Tips from gaining health

Regular aspirin use appears to be associated with an increased risk of neovascular age-related macular degeneration (AMD), which is a leading cause of blindness in older people, and it appears to be independent of a history of cardiovascular disease and smoking, according to a report published Online First by JAMA Internal Medicine.

Aspirin is one of the most widely used medications in the world and is commonly used in the prevention of cardiovascular disease, such as myocardial infarction (heart attack) and ischemic stroke. While a recent study suggested that regular aspirin use was associated with AMD, particularly the more visually devastating neovascular (wet) form, other studies have reported inconsistent findings. Smoking is also a preventable risk factor for AMD, the authors write in the study background.

Gerald Liew, Ph.D., of the University of Sydney, Australia, and colleagues examined whether regular aspirin use (defined as once or more per week in the past year) was associated with a higher risk of developing AMD by conducting a prospective analysis of data from an Australian study that included four examinations during a 15-year period. Of 2,389 participants, 257 individuals (10.8 percent) were regular aspirin users.

After the 15-year follow-up, 63 individuals (24.5 percent) developed incident neovascular AMD, according to the results.

"The cumulative incidence of neovascular AMD among nonregular aspirin users was 0.8 percent at five years, 1.6 percent at 10 years, and 3.7 percent at 15 years; among regular aspirin users, the cumulative incidence was 1.9 percent at five years, 7 percent at 10 years and 9.3 percent at 15 years, respectively," the authors note. "Regular aspirin use was significantly associated with an increased incidence of neovascular AMD."

The authors note that any decision concerning whether to stop aspirin therapy is "complex and needs to be individualized."

"Currently, there is insufficient evidence to recommend changing clinical practice, except perhaps in patients with strong risk factors for neovascular AMD (e.g., existing late AMD in the fellow eye) in whom it may be appropriate to raise the potentially small risk of incident neovascular AMD with long-term aspirin therapy," the authors conclude.

Commentary: Relationship of Aspirin Use with Age-Related Macular Degeneration

In an invited commentary, Sanjay Kaul, M.D., and George A. Diamond, M.D., of Cedars-Sinai Medical Center, Los Angeles, write: "This study has important strengths and limitations. It provides evidence from the largest prospective cohort with more than five years of longitudinal evaluation reported to date using objective and standardized ascertainment of AMD."

"The key limitation is the nonrandomized design of the study with its potential for residual (unmeasured or unobserved) confounding that cannot be mitigated by multivariate logistic regression or propensity score analysis," the authors continue.

"From a purely science-of-medicine perspective, the strength of evidence is not sufficiently robust to be clinically directive. These findings are, at best, hypothesis-generating that should await validation in prospective randomized studies before guiding clinical practice or patient behavior," the authors conclude. "However, from an art-of-medicine perspective, based on the limited amount of available evidence, there are some courses of action available to the thoughtful clinician. In the absence of definitive evidence regarding whether limiting aspirin exposure mitigates AMD risk, one obvious course of action is to maintain the status quo."

Sweet readers! I apologize for being kind of AWOL this week. (No Wednesday article! Ack.) Wedding planning is starting to really kick in, and our world is slowly being consumed by strapless bras and canapés. How did people do this before Excel spreadsheets?

Still, it’s a strong round of links this week with various tutorials, a coupla neat new sites, and a dashing finale. (Hint: The Old Spice Guy is involved.) Enjoy!

1) Wise Bread: 50 Healthy Foods for Under $1 a Pound
Wise Bread wins. They just do. (Pic from Natalie Dee.)

2) Washington Post: Kentucky town of Manchester illustrates national obesity crisis
If you’ve ever wondered how obesity affects and why it prevails in small towns, this moving, in-depth account of Manchester is the piece to read. The line about the intersection will tell you just about everything.

3) Casual Kitchen: Knowing When Not to Be a Food Snob
Sadly, the anonymity of the interwebs often means we foodies come off like raving packs of Comic Book Guys. (“Worst. Recipe. Ever.”) When do we hold back? When is it okay to unleash our inner elitists? Dan uses a fairly recent piece by Ratio guy Michael Ruhlman to discuss.

4) Surviving and Thriving: A big meal plus leftovers for less than a buck. (Hint: Let others do most of the cooking.)
Donna Freedman waxes poetic about potlucks. Most helpful? This gem: “Deviled eggs are a big hit because everybody loves them and nobody likes to make them.” Truer words, never spoken.

5) Urlesque: Annoying Cooks on the Web – a Field Guide
The title is a tad misleading; it should really be “15 Reviewers You Meet on Community Recipe Sites.” My favorite, and the one that makes me most crazy: The Ingredient Switcher. To wit: “I hated this recipe! I followed the instructions to a T but instead of white flour I used cornstarch and I swapped the honey for chili powder. It was terrible"

6) New York Times: Hungry Girl Offer a Real Take on Diet Foods
NYT’s (first?) profile of Lisa Lillien echoes a running theme in almost all HG articles. The author is clearly wary of her endorsements and use of processed foods, but has to maintain a respectful tone out of deference to Lillien’s bagillions of followers. Despite that, it’s still one of the better Hungry Girl pieces I’ve seen.

7) The Kitchn
10 Things to Eat When You Return From Vacation
Quick, Easy Ways to Get More Vegetables Into My Diet?
You think you’re so cool, don’t you, The Kitchn? “Blah blah blah here’s another positive, incredibly helpful and thoughtful post with a bunch of pictures that put Ansel Adams to shame blah blah blah.” Yeah, we getcher point. Punks.

8) Kitchen Myths
Oodles of Alton Brown-type cooking myths, busted in no-nonsense style, presented ing Internet-circa-1996 style. I give this three Bill Clinton heads out of a possible four.

9) Marketplace: Farmers Market Guide – 20 Cities, Coast to Coast
Ooo … handy!

10) Bargaineering: How to Dry Fresh Herbs
Just in time! We inherited our friends’ CSA shipment this week, and it came with the most enormous bag of tarragon you’ve ever seen in your whole puff. Anyone for some Tarragon Pops?

HONORABLE MENTION

Jim’s Pancakes
Oh, yay! It’s amazing what you can do with a little food dye and some hungry children.

The Kitchn: Zucchini At Your Door? 12 Recipes to Help Eat It Up
Again? Again with the practical deliciousness? Harrumph.

Promo Machine UK: Discount Design - 23 Fantastically Vintage Coupons
Who wants $0.07 off a box of Life cereal?

Village Voice: Americans Getting Too Fat for Theater Seats
Hey! We’re still fat! Whee! On a related note: Has anyone seen Twilight: Eclipse? My sister and I have three questions:

1. Why are these two supernatural, smokin’ hot dudes fighting over The Most Boring Woman in the World?
2. Why is being turned into a vampire so bad? You live forever, receive awesome powers, and still get to have sex. I don’t see the downside here.
3. Where was the eclipse?

AND ALSO

New York Times: On Facebook, Telling Teachers How Much They Meant
God, I love this story. Mr. Leogrande, this one’s for you.

BoingBoing: Goodbye Old Spice Guy
I will miss you most of all. SWAN DIVE!



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Research published in the prestigious journal Diabetes Care (published by the American Diabetes Association) suggests that two ounces of nuts consumed daily when substituted for ined carbohydrate foods can prevent diabetes and the deadly complications caused by the disease. Researchers found that nuts eaten as part of a healthy diet can lower serum blood glucose and lipids to lower long-term blood sugar control as measured by the HbA1C blood test. Grab a big handful of almonds, walnuts, pecans or macadamias to ward off diabetes and metabolic syndrome, devastating conditions currently evolving to threaten human health and longevity.

Were switching the schedule around a bit this week, due to the gremlin that has taken up residence in my face. Wednesdays usual article is postponed until next week, replaced by this lovely recipe.

As this popular and highly rated Rosemary Chicken Salad recipe from Cooking Light is presented, it’s essentially a blank slate. I mean, its moist, it tastes good, and it uses up a bunch of leftover chicken, but no single flavor ever comes forward to assert itself as master and ruler of its subordinates. But theres a reason for that. A good reason. Nay – a really good reason.

And that reason? Is you.

Seriously, though. Recipes like this one are invaluable, because they allow the chef (a.k.a. you) near-infinite possibilities for improvisation. You can add nearly any ingredient you like to the original dish, because its highly improbable youll go wrong with your choices. Why not try:

• Celery
• Grapes
• Apples
• Dried cranberries
• Smoked almonds
• Raisins
• Cashews
• Pecans
• Walnuts
• Cayenne

Eggs, beans, oatmeal, polenta, and pasta salads are similarly inclined, in that they can be customized until the cows come home, with huge, gaping room for error. Well discuss more about the customization itself next week, but in the meantime, should you decide to whip this up, there are a few things to know:

1) My loathing for mayonnaise is surpassed only by my loathing of sinusitis, but it’s in here because the other flavors cover up the flavor and texture enough so I don’t ever have to taste, smell, or think about it.

2) The calculations are very different from Cooking Light’s, largely because I don’t include bread, and have changed the proportions of the original recipe a bit (less mayo, more yogurt).

In conclusion, go nuts with this thing. The salads the limit.

~~~

If this recipe looks tantalizing, man, youll like these:

• Autumn Apple Salad
• Golden Delight Egg Salad
• Potato Salad for Rainy Day People

~~~

Rosemary Chicken Salad
Serves 5
Adapted from Cooking Light.


3 cups (about 3/4 pound) roasted skinless, boneless chicken breasts or rotisserie chicken, chopped
1/3 cup chopped scallions
1/4 cup slivered or sliced almonds
6 tablespoons Greek low-fat yogurt
2 tablespoons light mayonnaise
1/2 tablespoon chopped fresh rosemary
1/2 tablespoon Dijon mustard
1/8 teaspoon salt
1/8 teaspoon freshly ground black pepper
Chopped: celery, grapes, apples, dried cranberries, smoked almonds, raisins, cashews, pecans, walnuts, cayenne (optional)

In a medium mixing bowl, combine chicken, scallions, almonds, yogurt, mayonnaise, mustard, salt, pepper, and chosen optional ingredients. Serve on whole wheat bread with mixed greens.

Approximate Calories, Fat, Fiber, Protein, and Price Per Serving
134 calories, 5.1 g fat, 3.7 g fat, 0.7 g fiber, 18.5 g protein, $0.78

NOTE: These calculations are for chicken breasts, and no optional add-on ingredients.

Calculations
3 cups (about 3/4 pound) roasted skinless, boneless chicken breasts, chopped: 373 calories, 4.1 g fat, 0 g fiber, 78.3 g protein, $1.48
1/3 cup chopped scallions: 11 calories, 0 g fat, 0.9 g fiber, 0.6 g protein, $0.30
1/4 cup slivered or sliced almonds: 144 calories, 12.6 g fat, 3 g fiber, 5.3 g protein, $0.63
6 tablespoons Greek low-fat yogurt: 65 calories, 1.8 g fat, 0 g fiber, 8.5 g protein, $0.97
2 tablespoons light mayonnaise: 70 calories, 7 g fat, 0 g fiber, 0 g protein, $0.16
1/2 tablespoon chopped fresh rosemary: 1 calorie, 0 g fat, 0.1 g fiber, 0 g protein, $0.25
1/2 tablespoon Dijon mustard: 8 calories, 0 g fat, 0 g fiber, 0 g protein, $0.07
1/8 teaspoon salt: negligible calories, fat, fiber, and protein, $0.01
1/8 teaspoon freshly ground black pepper: negligible calories, fat, fiber, and protein, $0.01
TOTALS: 672 calories, 25.5 g fat, 3.7 g fiber, 92.7 g protein, $3.88
PER SERVING (TOTALS/5): 134 calories, 5.1 g fat, 3.7 g fat, 0.7 g fiber, 18.5 g protein, $0.78

Oats may deserve the well-earned status of "super grain", according to research presented at the American Association of Cereal Chemists International annual meeting, being held this week in Albuquerque, NM. World-renowned grain researchers presented compelling data to support the important role that oats can play in improving diet quality and supporting human health.

YiFang Chu, Ph.D., PepsiCo R&D Nutrition, shared new data about antioxidants in oats (Avena sativa L.) and their role in human health. In the session, "Antioxidants in Grains and Health: Is there a Linkage?" Chu emphasized that oats are a nutritious whole grain with evidence to show that oats are even more complex than previously thought. They possess a wide spectrum of biologically active compounds including carotenoids, tocols (Vitamin E), flavonoids and avenanthramides – a class of polyphenols.

"The polyphenols, avenanthramides, are unique to oats and have been widely used in skincare products because of their anti-inflammatory and anti-itching effects," says Chu. "As scientists continue to link inflammation to chronic diseases, they are also investigating whether bioactivities produced by the polyphenols in oats can be as beneficial from within the body as they are on the skin." There are over 25 different biologically active avenanthramides in oats that look similar chemically, but behave differently. Theore, adds Chu, "compared to the bioactive compounds identified in other grains—like wheat and rye—oats may be more bioavailable and possess more anti-inflammatory properties."

In addition to avenanthramides, oats and oat products have many bioactive compounds that may provide health benefits. Oats and oat-containing products that meet a minimum level of oat beta-glucan are allowed to bear a Food and Drug Administration-approved health claim for cholesterol-lowering benefits. Studies also suggest oats can enhance satiety and may also help reduce the risk of other chronic conditions.

It’s the second full week of 2010. By now, you may be ten or eleven days into a resolution diet. You’re probably feeling really good about your progress. Chances are you lost a little weight. There’s a possibility you noticed a physical change already. You might even be thinking (and justifiably so): “I am the greatest person alive! Besides Eddie Vedder, I mean.”

Sadly, this may also have crossed your mind: “If eat one more salad, I’m going to set my face on fire.”

Sweet baby Jane, I hear you. When I began to change my eating habits, salads made up a big chunk of my diet. Office lunches were never-ending parades of the Caesar varietals (with light dressing, natch), and I got real tired, real fast of baby spinach. Then, I learned to cook and life got exponentially better. (Exponentially! That’s a lot.)

Anyway, once I started puttering around the kitchen, I realized the following:


With a creative topping, you can turn five ounces of pedestrian grilled chicken into a succulent celebration, a flavoral fooferaw, or even a scrumptious shindig. (Or any other gratuitously alliterative party.) Think of the meat as your canvas, and the accompaniment as your pretty rainbow paint of rainbows.

Take Gail Simmons’ Tomato and Avocado Salsa from Food & Wine, for example. You can use it as a dip for chips or veggies, sure. (The Super Bowl’s coming up, after all.) But on plain poultry, it becomes something else entirely: a tasty, filling, healthy dinner. Like almost all salsas, the recipe is staggeringly easy to make and constitutes a solid serving of vegetables. For $1 and 100 extra calories, that ain’t too shabby.

This week, when you’re choking down another round of Romaine, stop. Grab an avocado and a few grape tomatoes, grill a slice of chicken, and treat yourself to Tomato and Avocado Salsa. It’ll make the next few months a lot easier to stomach.

~~~
If you like this recipe, you might also dig:

• Guacamole-Bean Dip Mashup
• Mango Salsa
• Tomatillo Guacamole

~~~

Tomato and Avocado Salsa
Serves 4.
Adapted from Food & Wine.

1 1/2 cups grape tomatoes, halved or quartered
1 Hass avocado, diced small
1/4 cup onion, chopped small
1/2 small jalapeno, seeded and minced
1/8 cup cilantro, chopped
1/8 cup fresh lime juice
Kosher salt and freshly ground pepper

1) In a medium bowl, gently combine all the ingredients. Salt and pepper to taste. Stir again to combine. Serve on meat, chicken, fish, chips, cheese, or … anything, really.

NOTE: If you’d like a less chunky salsa, chop the tomatoes and avocado even smaller.

Approximate Calories, Fat, Fiber, and Price Per Serving
4 servings: 100 calories, 7.4 g fat, 3.7 g fiber, $1.04

Calculations
1 1/2 cups grape tomatoes, halved or quartered: 45 calories, 0 g fat, 0.1 g fiber, $2.50
1 Hass avocado, diced small: 322 calories, 29.5 g fat, 13.5 g fiber, $0.99
1/4 cup onion, chopped small: 13 calories, 0 g fat, 0.6 g fiber, $0.08
1/2 small jalapeno, seeded and minced: 9 calories, 0 g fat, 0.3 g fiber, $0.05
1/8 cup cilantro, chopped: negligible calories and fat, 0.1 g fiber, $0.25
1/8 cup fresh lime juice: 10 calories, 0 g fat, 0.2 g fiber, $0.25
Kosher salt and freshly ground pepper: negligible calories, fat, and fiber, $0.03
TOTAL: 399 calories, 29.5 g fat, 14.8 g fiber, $4.15
PER SERVING (TOTAL/4): 100 calories, 7.4 g fat, 3.7 g fiber, $1.04

For those whose mothers lived beyond 85, mortality rates were 40 per cent lower

The offspring of parents who live to a ripe old age are more likely to live longer themselves, and less prone to cancer and other common diseases associated with ageing, a study has revealed.

Experts at the University of Exeter Medical School, supported by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care in the South West Peninsula (NIHR PenCLAHRC), led an international collaboration which discovered that people who had a long-lived mother or father were 24% less likely to get cancer. The scientists compared the children of long-lived parents to children whose parents survived to average ages for their generation.

The scientists classified long-lived mothers as those who survived past 91 years old, and compared them to those who reached average age spans of 77 to 91. Long-lived fathers lived past 87 years old, compared with the average of 65 to 87 years. The scientists studied 938 new cases of cancer that developed during the 18 year follow-up period.

The team also involved experts from the National Institute for Health and Medical Research in France (Institut national de la santé et de la recherche médicale), the University of Michigan and the University of Iowa. They found that overall mortality rates dropped by up to 19 per cent for each decade that at least one of the parents lived past the age of 65. For those whose mothers lived beyond 85, mortality rates were 40 per cent lower. The figure was a little lower (14 per cent) for fathers, possibly because of adverse lifestyle factors such as smoking, which may have been more common in the fathers.

In the study, published in the Journals of Gerontology: Series A, the scientists analysed data from a series of interviews conducted with 9,764 people taking part in the Health and Retirement Study. The participants were based in America, and were followed up over 18 years, from 1992 to 2010. They were interviewed every two years, with questions including the ages of their parents and when they died. In 2010 the participants were in their seventies.

Professor William Henley, from the University of Exeter Medical School, said: “Previous studies have shown that the children of centenarians tend to live longer with less heart disease, but this is the first robust evidence that the children of longer-lived parents are also less likely to get cancer. We also found that they are less prone to diabetes or suffering a stroke. These protective effects are passed on from parents who live beyond 65 – far younger than shown in previous studies, which have looked at those over the age of 80. Obviously children of older parents are not immune to contracting cancer or any other diseases of ageing, but our evidence shows that rates are lower. We also found that this inherited resistance to age-related diseases gets stronger the older their parents lived.”

Ambarish Dutta, who worked on the project at the University of Exeter Medical School and is now at the Asian Institute of Public Health at the Ravenshaw University in India, said: “Interestingly from a nature versus nurture perspective, we found no evidence that these health advantages are passed on from parents-in-law. Despite being likely to share the same environment and lifestyle in their married lives, spouses had no health benefit from their parents-in-law reaching a ripe old age. If the findings resulted from cultural or lifestyle factors, you might expect these effects to extend to husbands and wives in at least some cases, but there was no impact whatsoever.”

In analysing the data, the team made adjustments for sex, race, smoking, wealth, education, body mass index, and childhood socioeconomic status. They also excluded results from those whose parents died prematurely (ie mothers who died younger than 61 or fathers younger than 46).

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.

New research from the University of Reading has shown that eating four slices of bread containing beetroot lowers blood pressure and improves the function of blood vessels, significantly improving heart health.

The researchers provided 24 participants with four slices (200g) of bread containing 100g of beetroot, or control bread with no beetroot enrichment once on two separate occasions. They found the diastolic¹ blood pressure of those who consumed ‘beetroot bread was lowered by up to 7 mmHg when compared to the control group approximately 3 hours after consumption.

Evidence suggests that a reduction in diastolic blood pressure of 5-6 mmHg over a five year period could reduce the chances of a stroke by 38% and coronary heart disease by 23% less. In addition, prolonged high blood pressure is an important risk factor for the development of heart disease, which is the single biggest killer in the UK, causing nearly 179, 000 deaths per year.

The component of beetroot bread thought to be responsible for the beneficial effects on blood vessel function and blood pressure is dietary nitrate. Dietary nitrate is a natural component of beetroot and a number of other vegetables such as spinach, lettuce and rocket.

When dietary nitrate is eaten it produces nitric oxide in the blood vessel wall which causes relaxation of the vessel and increased blood flow. This ultimately results in lowering of blood pressure and an improvement in blood vessel function.

Julie Lovegrove, Professor of Human Nutrition, Head of the Hugh Sinclair Unit of Human Nutrition and the Deputy Director of the Institute for Cardiovascular and Metabolic Research (ICMR) at the University of Reading, who led the study said: "These exciting and novel findings show for the first time that bread containing beetroot improves blood vessel function. This is an important addition to the increasing body of evidence that suggests beneficial effects of dietary nitrate rich foods on the heart.

"This research also supports the findings of our previous study which was carried out last year and showed that beetroot in the form of juice or bread lowers blood pressure. Collectively, these studies suggest a potential role for foods rich in dietary nitrate in the management of high blood pressure."

The study, published in the Journal of Nutrition, was undertaken by Dr Ditte Hobbs in the University of Readings Hugh Sinclair Human Nutrition Group, which has an international reputation for its research into the relationship between diet and the risk of chronic disease such as cardiovascular disease, diabetes, neurodegenerative disease and cancer.

The Disease Management Care Blog recently received a curious email from the Patient Centered Primary Care Collaborative.  As readers may recall, this is the Washington DC-based coalition that advocates on behalf of the Patient Centered Medical Home(PCMH). 

The content of that rather defensive communication can be found here.

What provoked this? The premier internal medicine specialty journal, the Annals of Internal Medicine, published a comprehensive review of the peer-reviewed literature on the PCMH, and its authors skeptically concluded:

The PCMH holds promise for improving the experiences of patients and staff and potentially for improving care processes, but current evidence is insufficient to determine effects on clinical and most economic outcomes

Ouch. No "economic outcomes" means that there is no proof that the PCMH saves money.

Unlike the PCPCC membership, regular DMCB readers arent surprised.  For example, the DMCB pointed out months ago that the U.S. governments Agency for Healthcare Research and Quality ("AHRQ") had concluded the same thing.  Countless other DMCB posts on the medical home have pointed out that there were problems with the published PCMH literature (for example, here and here).

Thanks to a past Congressional Budget Office report, the DMCB feels the PCPCC pain. It also knows that a) finding statistically significant cost savings in health insurance data bases are notoriously difficult, b) successful medical home initiatives that are outside the academisphere are the least likely to be reported it in the peer-reviewed literature, c) "savings" isnt the only measure of patient value and d) journals like the Annals of Internal Medicine are being sidelined by innovators who are more astute judges of what works for their patients.

Whats changed for the medical home and the PCPCC after this unpleasant dust-up?  Ultimately nothing. Pairing nurses and physicians in team-based care, whether its done remote telephonic "disease management" style or in the clinic "medical home" style is ultimately a good idea with obvious face validity. The Annals problem is that we dont have pristine scientific methodologies that can identify, capture and measure the benefit.

The good news is that the science is getting better. Until it catches up, the population health and disease management service providers will remain in business and the medical home will continue to have a bright future.

Hi team CHG! Gonna keep this one a little short today, so I may bask in the glorious shiny thing thats planted itself in the middle of the sky. Yes, Im talking about the alien ship. We are theirs now, and I, for one, greet our green-gilled overlords.

1) The Atlantic: The World-Class Local Foods That Gardeners Have Overlooked
Neat, neat piece by Hunger Angler Gardner Cook blogger Hank Shaw about oft-ignored food that grows in the wild. Groundnuts, ho!

Wiki - Ansel Adams

2) New York Times: Itinerant Life Weights on Farmworkers Children
The families who pick our vegetables have children who must go to school. Only, they have it way, way, way tougher than other kids.

3) Oregon Live: The pantry principle - Serve up easy dinners by cooking what you have
I love the Oregonians food articles because theyre always way thoughtful and extensive. This ones another winner.

4) Grub Street: Americas Next Great Restaurant (Recap)
Why watch the show when David Rees recaps are so much fun?

5) Huffington Post: Giving Back - How You and the Food Community Can Help Struggling Families
Marcus Samuelsson says: Buy local. But with more words and better explanations.

6) Diner’s Journal: The DIY Cooking Bibliography
Love this link roundup of make-it-yo-dang-self blogs, focusing on food and the kitchen. Especially helpful if youre into preserving.

7) Food Politics: Soda companies vs. soda taxes - breathtaking creativity
Though their products are almost always mentioned as part of the reason for the rise in obesity, Pepsi, Coke, and similar businesses are making huge contributions toward anti-obesity initiatives. And the cycle continues.

8) Wise Bread: Affordable Sustainable Seafood Choices for Your Table
Nice little roundup with some unexpected suggestions. (Seaweed!) Also worthy of notice: squid, clams, sardines and anchovies, as well as various other shellfish and some cephalopods.

9) Casual Kitchen: An Easier Way to Crack an Egg - Blunt Force Trauma
Love the title, love the process.

10) Money Saving Mom: My Stock-Up Price List
Crystal finally shares what shell pay for food. We are rank amateurs, people.

HONORABLE MENTIONS

The Epi-Log: Best Recipes for New Teen Vegetarians?
Chili! Chili!

Food Politics: Once again, kids per foods in packages with cartoons
Um … duh?

Serious Eats: What You Should Know About the Primer
"The Farm Bill, formally titled the Food, Conservation, and Energy Act, is a huge piece of legislation. Its 15 titles outline policies ranging from crop subsidies to agricultural research to nutrition programs." Will it be affected by the newfangled initiatives towards healthier eating? Remains to be seen.

Words to Eat By: Food Swap in The New York Times
Yay Deb!

AND ALSO

Endless Simmer: 100 Ways to Cook with Guinness
Guinness: Its not just for drinking anymore. You can eat it now, too.

From Wiki Commons Koolgiy

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