Tips from gaining health

You can wreck your back in any number of ways, but a few major offenders stand out: Not stretching, not paying attention to your movements, and years of wear and tear, says Nick Shamie, MD, associate professor of orthopedic neurosurgery at UCLA and a spokesman for the American Academy of Orthopaedic Surgeons.

Here are five habits that put your spine at risk and simple strategies to stop them before the damage is done.
Back Wrecker #1: Weekend Warfare

"Most often, I see people who injured themselves during a weekend basketball game or a round of golf," Shamie says. "These people think theyre athletes, but dont train like the pros, and as a result, their backs suffer."

Tackling those "Honey Do" lists at home can also set you up for injury, especially if you were idle for most of the week. Cleaning out the garage, bending over a workbench, or spending hours in the yard or garden can be just as hard on your back as anything you do on a playing field.

"Like any other part of the body, the back is likely to be injured if you havent warmed up or stretched," Shamie says.

Prevent it: "The only preventive solution Ive found for back pain is exercise," says Michael Hisey, MD, orthopedic surgeon and president of the Texas Back Institute in Denton, Texas. "The fix is to stretch and strengthen your core muscles."

The obliques -- the abdominal muscles on your sides -- are especially important for back stability, Hisey tells WebMD.

Hiseys tip: Get an inflatable exercise ball. Use it in your workouts and sit on it, instead of a chair, to engage your abs.
Back Wrecker #2: Poor Lifting Technique

"Improper bending and lifting causes back injury; thats all there is to it," says Dan McMackin, a spokesman for UPS.

Prevent it: Engage your abs to help support your back. Here are the basic principles that UPS uses for safe lifting, according to McMackin:

    * Bend your knees and keep your back straight. Dont bend at your waist.
    * Keep the object close to you. The farther away you hold it from your body, the more it stresses your back.
    * Never hold an item higher than your armpit or lower than your knees.
    * Dont move something that weighs more than 20% of your body weight.
    * Dont pivot, twist, or turn while lifting. Point your feet at the item youre lifting and face it as you pick it up. Change direction with your feet, not your waist.

Back Wrecker #3: Absentmindedness During Daily Activity

Simple tasks like taking out the trash or washing the dishes can get your spine bent out of shape if your body isnt ready.

Back Wrecker #3: Absentmindedness During Daily Activity continued...

"The movement doesnt necessarily have to be exaggerated or involve a heavy object," Hisey says. "You can hurt your back grabbing a paperclip off the floor or loading the dishwasher."

And if your mind is running on auto-pilot instead of focusing on what youre doing, you could be in trouble.

"At UPS, weve seen a higher proportion of injuries occur at the end of the shift, due to fatigue of the mind and body," McMackin says.

Prevent it: Train yourself to keep your core muscles engaged.

A simple way to do that is to pull your navel toward your spine and imagine youre wearing a corset that pulls the sides of your abs inward. Doing that throughout the day -- and especially when lifting or bending -- strengthens and supports your back, says Esther Gokhale, author of 8 Steps to a Pain-Free Back and owner of Ester Gokhale Wellness Center in Palo Alto, Calif.
Back Wreckers #4 and #5: Commuting and Computing

You sit, and you sit, and you sit some more -- at work, while driving, and in front of the TV. And your back doesnt like it. Heres why.

Your discs are spongy and cushion the vertebrae in your spine, but discs have poor blood supply, Hisey says. When you move, fluid circulates through the discs. When you sit still, the fluid is wrung out, so youre depriving discs of nutrition, he says. Spending so much time behind the wheel of a car or sitting in front of a computer adds mileage to our discs, which leads to stress in your back.

"The discs in your spine are nourished by motion," Hisey says. "So sitting still is hard on your back and neck, and can do long-term damage." Studies have also shown that sitting puts more pressure on your spine than lying down or standing up.

"The worst posture is sitting and leaning forward," Shamie says. This makes you lock your pelvis and flex your spine, putting pressure on the front of the vertebrae, where your discs are. The more you arch forward and exaggerate the curve of the spine, the more pressure youre putting on your discs. "This uneven pressure on a disc puts it at high risk of rupture," Shamie explains.

Prevent it: Youre going to sit. So try these tactics to lessen its impact on your back:

    * Get up and move at least once every 20 minutes, unless youre driving. Set your screen saver to remind you; make a habit of going for a drink of water; when you answer the phone, stand up to stretch and change positions.
    * Keep your spine properly aligned by holding reading material at eye level (when sitting or standing) rather than bending over. Dont lean over a desk or table to work. Whenever possible, your spine should be straight.
    * Choose a chair that supports your back. Adjust the chair so that your feet stay flat on the floor. If the chair doesnt support your lower backs curve, place a rolled towel or small pillow behind your lower back. Remove anything from your back pockets, especially a wallet, if youll be seated for long periods of time because this puts your spine out of alignment.

Gokhale suggests doing the following exercises to help lengthen your spine:

    * Get on your hands and knees. Reach your left arm straight ahead and straighten your right leg behind you. Use your stomach muscles to stabilize. Hold for 5-10 seconds and slowly return to starting position. Switch arm and leg. Repeat 3-5 times on each side.
    * Sit tall, lengthen your spine, and let your shoulders relax. Concentrate on squeezing your shoulder blades together, keeping your arms hanging at your sides. Hold for 3-5 seconds, then release. Repeat 10-20 times.

 If All Else Fails

The experts interviewed for this story all told WebMD that most back pain should abate with in 48 hours with a nonprescription pain reliever. But in some cases, your pain could require urgent care.

You need immediate attention if you suffer any loss of bladder or bowel control with your back pain, Hisey says. This is associated with a disc thats pressing on nerves and the faster you relieve the pressure, the faster the function returns.

"Most back pain wont radiate below the waist," Shamie says. "If you feel pain in the thighs or knees, you likely have a disc herniation causing nerve compression." Seek medical attention to ensure there isnt more serious damage.

If your back pain keeps coming back, see a medical professional. You may have begun to rupture a disc or have another injury that could require treatment. "The older you are, the quicker you should get to a specialist.

Every Saturday, we post a piece from the CHG archives. This one is from March 2009.

Spend an afternoon perusing family-oriented frugality blogs, you’ll discover there are a few recurring themes. Among them: yard sales, thrift store shopping, a widespread love of free shampoo, and of course, weekly menu planning.

Menu planning, it’s argued, will streamline evenings in the home. Ma and Pa are saved money, time, and mounds of frustration because they know what the brood’s having for dinner days ahead of time. There’s no scrambling in the kitchen or supermarket, since both shopping and cooking are ined to a science. Kids (sometimes) get to have a say in what they eat, too, which makes the whole thing a family activity rather than merely a parental chore.

All in all, it’s a fantastic strategy. Even better, EVERYBODY can use it.

See, while weekly menu planning for non-families is a rare topic around the blogosphere, it’s just as monumentally helpful for post-collegiates, office workers, struggling singles, and young couples. It even offers extra benefits, mostly involving time management. Like:

• You’re saved from 8pm post-work dinner freakouts, because dinner is ALWAYS planned.
• Ingredients are guaranteed to be on hand.
• Cooking goes much faster, since you go in knowing how to prepare a meal (by instinct or through print-out recipes).
• You eat healthier, as home-cooked meals are generally much more nutritious than calorie-laden takeout or heat-and-eat dinners (Hot Pockets, Hungry Man, etc.).
• Grocery shopping goes waaaaay faster. You go in knowing exactly what you want, and don’t have to blow an extra half-hour wandering around. Case in point: last night, using my weekly menu plan, I did all my shopping in 59 minutes, door to door, WALKING. In that time, I hit two stores, the further of which is about a half-mile away. Woo!
• Extra trips to the grocery store are mostly eliminated.
• You can plan for leftovers for office lunches. This is huge, personally speaking, because turkey sandwiches get tired 40,000 times in a row.
• You always have food for those bag lunches (the night before, no less), saving you $30 per week, or around $1500 per year.
• For budgeting purposes, you can pretty much estimate the cost of your bill to the dollar.
• There’s less food waste, because you’re buying only what you need.
• It allows for variety during the week, since you’ve got all the ingredients on hand anyway.

But how to begin? How do you organize this stuff? How do you create a weekly menu and grocery list without it taking a billion, gazillion years?

The answer: I don’t know. Everybody has their own system, based on what works best for them. But here’s what The Boyfriend and I do currently:


STEP 0
Create a new word document
This is what you’ll be typing, cutting, and pasting to. It’s much easier than writing everything down, and at the end, you can print out the grocery list, weekly menu, and recipes all at once.


STEP 1
Make a quick grocery list of what you need
What groceries are running low? What foods do you eat regularly from week to week? This is my most recent list:

Cereal
Cumin
Deli ham or turkey (for lunches)
Eggs
Fruit (for breakfast and lunch)
Meat (general)
Yogurt (for lunches)


STEP 2
Brainstorm the dinners you want to eat this week
New dishes? Old favorites? Seasonal experiments? Whatever you’re in the mood for, list ‘em here, with special attention paid to food you need to use up before it goes bad. This is also a good time to take a cursory glance at your local online circulars. Entire menus can be built around loss leaders (biggest bargains).

This week, our dinner list includes:

• Chickpea and Bread Soup from the Kitchn
• Spinach Rice Casserole from Tammy’s Recipes
• Brunch Clafouti from Serious Eats
• Spiced Chicken with Tangerine Sauce from Cooking Club
• Curry Cauliflower Soup with Honey from Sunday Nite Dinner
• Pasta with veggies
• Turkey burgers with rice and frozen veggies

For the sake of convenience, cut and paste each new recipe IN ITS ENTIRETY into your document. That way, you can print it up and consult it when you’re cooking.

(Note: I cook a lot of new dishes for both Serious Eats and CHG, so chances are your list will be a lot less complicated.)


STEP 3
Make a rough menu
Based on what you have in the fridge, what you’re planning for the week, and what you usually have, create a weekly menu. Take care to note when you won’t be home for a meal. Yours can be simple or complex, but I might start off pretty low-key until you get the hang of it. Heres ours:

WEDNESDAY
Lunch: sandwich, leftovers yogurt, Kix, fruit
Dinner: Spinach Rice Casserole with leftover Irio

THURSDAY
Lunch: Leftover casserole, salad, fruit, yogurt
Dinner: The Boyfriend OUT; Me - Chickpea and Bread Soup w/asparagus

FRIDAY
Lunch: Leftover soup and/or casserole or sandwiches, fruit, yogurt
Dinner: Both OUT @ comedy show

SATURDAY
Brunch: Brunch Clafouti
Dinner: Both OUT @ friends’ house for dinner

SUNDAY
Brunch: Omelets, toast, and fruit
Dinner: Spiced Chicken Breast w/tangerine Sauce and Cauliflower-Honey Soup

MONDAY
Lunch: Leftovers, crackers, fruit
Dinner: Pasta with veggies

TUESDAY
Lunch: Sandwiches, popcorn, fruit
Dinner: Turkey burgers with rice and frozen veggies

(Note: 90% of our weekday breakfasts consist of cereal [or homemade whatever], so we don’t list them. Also, we keep our beverages limited to coffee, beer, and water. This way, we’re always awake, tipsy, and hydrated, just the way we like it.)


STEP 4
Add additional ingredients to the grocery list
Now that you have a concrete menu, add your new needs to the foods you listed in STEP 1. Mine are at the bottom here, for the recipes I plan to make:

Cereal
Cumin
Deli ham or turkey (for lunches)
Eggs (for Clafouti and otherwise)
Fruit (for breakfast and lunch)
Meat (general)
Yogurt (for lunches)
2 15-oz. cans chickpeas (for Chickpea Soup)
4 cups beef stock (for Chickpea Soup)
2 cups low-sodium chicken stock (for Cauliflower Soup and Tangerine Chicken)
3/4 a baguette (for Chickpea Soup)
9 or 10 ounces fresh spinach leaves (for Casserole)
1 1/2 cup fresh fruit (for Clafouti)
4 boneless skinless chicken breast halves (for Tangerine Chicken)
1/2 cup tangerine juice (for Tangerine Chicken)
2 tangerines (for Tangerine Chicken)


STEP 5
Go through circulars (thoroughly this time)
Now that you have a general plan, comb your online (or paper) circular for sale items corresponding to your list. If you have coupons, this is a good time to see if there are any good discounts.

One more thing: if you see something you love but don’t need on mega-sale, go for it. For example, I don’t NEED red peppers this week, but I use them frequently for salads, pastas, and whatnot. So, I’ll probably pick up a few because $1.99 is a good price. If beans were on sale, I’d be all over that, too. But they’re not. Boo.

This week, this was on sale from my list:

SUPERMARKET #1
Chicken Breast - $1.69/lb (for Tangerine Chicken)
Bananas – 2lb/$1 (for breakfasts/lunches)
La Yogurt – 2/$1 (for lunches)
Oranges – 8/$2 (for breakfasts/lunches)
Red Peppers - $1.99/lb (for whatever)

SUPERMARKET #2
Cantaloupe - $0.99/ea (for breakfasts/lunches)
Blueberries - $1.99/6oz (1-1/2 cups for Clafouti)
Eggs – 2/$3 (for Clafouti and otherwise)


STEP 6
Finalize the list
Okay, stocks weren’t on sale. Neither were tangerines, chickpeas, baguettes, cold cuts, or spinach. So now, I assign them to a grocery store that I think will have the lower price.

In the end, my list looks like this:

SUPERMARKET #1
Chicken Breast - $1.69/lb (for Tangerine Chicken)
Bananas – 2lb/$1 (for breakfasts/lunches)
La Yogurt – 2/$1 (for lunches)
Oranges – 8/$2 (for breakfasts/lunches)
Red Peppers - $1.99/lb (for whatever)
2-15 oz. cans chickpeas (for Chickpea Soup)
2 tangerines (for Tangerine Chicken)
1/2 cup tangerine juice (for Tangerine Chicken)

SUPERMARKET #2
Cantaloupe - $0.99/ea (for breakfast and lunch)
Blueberries - $1.99/6oz (1-1/2 cups for Clafouti)
Eggs – 2/$3 (for Clafouti and otherwise)
Cereal
Cold cut ham or turkey (for lunches)
4 cups beef stock (for Chickpea Soup)
2 cups low-sodium chicken stock (for Cauliflower Soup and Tangerine Chicken)
3/4 a baguette (for Chickpea Soup)
9 or 10 ounces fresh spinach leaves (for Casserole)

(Note: I get cumin in bulk from an ethnic grocer on the walk home, so it’s not included here.)

~~~

And that’s it. Now, after only 40 minutes of planning, I have an exact grocery list AND menu for the whole week. Plus, I’m guaranteed to save money on sale items, prepare healthy foods, and have plenty to bring to the office. And that’s good for everyone involved.

Readers, how about you? Do you menu plan? What’s your plan like? How might you change this one? Fire away in the comments section.

Looking through the MRI

In a prior posting, the Disease Management Care Blog was reminded that the U.S. health care system  is exceptionally complex and non-linear. Thanks to its many overlapping, contradictory, shifting and often non-medical inputs, it defies the simple logic of a single-cause-leading-to-a-single-effect. If economics is the dismal science, health care economics is its dubious spawn.

However, that doesnt mean that multiple coordinated inputs combined with some good luck wont push the health care weather vane in the right direction. For the latest example of this fundamental truism, check out David Lee and Frank Levys Health Affairs article The Sharp Slowdown In Growth Of Medical Imaging: An Early Analysis Suggests Combination Of Policies Was The Cause.

By way of background, medical imaging has been a high profile issue for policy makers and a headache for insurers because, until recently, the rate of costly "high dollar" imaging studies has been growing much faster than other medical costs.  It has been blamed as one technology-laden driver of health care inflation.  In the meantime, physicians have pointed to a variety of causes (and, by the way, left others unmentioned).  

In this study, the authors examined 10 years worth of insurance claims for advanced imaging MRI and CAT scans from two multi-state commercial insurance plans and another smaller single state plan.  These data were then pooled with a 5% national random sample of imaging claims from Medicare beneficiaries.  The authors also interviewed radiologists, health administrators, radiology benefit managers and physician recruiters.

The results?  From 2000 through 2005, CT scans grew at a whopping rate of 14.3% but then slowed to 1.4%. MRI slowed in the same periods from 14% to 2.6%. At the same time, starting salaries for radiology specialist physicians significantly declined.
 
What happened?  According to the authors:

1. An industry sprung up.  In another example of the adage that "need is the mother of invention," companies that prior authorize imaging studies for medical necessity (for example) were hired by many commercial insurers.  They had an impact.

2. Skin in the game. Deductibles, co-insurance and co-pays made consumers think twice about agreeing to a study that was going to result in some out-of-pocket spending.

3. Unilaterally imposed fee reductions. Medicare cut the amount it paid for CAT and MRI studies performed in freestanding centers and physicians offices. Hospitals were left untouched.

4. Glow in the dark.  Media reports on the amount of radiation prompted patients to worry about the long term impact of all those x-rays.

In other words, there was no single lever. Instead, the reduction of high utilization of pricey imaging was due to the confluence of at least four mutually reinforcing trends.

As further evidence of the overlapping trends that extended beyond simple cause-and-effect, Medicare never relied on prior authorization, didnt alter the out of pocket testing expenses for beneficiaries and left the payments for hospital-based imaging untouched. Yet Medicare saw an across-the-board reduction. MRIs dont involve ionizing radiation (they use relatively harmless magnets), but their overall rate went down in concert with CAT scans..

This has important implications for other laudable policy targets.  Based on this experience, waiving out of pocket costs alone are unlikely to increase the use of preventive health care services. Simply paying for the medical home may not make that big a difference.  Quoting the DMCB may not be enough to convince your skeptical friends.  So on and so on.

The obvious implication for the population health management service companies is that if theyre going to have a significant impact, the likelihood of a successful outcome is far greater if it is implemented concurrently with other supportive interventions.

Making her CHG debut, please welcome todays guest blogger, Amy Dickenson. Amy is an actor, writer, producer, and mom to the cutest baby girl in the five boroughs.

Forty. Forty is the new 30, right? Well, in my house, 40 is starting to look like the new 60. My gorgeous husband and I have recently been diagnosed with high blood pressure and high cholesterol—hypertension and hypercholesterolemia, to be fancy, like certain cheeses which I love and will never be able to eat again.

Photo: Jami Dwyer via Flickr

Let’s jump in the Crisco Time Machine. It all started 18 years ago when our courtship took a decided slant toward biscuits slathered in butter and jam. Have you ever tasted butter? It’s like a miracle married to a unicorn wrapped in a rainbow. Much like its cousin, bacon, which is a miracle married to a unicorn dipped in chocolate, butter’s not so good for your arteries. But it was the early ‘90s and we didn’t know about cholesterol and vegetables back then. Did we?

Back in the time machine to August 2010. My cholesterol is 254. WHAT? I am not a high-falutin’, pin-stripe-wearin’ banker chugging scotch, smoking stogies, eating aged porterhouse steaks with my big wig partners, guffawing over “that deal” that made “lots of money” while flashing my newly laminated AARP card. I am a working mom. I eat veggies. I make sure my family gets a salad at least once a day. So, what gives? And why is my husband’s blood pressure 180/2 million?

My husband (let’s call him Adam) and I do not agree all the time (shocking) but we do agree on one thing: We want to be around for our baby daughter’s graduation from college. And her wedding. And her babies. And their graduations from college. Even if she doesn’t get married or go to college, we want to be around to lament those things.

She is worth all the broccoli in China. And I know they have tons, because, let’s face it, nobody ever eats that side of bright green buried under the General Tsao’s chicken. I imagine the Great Wall as an agricultural implement built to contain the cruciferous invaders from the steppes of central Asia. They must love it as much as I do.

Photo: La Grande Farmers Market via flickr

Our daughter, however, loves broccoli (a secret point of pride), and for now, she needs us to make it for her. Time to act.

Adam’s doctor put him on the First Line Therapy diet. Mine gave me a prescription cholesterol reducer, a pharmaceutical of the most common side effects reported are headache, muscle pain, abdominal pain...variety.

One of the scariest side effects I read about is birth defects. Since Adam and I are “not not trying” to have another baby, the meds are sitting on my desk, looking forlorn while I debate whether to take it. Or I could give this First Line Therapy diet a try too.

Adam and I are fly-by-the-seat of our pantsers, not planners. I love to cook, but I have been known to open the freezer at 5 pm and stare blankly for three minutes before I reach directly above it for the takeout menus. (OK, the restaurant numbers are in my cell phone.)

How do two nonplanners plan to be healthy, live longer, and learn about nutrition on a diet that requires grocery shopping in advance of the moment we might need said ingredients?
I started by reading the cute little binder Adam got from his doctor. It has menus, recipes, and tips like pretty much every other diet book. I thought, “Hmmm. This looks really great.” And I said to Adam, “Babe, this is really great.” And then I put down the book and we ordered chicken ceasar wraps with feta from Zorba’s. Because you can have fat-free feta on this diet. (Zorba’s doesn’t have fat-free anything.)

Oh I needed a PLAN. I gave myself a goal of meal planning for three days. My mind can grapple with Sunday, Monday and Tuesday just fine. I didn’t want to get too ambitious and hope for a week.

First Line Therapy (FLT) is basically the reduced-carb, high-veggie, lean protein, healthy fat diet that we have all read about, tried, and maybe succeeded at. It’s similar to the South Beach approach or the Mediterranean diet…or Weight Watchers if you do it right.

You aim for a set number of calories per day within a certain set of food groups. For instance, Adam can eat 2000 calories a day, and this is how they break it down:

Servings per Day
3–4 “Category 1” veggies (the green leafies, the zucchinies, the tomatoes, the peppers, etc.)
2 legumes
1 dairy
3 concentrated proteins
2 fruits
4 healthy oils
1 nut
1 grain
1 “Category 2” veggie (the yummy orange ones)

You can read more about FLT here, where people are dangerously perched on two-wheels or here, where they weigh giraffes. I per the giraffes.

Among the many challenges of embracing FLT is that it’s kinda pricey. They recommend you eat what they call “medical food,” which includes Ultra Meal 360 Plus shakes with delicious "Selective Kinase Response Modulators,” twice a day and take a variety of supplements. You can indulge in medical chalklate, medical chalkberry or medical chalknilla flavored shakes, which you mix with cold water. Or you can get purse-friendly bars in flavors approximating fudge or apple cinnamon. (We have yet to try the apple cinnamon bars or strawberry shake flavors.) If there is a cookie variety, they are holding out on us.

“Medical food,” in combination with the cost of fresh produce, was looking a little forbidding until we looked at our daily Starbucks intake—$10 easy for both of us, which adds up to over $3600 a year. If we cut that out, along with our takeout habit, we could maybe swing this thing.

I comparison shopped at our local grocery store vs. the health food store vs. the farmer’s market. A head of lettuce at our grocery store costs around $3. I never used to buy a head of lettuce that I’d have to cut up and WASH and spin and hang to dry. It’s like doing laundry. Especially when have these cute little plastic boxes of cut up, triple-washed lettuce. But, they’re $4.99 a box. And, if truth be told, we usually throw away about 1/3 of it when the purple leafy things get all slimy. Hmmm… I see savings in my salad spinner.

The farmer’s market had locally grown lettuce for (drum roll please) $2! And it doesn’t come in those plastic shells which I always feel guilty about buying and tossing. So, not only am I supporting local growers, I can get my green on too? I’m sold. Or least sold on Wednesdays. Because that’s the only day the farmers market comes to my area.

To fill out the week, I decided to go for Romaine hearts at my grocery store, saving roughly $4 a week. Over a year, that’s $200. Which means I can buy those fancy Omega-3s FLT recommends we take. Or the “Medical food,” which is $50 a canister for 14 servings. OUCH, but remember the lettuce. Remember the lettuce!

Here is my 3-day plan:
Breakfast: a medical food shake, plus 2 eggs – anyway you like ‘em
Snack: fruit with a nut butter (Almond butter is pricey, but a little goes a loooong way. Plus, you can only have 1 tbsp.)
Lunch: here’s where the planning kicks in…yesterday’s dinner leftovers
Snack: another fruit
Dinner: a recipe from Adam’s cute binder and a salad
Snack: another medical food (This stuff is pricey.)*

Sunday’s dinner was turkey chili from the book (surprisingly delicious); Monday’s dinner was salad with grilled chicken breast; and Tuesday’s dinner was turkey and bulgur with peas (also yummy).

Not only did we have plenty of chili for lunch, I actually froze two servings for another day. The bulgur recipe looks like it might be another loaves and fishes story. I have never cooked bulgur, which I had to get at my health food store, but it was only $4 for a bag that will last me until the Buffalo Bills win a superbowl.**

Now I have to take a deep breath because today is Wednesday. And I have to plan again. But I did it THREE DAYS in a row. And I think I can, I think I can, I think I can… I talked to my doctor about Adam’s FLT diet, and he asked how it was going. “Well, it’s challenging, figuring out how to cook and plan and get all the food groups in.” He said, “That’s what it is. It’s practice.”

Hmmm... Practice. I can do that.


*According to the American Heart Association, in 1995, the last yearly figures they publish, there were 1,460,000 angiograms performed at an average cost of $10,880 per procedure. This resulted in 573,000 bypass surgeries at an average cost of $44,820, and 419,000 percutaneous transluminal (balloon) coronary angioplasties (PTCAs) at an average of $20,370 each. The total bill in 1995 was $50 billion, or $137 million per day―$5.7 million per hour. The total annual cost of cardiovascular disease in the United States, including medications and disability, is approximately $274 billion per year. And that was in 1995. When we were slathering butter on our biscuits. Good grief.

**Adam and I proudly hail from Buffalo, NY.

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The Disease Management Care Blog is still waiting to be listed in the CMS "clear accurate information is essential in times like these" Op-Eds & Blogs web page.  Will the CMS mandarins find favor with this particular DMCB post and include it with the other insightful masterpieces theyve linked, like "Health Reform Helps Many" and "Public Service Recognition Week?"

Probably not, says the DMCB.  Its not because the DMCB is again linking this report showing how CMS seems to be incapable of delivering disease management services to its fee-for-service enrollees.  Its not because of this report revealing how Medicares Hospital Compare isnt having much of an impact on outcomes.

Its because the DMCB is bringing up the inconvenient truth of this independent evaluation of Medicares Premier Hospital Quality Incentive Demonstration. This demo tested whether pay for performance can increase the quality of care for acute heart attack, chronic heart failure, pneumonia, heart bypass surgery and total knee as well as hip replacements.  33 measures for these conditions were collected from 252 participating hospitals. The hospitals that scored in the top measurement deciles received bonus payments, while those that were underperforming were hit with a payment penalty.

Think of it as "pay-for-performance" for hospitals.

After excluding hip and knee surgery (where mortality rates are very low), the researchers were interested in measuring whether the Premier Incentive Demo was associated with one of the most important outcomes of all: lower death rates. Based on 6 million patients worth of data from 2002 through 2009, the researchers found that there was no difference in overall 30-day mortality rates for all of the four conditions compared to non-demo hospitals (11.8% vs. 11.7%). In addition, mortality rates for the individual conditions of heart attack, heart failure and pneumonia were no different either. For heart surgery, there was a slight excess of deaths in the Premier group (4.1% vs. 3.3%).

These results are quite a contrast from this Premier press release that estimates that the Demo "saved an estimated 6500 heart attack patients." The DMCB suspects that that particular number was derived and extrapolated from prior studies linking less tobacco cessation or greater aspirin use to improved death rates.

It seems the math may have been wrong. And it was that same math that led the architects of the Affordable Care Act to establish the Medicare Hospital Value-based Purchasing Program ("Hospital VBP"). As the DMCB understands it, its just now getting underway.

Egads.

Go to this particular HHS web page and youll find that the Department....

"...monitors and evaluates programs to assess efficiency and responsiveness and to ensure the effective use of information in strategic planning, program or policy decision making, and program improvement."

Hopefully, the leaders at HHS will be doing precisely that by reexamining its assumptions and its ability to achieve real value with the Hospital VBP.

A University of Eastern Finland study showed that low serum vitamin D levels are a risk factor for pneumonia. The risk of contracting pneumonia was more than 2.5 times greater in subjects with the lowest vitamin D levels than in subjects with high vitamin D levels. The results were published in Journal of Epidemiology and Community Health.

The follow-up study carried out by the UEF Institute of Public Health investigated the link between serum vitamin D3 and the risk of contracting pneumonia. The study involved 1,421 subjects living in the Kuopio region in Eastern Finland. The serum vitamin D3 levels of the subjects were measured from blood samples drawn in 1998–2001, and these data were compared against reported cases of pneumonia in hospital records in the same set of subjects in 1998–2009. The results showed that during the follow-up, subjects with serum vitamin D3 levels representing the lowest third were more than 2.5 times more likely to contract pneumonia than subjects with high vitamin D3 levels. Furthermore, smoking constituted a significant risk factor for pneumonia. The risk of contracting pneumonia also grew by age, and was greater in men than women. At baseline, the mean serum D3 concentration of the study population was 43.5 nmol/l, and the mean age of the study population was 62.5 years.

Earlier research has shown that vitamin D deficiency weakens the immune defence system and increases the risk of mild respiratory infections. This University of Eastern Finland study was the first one to establish that vitamin D deficiency also increases the risk of contracting pneumonia in the ageing general population. According to the researchers, this finding supports earlier observations on the diverse role of vitamin D in the body, and it also calls for further research on vitamin D deficiency as a public health issue. In northern latitudes, there is enough sun exposure to maintain sufficient vitamin D levels in summer, but not during the winter season, and vitamin D supplementation is often required.

Why do different insurers pay different amounts for the same service?  While Medicaid and Medicare are notorious for their take-it-or-leave-it fee schedules, competing commercial insurers payment rates for vary considerably across providers, even within the same region.

Uwe Reinhardt tackles this mystery in a just-published article in Health Affairs.  Not only is this “price discrimination” untidy, says he, it’s also been unfairly credited as being evidence of “cost shifting.”

It turns out that there are some credible studies that show that as public payer fee schedules get squeezed, commercial insurers seem to pay more.  Yet, in order for a cause and effect to be present, that would mean that providers are not acting in their own economic self interest and are waiting on Medicare and Medicaid before bargaining with their local managed care plans. To Dr. Uwe, that seems suspect.  That would mean commercial insurers have little negotiating leverage which would also mean that the U.S. cannot rely on them to control costs.  Yikes.

Compounding this untidiness are the big swings in the costs of goods and services in an opaque market that seems better suited to upside price gouging and not downside discounting. This is not only hurting the uninsured, the dysfunction is now reaching into the pocketbooks of the middle class.  No wonder Americans are grumpy about the cost of health care.

Dr. Uwe’s suggestion? An “all payer” system.  Not to be confused with a “single payer” system involving some sort of Obamaesque Price Czar, all payers would negotiate prices with all providers in regional blocks across counties, regions or even states.

Some of the European countries use this approach and so, by the way, does the state of Maryland.  The role of government would presumably be limited to brokering a yearly Big Meeting between representatives of both camps; in fact, government could make sure all parties agree to prices that are indexed to the GDP.  The result?  Patients would benefit from an average price applied equally to all, insurers would know they’re paying their fair share and best of all, hospitals would get a fair price for their services.

The DMCB likes the approach but suspects that politicians would be tempted to meddle by showing favoritism.   It would per to see it implemented at the state level while the Feds are kept at arms length.  It should be limited to hospitals at first.  Depending on how things work out, it could be tested on a trial basis involving physicians, such as the Patient Centered Medical Home.

According to this CNN article, its naïve for the Disease Management Care Blog to expect U.S. Presidents to never lie. From time to time, political realities force occupants of the Oval Office to use falsehoods to advance a greater good and/or protect the integrity of their office.  Whats more, when theyre found out, voters tend to be remarkably forgiving. So, When Mr. Obama repeatedly reassured Americans that "you can keep your health insurance," the DMCB should conclude that this was business-as-usual statecraft and that it will all work out.

But even if many Americans sign up for health insurance and the President rebuilds his approval ratings, the contrarian DMCB has a deeper concern.

It thinks a dishonest "tone at the top" can have a corrosive effect on how Americans will access their premium subsidies. 

In the business world, it is well known that the misbehavior of corporate boards and C-suite leaders can infect an entire company. The Board Chairs or the CEOs dubious financials, revenue schemes, stock manipulation, predatory behavior or just plain arrogance can roll right through the managerial ranks and destroy a company in a matter of months. When leaders lie to serve some other business need, you can be sure that others in the company will also lie.

The same may be true for the government of the United States. Its one thing to lie about Japans military might (Roosevelt), trading arms for hostages (Reagan) or Iraqs weapons of mass destruction (Bush), its quite another to lie about buying health insurance. The DMCB suspects that "tone of the Oval Office" is subtly signaling to regulators, insurers and ultimately consumers that its OK to manipulate the truth when it comes to buying health insurance.

Recall that as part of health orm, the health insurance exchanges prompt applicants to estimate future income. Its also temptingly easy to misrepresent projected 2014 income.  A mild "fudge" that lowballs income can make the difference of thousands of dollars in subsidies.

Long before the President landed in hot water over his "you can keep it" promise, Americans had a huge incentive to lie about their income. That has been especially true for low income earners who really need the insurance. Now that everyone - including Mr. Obama - has admitted that he stretched the truth, the DMCB suspects Americans now have one more reason to do the same when it comes to getting health insurance subsidies. Once that pattern of insurance fraud becomes established in the marketplace, the DMCB thinks it will never go away and hundreds of millions of dollars will go to where its not intended year after year after year.

The DMCB predicts tens of thousands of Americans who purchase insurance on the exchanges will succumb to lying in 2014.

You read it here first. 

Coda: The good news is that when it comes to the health insurers who are responsible for signing up the millions of Americans, theres no evidence that theyre helping enrollees lie.  The DMCB suspects that in the battle to capture market share, its just a matter of time until one of them has a renegade employee or two who channel the President and likewise help prospective customers to lie. Well see.

Three years ago (!), we posted a piece called Cheap, Healthy Party Food, filled to the brim with inexpensive, Super Bowl-appropriate recipes. Most of them came from thoroughly vetted outside sources like All Recipes and Cooking Light. All appeared delicious.

Since then, between CHG and my weekly Healthy & Delicious column at Serious Eats, we’ve compiled hundreds of our own recipes, many of which are floofin’ perfect for the Packers/Steelers game. We made and ate every single one of these, and can recommend them without reservation. Even to your Dad (whom I’m sure totes loves healthy food, especially on Super Bowl Sunday).

If you have suggestions or excellent, apropos recipes from your own blog, leave ‘em in the comment section! Together, we can make this the most delicious Super Bowl since the last time Pittsburgh was in it.

(Special note: Frugal shoppers! Even if you hate football with the white-hot intensity of a thousand angry suns, this is a great week to stock up. Look for sales on cheese, sour cream, beans, frozen foods, crackers, dip, and more at your supermarket.)

APPETIZERS
Baked Loaded Potato Skins
Greek Antipasto Pitas
Greek Salad Skewers
Provencal Deviled Eggs
Roasted Pepper Halves with Bread Crumb Topping
White Bean Bruschetta
White Bean and Roasted Red Pepper Wraps with Spinach
Zucchini Crostini

DIPS, SALSAS, and GUACAMOLE
Avocado Corn Salsa
Baba Ghanouj
Black Bean Dip
Easy White Bean Dip
Fresh Salsa
Guacamole-Bean Dip Mashup
Lemony Hummus
Mango Salsa
Raw Tomatillo Salsa
Roasted Eggplant Spread
Seven-Layer Taco Dip
Spinach and Artichoke Dip
Spinach and Cannellini Bean Dip
Tomatillo Guacamole
Tzatziki (Greek Yogurt and Cucumber Sauce)

CHILI
All-American Chili
Cactus Chili
Camp Stove Veggie Chili
Chili Corn Pone Pie
Easy Vegetarian Bean Chili
Pumpkin Turkey Chili
Turkey Chili
Turkey Chili with Beans
Vegetarian Chili on the Fly
White Chicken Chili
Winter Vegetable Chili

SALADS and SIDES
Avocado Chicken Salad
Black Bean and Tomato Quinoa
Chickpea Salad
Chili-Spiced Potatoes
Ellie Krieger’s Refried Beans
Gazpacho Pasta Salad
Golden Delight Egg Salad
Greek Orzo Salad
Lemon Basil Pasta Salad
Lime Chicken Salad with Avocado and Tomato
Malt Vinegar Oven Fries
Potato Salad with Green and White Beans
Potato Salad for Rainy Day People
Quick Red Posole with Beans
Semi-Southern-Style Cornbread
Spicy Sweet Potato Fries

MAINS
Baked Ziti
Black Bean Burrito Bake
Blue Cheese Portobello Mushroom Burgers
Chicken Fried Rice
Chinese Chicken and Broccoli
Chipotle Pork Tenders
DIY Hot Pockets
Falafel with Tahini Sauce
Grilled Flank Steak with Tomato Relish
Grilled Portobello Mushroom Burgers
Homemade Pizza
Italian Turkey Sliders
Macaroni and Cheese
Pork Tacos
Sausage and Pepper Sandwiches
Skillet Chicken Fajitas
Sloppy Jacks
Spiced Chicken Skewers
Stuffed Peppers
Stuffed Peppers with Black Beans and Corn
Tofu Banh Mi
Vegetable Lo Mein

DESSERTS and SNACKS
Black Bean Brownies
Crunchy Pecan Cookies
DIY Microwave Popcorn
Roasted Chickpeas
Tamari Almonds

Readers? Your recipes?

~~~

If you like this article, you might also like:

• A Beginner’s Guide to Beans, Plus 42 Bean Recipes
• Cheap Healthy Beef, Part I: Recipes and Methodology
• Cheap Healthy Pork: Recipes, Methodology, and Tips

Research at Oregon State University has found that one particular omega-3 fatty acid has a powerful effect in preventing liver inflammation and fibrosis – common problems that are steadily rising along with the number of Americans who are overweight.

The American Liver Foundation has estimated that about 25 percent of the nation’s population, and 75 percent of those who are obese, have nonalcoholic fatty liver disease. This early-stage health condition can sometimes progress to more serious, even fatal diseases, including nonalcoholic steatohepatitis, or NASH, as well as cirrhosis and liver cancer.

The study, published online in the Journal of Nutrition, was one of the first to directly compare the effects of two of the omega-3 fatty acids often cited for their nutritional value, DHA and EPA.

In research with laboratory animals, it found that EPA had comparatively little effect on preventing the fibrosis, or scarring, that’s associated with NASH. However, DHA supplementation reduced the proteins involved in liver fibrosis by more than 65 percent.

“A reduction of that magnitude in the actual scarring and damage to the liver is very important,” said Donald Jump, a principal investigator with the Linus Pauling Institute at OSU and a professor in the College of Public Health and Human Sciences.

“Many clinical trials are being done with omega-3 fatty acids related to liver disease,” Jump said. “Our studies may represent the first to specifically compare the capacity of EPA versus DHA to prevent NASH. It appears that DHA, which can also be converted to EPA in the human body, is one of the most valuable for this purpose.”

The issues have taken center stage as the weight of Americans continues to rise, with a related increase in the incidence of fatty liver disease and liver damage.

NASH is a progressive form of liver disease that is associated with chronic inflammation and oxidative stress, resulting from excess fat storage in the liver. Chronic inflammation can eventually lead to fibrosis, cirrhosis, or even liver cancer. While management of lifestyle, including weight loss and exercise, is one approach to control the onset and progression of fatty liver disease, other approaches are needed to prevent and treat it.

About 30-40 percent of people with nonalcoholic fatty liver disease progress to NASH, which in turn can result in cirrhosis, a major risk factor for liver cancer. While this research studied the prevention of fatty liver disease, Jump said, ongoing studies are examining the capacity of DHA to be used in NASH therapy.

The levels of omega-3 oils needed vary with the health concern, officials say.

“Omega-3 fatty acids are typically recommended for the prevention of cardiovascular disease,” Jump said. “Recommended intake levels of omega-3 fatty acids in humans for disease prevention are around 200-500 milligrams of combined DHA and EPA per day.”

Levels used in therapy to lower blood triglycerides, also a risk factor for cardiovascular disease, are higher, about 2-4 grams of combined EPA and DHA per day. The OSU studies with mice used DHA at levels comparable to the triglyceride therapies.

“DHA was more effective than EPA at attenuating inflammation, oxidative stress, fibrosis and hepatic damage,” the researchers wrote in their conclusion. “Based on these results, DHA may be a more attractive dietary supplement than EPA for the prevention and potential treatment of NASH in obese humans.

A few months ago, our own Jaime posted a piece called Little Meals for One. It was a brief, well thought-out article all about simple, small-scale home cooking. I loved it, as did many readers who were looking for both inspiration and validation. (A spoonful of peanut butter IS TOO a meal, dangit.)

Because sometimes? You just want food in your mouthhole. You want it in a single portion, and you want it a.s.a.p. Why? Well, maybe you’re late coming home from the office. Maybe it’s a lazy Sunday afternoon in August, and you have no great urge to further heat your already-sweltering apartment with a 450ºF oven. Maybe you’re just really hungry, and whipping up a whole lasagna for one person seems totally freaking insane.

Unfortunately, quick, single-portion recipes are hard to come by, probably because it’s difficult to prepare most gourmet meals in smaller serving sizes. So, how do you do it? How do you make a convenient, speedy meal without resorting to A) expensive and unhealthy processed food, B) takeout, or C) licking crumbs off your kitchen floor?

Well, first, it’s good to keep tricks these in mind:

1. Keep your rigerator, pantry, and freezer stocked with food easily portioned into small servings: eggs, cheese, pasta, etc.
2. When you buy bigger packages of food (meat, veggies, etc.), portion them off in smaller grab-and-go bags as soon as you arrive home from the supermarket.
3. Look for recipes where you broil, grill, steam, sauté, boil, and microwave. Avoid recipes where you roast, braise, soak, brine, or marinate.
4. Keep low-cost, high-impact condiments and ingredients handy. Stuff like soy sauce, capers, olives, roasted red peppers, parmesan, curry powder/sauce, Dijon mustard, and horseradish can lend big flavor to tiny dishes in a hurry.
5. Don’t limit yourself to traditional dinner cuisine. Breakfast and lunch foods taste just as good at 7pm.
6. Don’t limit yourself to traditional American cuisine. Soups, curries, and stir fries are healthier and just as fast as burgers and hot dogs.
7. Consider raw fruits and vegetables for side dishes. They’re healthy as all get out, and take zero time to prepare.
8. Load up your freezer to your heart’s content. Frozen meats and produce can be defrosted quickly and cooked even faster. Consider canned versions of certain foods, as well, but be discerning when it comes to both sodium content and taste.
   
9. Before you do anything, scan your fridge for ideas and ingredients. Bits and pieces can become ingredients in larger, more delicious meals.
10. Speaking of bits and pieces, consider using many smaller foods to create one large meal. Eggs, a piece of fruit, and a side of ried beans never killed anyone.
11. Most of all, K.I.S.S. (Keep it Simple, Sistah)
    

After that, it’s always a good idea to er to the basics: a.k.a. Dinners You Learned to Make When You Were 12. Often, these are the easiest options because you already have the ingredients on hand AND youre familiar with the foods. Like:

• Bagels (with low-fat cream cheese, lox, butter, PB&J, etc.)
• Baked potatoes
• Breads (with dips, cheese, veggies, or quick soups)
• Chicken or turkey sausages
  
• Cottage cheese
• Couscous mixed with anything (chopped vegetables, beans, etc.)
• Crackers with toppings of your choice
• Eggs (omelets, scrambled, sandwiches, baked, etc.)
• Fruit
• Grilled or broiled chicken or pork tenders
• Mashed black, pinto, or cannellini beans
• Oatmeal (sweet or savory, a la Mark Bittman)
• Pasta (with sauce, vegetables, cheese, etc.)
• Pierogies (boiled/steamed)
• Pizza bagels/English Muffin pizzas
• Portobello mushrooms
  
• Raw vegetables with simple dips (hummus, baba ghanouj, etc.)
• Rice mixed with vegetables and/or salsa
• Salads (vegetables, fruit, bean, or otherwise)
• Sandwiches (hummus, PB&J, grilled cheese)
• Shish kabobs (meat, veggies, or fruit broiled on a stick)
• Smoothies
• Steamed or sautéed veggies
• Stir fry
• Turkey burgers
• Wraps and/or soft tacos
  
• Yogurt
  

If those fail to float your boat, you might want to do a quick search for some recipes around the web, using the terms "Meals for one," "single serving," or "15 minutes or less." Here are some fast, simple, cheap, healthy suggestions from CHG. All of them can easily be rescaled to feed one person.

• Autumn Apple Salad
• Baked Eggs
• Black-Eyed Pea Salad
• Bodega Beans
• Broiled Eggplant Japonaise
• Creamy Parmesan Orzo
• Egg Drop Soup
• Egg McMuffins
• Eggplant Mini Pizzas
• Garlicky Broccoli Rabe
• Grape and Feta Salad with Rosemary
• Hummus
• Light Chinese Chicken and Broccoli
• Light Garlic Bread
• Miso Soup
• Moroccan Beet Green Omelet
• North African Style Chickpea Salad
• Pancakes (Buttermilkand Whole Wheat Buttermilk)
• Parmesan-crusted Portobello Mushrooms
• Pea Soup
• Polenta
• Refried Beans
• Roasted Asparagus with Poached Egg and Parmesan
• Shaksouka (Eggs Poached in Tomato Sauce)
• Stuffed Peppers

Sweet readers, how about you? What do you eat when you need something small, fast, and nutritionally sound? Do tell. Lets make this the biggest single meal list, ever.

Cinnamon has received good press recently owing to USDA-sponsored research, some results of which appeared in the December 2003 issue of Diabetes Care. That study found that intakes of as little as 1/2 teaspoon cinnamon/day improved measures of blood glucose and blood lipids in people with type 2 diabetes. We reported those results here.

Results of 2 recent studies are at odds concerning the benefits of cinnamon.
________
The first study appeared in the April 2006 issue of The Journal of Nutrition.

Methods

• Participants - 25 postmenopausal patients with type 2 diabetes
  
• Length - 6-week intervention
  
• Type - Double-blind, placebo-controlled
  
• Dose - 1.5g cinnamon/day

Findings
Cinnamon did not improve measures of insulin sensitivity, oral glucose tolerance, or blood lipids.
________
The second study appeared in the May 2006 issue of the European Journal of Clinical Investigation.

Methods

• Participants - 79 patients with type 2 diabetes
  
• Length - 4-month intervention
  
• Type - Double-blind, placebo-controlled
  
• Dose - Water soluble cinnamon extract (equivalent to 3g of cinnamon/day)

Findings
Cinnamon extract led to a reduction in fasting glucose levels (down 10.3%, compared to the placebo groups 3.4%). Cinnamon did not improve HbA1c levels nor measures of blood lipids.
________
Neither of these studies is the final word on use of this spice for BG control. If youd like to try adding cinnamon to your diet, keep in mind that long-term safety of ingestion of powdered cinnamon bark has not been determined. Researchers at the USDA Agricultural Research Service note that:

"Table cinnamon made from cinnamon bark contains [potentially toxic] fat-soluble compounds. Those compounds may accumulate in the body if ingested consistently as more than a spice over long periods of time."
- Rosalie Marion Bliss, April 2004, Beneficial Compounds in Cinnamon Spice Up Insulin Sensitivity

If benefits of cinnamon supplementation prevail, a water soluble cinnamon extract - similar to that used in the second study above - may be the best bet.

________
For the April 2006 Journal of Nutrition study:
Cinnamon Supplementation Does Not Improve Glycemic Control in Postmenopausal Type 2 Diabetes Patients

For the May 2006 European Journal of Clinical Investigation study:
Effects of a Cinnamon Extract on Plasma Glucose, HbA1c, and Serum Lipids in Diabetes Mellitus Type 2

For a news summary of the European Journal of Clinical Investigation study:
New Study Shows Cinnamon Extract Lowers Blood Sugar Levels In People With Type 2 Diabetes

For the 2003 Diabetes Care study:
Cinnamon Improves Glucose and Lipids of People With Type 2 Diabetes

Research due in an upcoming issue of the British Medical Journal found that smokers had a greater risk of developing glucose intolerance than people who never smoked. But another finding of the study is raising eyebrows - that people exposed to secondhand smoke also experienced an increased risk for the condition.

The study, begun in 1985, followed 4,572 young men and women (age 18 to 30 at baseline) in four American cities for up to 15 years.

After adjusting for confounders (factors that could also influence development of glucose tolerance - age, sex, race, education, income, blood pressure, body mass index, triglycerides, and alcohol intake), researchers found, when compared to people who never smoked and had no passive smoke exposure:

• Current smokers (average 10 cigarettes/day) had a 65% greater risk of developing prediabetes.
  
• People who never smoked but were exposed to secondhand smoke (average 12.6 hours/week) had a 35% greater risk of developing prediabetes.

Prediabetes, also known as impaired glucose tolerance, was recorded when serum glucose ≥ 100 mg/dl and < 126 mg/dl. (Diabetes is diagnosed when fasting serum glucose ≥ 126 mg/dl.) Most people with prediabetes will develop full blown diabetes unless they make lifestyle changes.

Researchers said substances in cigarette smoke which are damaging to the pancreas may be present in higher concentrations in secondhand smoke, since passive smoke is produced under different temperatures and chemical conditions.

________
Some news summaries:
Secondhand Smoke Linked to Diabetes Risk

Passive Smoke Could Prompt Diabetes Precursor: Report

Smoking Linked to Glucose Intolerance in Young Adults

For the study abstract:
Active and passive smoking and development of glucose intolerance among young adults in a prospective cohort: CARDIA study

For the study (pdf):
Active and passive smoking and development of glucose intolerance among young adults in a prospective cohort: CARDIA study

Corporatization

The Disease Management Care Blog is ashamed to admit it, but its reading Edward Kleins The Amateur. While much of the book is a conservative-partisan rehash of Mr. Obamas alleged personal and political shortcomings, it did raise one issue that intrigued the DMCB:

"Corporatization."   It seems this White House likes it.

As the DMCB understands it, this is a policy agenda that favors the formation of huge corporate organizations that dominate the national business climate. Its argument is that, thanks to their size and scope, these gigantic private, public and not-for profit corporations are better able to marshal the resources it takes to launch transformative programs, achieve efficiencies, take risks and make profits that are beyond the normal reach of traditional commerce. Think about the hundreds of billions-of-dollars-approaches to housing, financial services, battery operated cars, high speed rail, solar power, privatized space travel and, last but not least, health care insurance and delivery.

A key ingredient of corporatization is "partnering" with government in a way that blurs the line between private enterprise and the public interest. Ingredients include government-backed financing, special tax breaks, loans, grants, mixed Boards of Directors and sovereign investment funds.  The downsides are quite familiar also: crony capitalism and too-big-to-fail status 

The best example of corporatization is China. Beijing centrally orchestrates many of its key economic sectors including finance, banking, housing, public transportation and heavy industry with an opaque mix of public and private companies. While political orms and respect for human rights have been found wanting, the prospect that China could eclipse the United States in the next 25 years has prompted many in the U.S. to admire China and reexamine the merits of old fashioned capitalism and unfettered markets. For an interesting example of that thinking, see this editorial by Andy Stern that recently appeared in the Wall Street Journal.

What could this explain and what are the implications?

1. The abandonment of the government-run "public option" early in the course of creating the Affordable Care Act. Despite his hostile anti-insurer rhetoric, Mr. Obamas ultimate belief in large mega-insurance corporations, a) regulations and b) public subsidies that bind the behemoth insurers to D.C. won the day.  And it aint going away anytime soon.

2. The near ideological support by this Administration for Accountable Care Organizations. Despite little track record that ACOs offer a viable business model, the notion of large regional providers partnering with and led by CMS is fully consistent with a belief in corporatization.  This makes the DMCB wonder if Mr. Obamas intent is to assure that ACOs succeed, no matter what.

Todays question comes from reader Alicia N. Its a super good one, especially for all you frommage lovers out there.

Q: What do you use when you need some cheap cheese for cooking? I made a great baked pasta last week and it called for a cup of shredded Jarlsberg. My husband came home from the store and asked me to please stop using $9 cheese. I dont mind splurging on expensive cheese if we are going to eat it on its own ... but it seems silly if we are just going to melt it with something else or make mac-n-cheese out of it. Extra points if its something I might be able to find already shredded.

From Dominik

A: Alicia, I do three things:

• For cooking, I tend to concentrate on recipes with four main cheeses: Cheddar, Parmesan, mozzarella, and feta. They go on sale the most, I can get good-to-great brands, and theyre widely applicable to a huge range of recipes.
• I let the sales be my guide. Rather than planning a dish and then buying the appropriate cheese, I wait until a cheese (any cheese) goes on sale, and plan a dish around that.
• Though I also use shredded cheese on occasion, I find that grating my own blocks isnt just cheaper, but better for most cooking purposes. It melts easier and tastes better, since you dont get the anti-caking grit endemic to bags of the pre-shredded stuff.

Readers, how bout choo? Im thinking this is right in your (cheese)wheelhouse. Does shopping at bulk stores make a difference? Do you combine a pricey cheese with thriftier ones to beef it up? Do tell.

Want to ask the interweb a question? Post one in the comment section, or write to Cheaphealthygood@gmail.com. Then, tune in next Tuesday for an answer/several answers from the good people of the World Wide Net.