night Live and now Jon Stewart is sniffing around. But there’s more to Mickey D’s woes. Wild man Atty. Gen. Kenneth Cuccinelli has bucked the state GOP establishment and is running for governor when Republican power brokers had already hand-picked affable Lt. Gov. Bill Bolling. An even bigger-time wingnut, Bob Marshall, is running for Senate, challenging GOP favorite George Allen. Neither move helps McDonnell.

The blogosphere is rife with rumors that Mickey D is considering some serious backpedalling. Norman Leahy, always a reliable source, reports that some Republican legislators and McDonnell are brainstorming schemes to weaken or delay the ultrasound fiasco, that has brought more than 1,000 protestors to Capitol Hill, not an ordinary event in genteel Richmond. Leahy quotes political insider Paul Goldman as saying, “You don’t get selected the VEEP on a winning political ticket when Saturday Night Live skits are part of the package put together by a Presidential nominee’s team vetting running mates.”

That raises another question. Which candidate would McDonnell serve as VP candidate? The easy answer had been Mitt Romney. But things aren’t going so well for Romney right now. As for Rick Santorum, the last thing they’d need is a VP with as much social conservative baggage as McDonnell has.

McDonnell might be able to finesse the problems by unplugging the transvaginal business and moving forward with his budget. He had planned one of his smoke and mirrors specials to boost transportation funding by cheating education out of a part of the sales tax. Now it looks like we might get a hike in the gasoline tax, at least to mesh with inflation. And that, dear children, would make Mickey D. look worse than Tim Kaine ever could have.

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