A challenging, clarifying, provocative style*

Gavin Mooney entered my life in the mid 1980s when he addressed the Sydney PHA conference entitled Just Health.  What does equity mean, he asked us?  Same cash-for-health for everyone?  Same opportunity for access to care for everyone?  Same outcome after treatment for everyone?  His challenging, clarifying, provocative style remained during the 25 years I knew him.

Gavin’s concern was always with the ethical quality of equity, which he came to summarise in relation to health, as equal access to equal care for equal need.  He developed with other health economists including Culyer the concepts of vertical equity (positive discrimination for those in unequal circumstances) and horizontal equity (giving equal care to those in the same socioeconomic bracket) as applied to health.  He was a strong communitarian, aligned in many respects with Amartya Sen, and a deep critic of neoliberalism, as his last book showed.  His criticism was his strongest card: in speaking with him about his final book I asked him “What now?  What can we do?”  This was far from clear. But a man of action he could be – witness his interest and work in Indigenous health and citizen’s juries.

A Scot to the core, and from Glasgow to boot, I was always surprised not to see him dressed more often in kilt and sporran.  His polemic and critique were modelled on tossing the caber.  This was a symbol of the way he criticised, assembling his arguments like a huge wooden pole, heaving the thing up on his shoulder, running and then letting it fly until it thudded into the ground with a mighty impact.

I have a picture of Gavin in my head, walking the Valley of the Waters in the Blue Mountains of New South Wales with us, when our son James was two.  Gavin had him on his shoulders and James, never one then or now to miss a moment for a politically correct and endearing statement (he is now 19), kept saying, as was indeed true as we passed cascade after cascade, ‘Bootiful waterfor!’ Bootiful indeed – a memory I feel fortunate to possess.

*Previously published in Croakey

The Potato Diet

In 2010, I wrote a series of blog posts on the health properties of potatoes (1, 2, 3).  The evidence showed that potatoes are non-toxic, filling per calorie, remarkably nutritious, and can be eaten as almost the sole source of nutrition for extended periods of time (though I'm not recommending this).  Traditional South American cultures such as the Quechua and Aymara have eaten potatoes as the major source of calories for generations without any apparent ill effects (3).  This is particularly interesting since potatoes are one of the highest glycemic and most insulin-stimulating foods known.

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Food Reward Friday

This week's "winner"...

The Pizza Hut hot dog stuffed crust pizza!

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Is it Time to Re-write the Textbooks on Insulin and Obesity? Part II

A new paper published on December 6th in the journal Science once again tackles the question of whether elevated insulin drives the development of obesity (1).  Mice were generated that lack Jun kinases 1 and 2 specifically in immune cells, impairing their ability to produce inflammation while having very few off-target effects.  These mice do not become insulin resistant when placed on a fattening diet, and their insulin levels do not increase one iota.  Are they protected from obesity?  People who read the last post should know the answer already.
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Food Reward Friday

This week's "winner"... Kellogg's Krave cereal!

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Is it Time to Re-write the Textbooks on Insulin and Obesity?

A recent study in Cell Metabolism by Dr. Arya Mehran and colleagues found a result that, according to a press release, "could overturn widely accepted notions about healthy eating habits" (1), and has set the Internet abuzz.

In this study, researchers generated mice that lack one copy of the pancreatic insulin gene, and compared them to mice carrying both copies (2).  Then, they exposed both groups to a fattening diet, and found that mice lacking one copy of the insulin gene secreted less insulin than the comparison group (i.e., they did not develop the same degree of hyperinsulinemia).  These mice were also completely resistant to fat gain, while the comparison group became obese.  The authors came to some rather large conclusions based on these results, suggesting that the "accepted model" that hyperinsulinemia is the result of obesity is "incompatible with our results that put the insulin hypersecretion genetically upstream of obesity".  Ergo, diet causes hyperinsulinemia, which causes fat gain.  It's a familiar argument to those who frequent Internet diet-health circles, except in this case the hyperinsulinemia is caused by a high-fat diet.

The problem is that the "accepted model" they want to replace overnight didn't come out of thin air-- it emerged from a large body of research, which was almost completely ignored by the authors.  When carefully considered, this evidence suggests an alternative explanation for the results of Dr. Mehran and colleagues.

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Food Reward Friday

This week's winner... the Starbuck's Double Chocolaty Chip Frappuccino!

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Facebook Revisited: Does the Platform Help or Hurt Users (or Both)?

The benefits and challenges of social media for public health are a frequent topic on Pop Health.  For example, I've explored the influence of these platforms on emergency response, increasing the number of organ donors, and health activism.  However, one of the debates that I hear the most among public health colleagues relates to Facebook.

Does it isolate users?  Does it connect users?  Does it do both?

Earlier this year, my colleague Elana Premack Sandler explored this debate as it relates to loneliness.  Inspired by a feature in the Atlantic Magazine, Elana asks key questions like, "Is Facebook part of the separating or part of the congregating?"  She also mentions concerns about how Facebook (and other social media platforms) affect our social skills and therefore our friendships.

I thought of Elana's writing as I read a new post on the Atlantic website today, "Are Your Facebook Friends Stressing You Out?  (Yes.)".  This post highlights a new report out from the University of Edinburgh Business School.  The report caught my eye because it identified a very specific cause of stress for Facebook users.  The more groups of "friends" a user had (e.g., family, real life friends, co-workers, etc), the more anxiety they had because there was a greater chance of offending someone with their posts.  The report stated that the greatest anxiety came from adding parents or employers as Facebook "friends".  As Megan Garber writes so eloquently in her Atlantic post, the stress comes from Facebook forcing users to "conduct our digital lives with singular identities".  The way we speak or act around family or friends or co-workers must jive on Facebook, or we run the risk of offending someone.  I'm sure many of us saw this conflict a few weeks ago when political and election posts ran rampant on Facebook!

The anxiety described above is interesting, because ideally what we would hope is that Facebook provides a source of social support to users.  Social support occurs when one is cared for by others (via emotional, tangible, or informational support).  The presence or absence of social support is a factor related to public health issues, such as suicide.    

So after reading through the various posts/articles, what do I think about my opening questions about Facebook?

Does it isolate users?  Does it connect users?  Does it do both?

I think it does both.  I have seen it do both.  For example:

Isolation:  I have spoken to friends and colleagues who feel terrible about themselves or their lives after scrolling through their Facebook news feed.  A friend with chronic illness feels isolated hearing about the latest vacation or new job taken by her "friends".  A friend suffering from infertility can't bear one more picture of a "friend" and their newborn.  I think much of this results from the "whitewash" that many of us put on Facebook.  We often paint a picture for our Facebook friends, full of engagements and babies and fun events.  

Connection:  Earlier this year I watched a suicide intervention unfold on Facebook via the comment section under a post.  A friend of a friend posted a suicidal message on their Facebook wall.  Within minutes, "friends" reached out in the comments.  However, not only did they "speak" to the person, but they interacted with each other and followed up in real life.  One comment read, "Did someone go to his house?"  The next comment read, "I went to his house and I called his parents".  After he was taken to the hospital, a comment was posted to inform all the friends that he was safe.  As a public health practitioner that worked in suicide prevention for years, I was amazed with what I saw. 

So what can we do to reduce the isolation/anxiety and increase the connection?  You can certainly start by exerting your control over your Facebook account.  For example:

• Create a policy about "groups of friends" that you accept into your circle.  I know lots of people that do not accept requests from co-workers or parents.  They make it clear to the individual that it is nothing personal, they just have minimal friends with which they share intimate information.
• Use the privacy settings!  You can control who can see your posts.
• Find and use the unfriend button!  I have done this frequently.  If someone posts messages that are offensive or disrespectful regarding something that I've posted- I get rid of them quickly.
• Take a break from Facebook.  If you realize that Facebook is making you feel bad about yourself, take a break or disable your account.  Use that time to connect with your in real life (IRL) friends or family.

Tell me what you think!  

• Does Facebook isolate and stress us?  
• Does Facebook connect us?
• What other strategies can help to reduce the isolation and increase the connection on Facebook or other social media platforms?

Food Reward Friday

This week's winner: poutine!

While not as appetizing looking as the Monster Thickburger, poutine is probably more popular.  For those who aren't familiar, poutine is a large plate of French fries, topped with gravy and cheese curds.  It originated in Quebec, but has become popular throughout Canada and in the Northern US.

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Food Reward Friday

This week's winner: the Taco Bell Doritos Locos Taco!

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A Superstorm of Social Media

Over the past week, there has been widespread discussion regarding the broad reach and value of social media during Superstorm Sandy.  Jim Garrow wrote about the emergency management field's adoption of social media and the powerful influx of images received through those channels.  In the New York Times, Brian Stelter and Jennifer Preston discussed how public officials use social media during a crisis.  Technology bloggers have posted analyses regarding the increase in internet use during the storm.

So what can Pop Health add?  I wanted to break down "social media use" even further.  I wanted to discuss the specific ways in which I saw it being used.  And although I think we all have a primarily positive view of social media's contribution during an emergency, I think it is also important to highlight some of the challenges that may appear with these communication channels.

Let's start with the good stuff!  During and after the storm, I saw social media being used for:

Individual-Level Advocacy

Affected residents used social media to communicate directly with local and state officials to report property damage, ask questions, and request direct assistance.  For example:

• As the screen shot above shows, Cory Booker (the Mayor of Newark, NJ) has been corresponding directly with his residents on twitter and following up with the necessary supplies or services.

• Locally in Philadelphia, I've seen the same thing with Mayor Michael Nutter.  He has been messaging with citizens about downed trees and power, in order to direct assistance to areas that need it the most.

Community-Level Advocacy

One thing that amazed me during Sandy was the power of social media in terms of advocacy on behalf of whole communities (whether they be particular neighborhoods or cities).

• When Margate, Longport, and Brigantine, NJ were reopened after the storm, there was immediate and overwhelming protest to the toll on the Margate bridge.  Residents felt that it was extremely insensitive (and selfish) for the bridge owners to charge storm refugees to get back onto the island (especially when they had no choice but to take that particular route).  Through protests on twitter and Facebook, the bridge owners were persuaded to reverse their decision to charge.

• The decision to cancel the NYC marathon was a difficult- and some would say delayed- decision.  While objections to the marathon (and the resources it would require) were widespread, much of the discussion happened on social media.  These channels were used to post online petitions and plan protests.  As you know, the race was finally canceled two days before the start.

Donations

Social media has been a key place to ask for donations to help the victims of Sandy.  Some strategies have been more traditional (e.g., asking for donations for the Red Cross).  Others have been quite creative!

• For example, runners in the canceled NYC marathon could follow a link posted on twitter in order to donate their hotel room to someone displaced by the storm.

The power of social media lies in its reach and ability to deliver information in real time.  On the flip side, the concern is that false information can spread quickly as well.  Here are a few examples that happened during Sandy:

• If you were using social media when the storm hit, you may remember seeing many unbelievable images.  One that I saw over and over was a group of soldiers guarding the Tomb of the Unknown Soldier.  However, we later learned that this image was taken back in September.  Mashable pulled together a list of "7 Fake Hurricane Sandy Photos You're Sharing on Social Media".  

• A congressional campaign manager in NYC resigned after sending out false information on twitter.  One of the rumors he started was that the trading floor of the New York Stock Exchange had 3 feet of flood water.  Many of his tweets are shown here.

As you can imagine, there is great danger to the public's health if incorrect information is widely shared.  Residents may panic and evacuate from a location that is actually safe.  Emergency management and public officials may be distracted from the work at hand, because they have to deal with clarifying a rampant and destructive rumor.

I think we can all agree that the value of social media in a crisis far outweighs the potential challenges.  However, this is an important conversation to keep having and I'd like to hear from you:

• In addition to the examples above, how did you see social media used during Sandy?
• How can we be even more innovative?  In what ways could we use social media during a crisis that we haven't yet tried?
• How can we prevent false information from spreading during a crisis?

An Encouraging Trend

I was in the Seattle/Tacoma airport today, and I noticed quite a few people taking the stairs even though they're flanked by escalators.  It's been my impression lately that more people are using stairs than even five years ago.  I used to be the only weirdo on the stairs, but today I shared them with about ten other people.  I know Seattle isn't necessarily representative of the nation as a whole, but I (optimistically) think of it as the vanguard in this respect.

One of the healthiest things a person can do is build exercise into daily life.  You don't have to be Usain Bolt or Lance Armstrong to reap the benefits of exercise.  In fact, evidence is accumulating that moderate exercise is healthier than extreme exercise.  Taking the stairs instead of the elevator/escalator, walking or jogging even a modest amount, or standing for part of the day, can have an immediate, measurable impact on metabolic health (1).

Maybe it's macho, but I'll feel defeated the day I need a giant energy-guzzling machine to take me up a 15 foot incline.  I have legs, and I intend to use them.  Escalators are good for people who are disabled or have very heavy bags, but the rest of us have an opportunity to use our bodies in a natural and healthy way.  Part of the problem is how buildings are designed.  Humans tend to take the path of least resistance, and if the first thing we come across is an elevator, and the stairs are grimy and tucked away down some side hallway, we'll tend to take the elevator.  Architects in some places are building in more prominent stairways to encourage gentle exercise throughout the day.

Food Reward Friday

This week's lucky winner... the Hardee's MONSTER THICKBURGER!

Two 1/3 lb beef patties, four strips of bacon, three slices of American "cheese", mayo and bun.  This bad boy boasts 1,300 calories, 830 from fat, 188 from carbohydrate and 228 from protein.  Charred and fried processed meat, fake cheese, refined soybean oil mayo, and a white flour bun. You might as well just inject it directly into your carotid artery.  Add a large fries and a medium coke, and you're at 2,110 calories.  Who's hungry?  Actually I am.  

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Australians' attitudes about the health system improve!

In recent weeks, two important surveys have been released that provide insight into the health of Australians and their beliefs about the health system - The Menzies-Nous Australian Health Survey and the Australian Health Survey. These surveys highlight areas of success and opportunities for further work to be done. The key findings from the two surveys are outlined below.

Menzies-Nous Australian Health Survey - The full report can be found here. 

How did Australians rate their health in 2012? 

• The majority of Australians rated their health as excellent, very good or good (86%)
• Younger Australians were more likely to rate their own health positively
• Higher levels of financial stress were associated with lower ratings of personal health
• Higher levels of education were associated with more positive health ratings

Has this changed since surveys conducted in 2008 and 2010?

• The ratings by Australians of their own health improved slightly between 2008 and 2012

How did Australians rate the health system in 2012? 

• Australians expressed a high level of confidence in the health care system. Over 85% of Australians expressed confidence in how the health care system would serve them if they were severely ill
• General Practitioners and pharmacies were the most highly used health care services in Australia between July 2011 and July 2012. Pharmacists had the highest rating of services as good-excellent. Services offered by mental health providers received the lowest rating. Australians were most satisfied with their recent visit to a pharmacy. They were least satisfied with their last visit to a residential aged-care facility or nursing home
• Australians living in capital cities generally had a more positive view of the health care system
• The need for more doctors, nurses and other health workers was identified as the area of the health system needing the most improvement
• Australians under high levels of financial stress were substantially less confident in being able to afford the care they needed compared with those with no financial stress. They were also more likely to use mental health providers and less likely to use dentists

Has this changed since surveys conducted in 2008 and 2010?

• Australians have a more positive view of the healthcare system compared to 2008
• Australians rated the services offered by dentists lower in 2012 compared to 2012
• Accessibility to General Practitioners did not change significantly in 2012 when compared with 2010, both for waiting time for an appointment and for after-horus acccess

Australian Health Survey - The full report can be found here.

Have risk factors changed since 2007-08?

Tobacco smoking - Rates of daily smoking have continued to drop to 2.8 million people (16.3%) aged 18 years and over in 2011-12 from 18.9% in 2007-08 and 22.4% in 2001.

Alcohol consumption

• The proportion of people aged 18 years and over who consumed more than two standard drinks per day on average, exceeding the National Health and Medical Research Council lifetime risk guidelines decreased to 19.5% in 2011-12 from 20.9% in 2007-08
• 44.7% of people aged 18 years and over consumed more than four standard drinks at least once in the past year, exceeding the National Health and Medical Research Council single occasion risk guidelines

Overweight and obesity

• Prevalence of overweight and obesity in adults aged 18 years and over has continued to rise to 63.4% in 2011-12 from 61.2% in 2007-08 and 56.3% in 1995
• However the prevalence of overweight and obesity in children aged 5-17 has remained stable at 25.3% in 2011-12

Physical measurements

• In 2011-12, the average Australian man (18 years and over) was 175.6 cm tall and weighed 85.9 kg. The average Australian woman was 161.8 cm tall and weighed 71.1 kg
• Between 1995 and 2011-12 the average height for men increased by 0.8 cm for men and 0.4 cm for women
• Between 1995 and 2011-12 the average weight for men increased by 3.9 kg for men and 4.1 kg for women

Waist circumference

• In 2012-12, 60.3% of men aged 18 years and over had a waist circumference that put them at an increased risk of developing chronic disease, while 66.6% of women had an increased level of risk
• On average, men had a waist measurement of 97.9 cm while women had a waist measurement of 87.7 cm

Blood pressure - In 2011-12, just over 3.1 million people (21.5%) aged 18 years and over had measured high blood pressure (systolic or diastolic blood pressure equal to or greater than 140/90 mmHg)

Food Reward Fridays

Each Friday, I'm going to post a picture of a modern food so ridiculous it makes you want to laugh and cry at the same time.  I'm doing this for two reasons:

1. To raise awareness about the unhealthy, fattening foods that are taking over global food culture.  These are highly rewarding, highly palatable, energy-dense foods that drive people to eat in the absence of hunger, and continue eating beyond calorie needs.  In many cases, the foods have been specifically designed to maximize "craveability" and palatability.
2. Because it's funny.

Without further ado... the first lucky winner:

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October is [Fill in the Blank] Awareness Month- A Guest Post for "The Public's Health"

Today I had the pleasure contributing another guest post on "The Public's Health".  The blog is a collaboration between the Drexel University School of Public Health and Philly.com.  In multiple posts each week, the authors highlight contemporary, historical, and ethical matters that challenge public health professionals.

In today's post, I examine health "awareness campaigns" and discuss their effectiveness for improving public health.

What do you think:  Is the public burned out on annual health observances? Or are they effective in helping to prevent illness/disease? In what other ways can organizations and individuals become more action-oriented to help improve the public’s health?

Rent The Runway Rocks Real Non-Airbrushed Models: Us!

Like many of you, I have tried ordering clothes online.  And it never goes well.  They are always too tight or too long.  They immediately make you feel bad about yourself.  And of course- it is a huge pain to have to pack it up again and mail it back.  And after all that- you still don't have anything to wear!!  Weird, right?  The clothes looked great in the pictures.

 

The frustration of online shopping is a symptom of a larger problem.  Many fashion lines are not made to fit the average woman.  Rader Programs, a group of  eating disorder treatment facilities, estimates that the average model weighs 117 pounds at 5'll and the average woman weighs 140 pounds at 5'4.  No wonder my purchases are too tight and too long!

 

However, I'm feeling optimistic about change being possible in the fashion world.  As of last week, Rent The Runway, an online service that lets users borrow current season high-fashion, has expanded their  use of real women as models on their site.  Users can upload pictures of themselves in the clothes, and include details about their height, weight, and chest size.  The site will also have the capacity to allow users to search for women of similar body type, so that they can see how the clothes actually fit.  I think this is fantastic.  Not only will it hopefully cut down on the dreaded returns, but women will see models that look like them.  It can reduce the shame and stigma that many women feel for lacking the 117 pounds at 5'll "ideal".

 

This initiative follows what I hope is a pattern of push back on pop culture for upholding women to unrealistic ideals that may lead to unhealthy body image.  For example, we are seeing opposition to magazine airbrushing.  Earlier this year, an ambitious eighth-grader put the pressure on Seventeen Magazine to review its policies on airbrushing and consider the impact it could have on young readers.  Her online petition led the magazine to sign an eight-point "Body Peace Treaty", which outlined a commitment to never change models' body or face shapes. 

 

We are seeing celebrities (especially recently!) disclosing their battles with eating disorders- often discussing the pressure they felt being in the entertainment industry.  Over the past few months, we've heard from Katie Couric, Nicole Scherzinger, and Stacy London.   Last year, Pop Health reviewed Portia De Rossi's book- Unbearable Lightness, which discussed her life-threatening eating disorder in much detail. 

 

I hope that we are continuing to see a shift.  I hope that there is less stigma in disclosing or discussing body image concerns and eating disorders.  I also hope that the public continues to make their voices heard...whether they are fighting the magazine airbrush or the high fashion gown that will look terrible on anyone under 5'10.

 

What do you think:  With the initiatives above and their predecessors (e.g., the Dove Campaign for Real Beauty)- do you see evidence of a shift in pop culture from "thin" to "real women"?  What else needs to change to keep this initiative moving forward?

 

 

 

 

 

 

 

Candy at the Cash Register

Last week, the New England Journal of Medicine published an interesting editorial titled "Candy at the Cash Register-- a Risk Factor for Obesity and Chronic Disease."  This fits in well with our discussion of non-homeostatic eating, or eating in the absence of calorie need.

There are a few quotes in this article that I find really perceptive.

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Photos and More Gardening

I've needed new professional and blog photos for a long time.  My friend Adam Roe was in town recently, and he happens to be professional photographer, so he graciously offered to snap a few shots.  Despite less than ideal conditions, he did an outstanding job.  Here's a larger version of the photo on my profile (which Blogger shrinks down to a tiny thumbnail):

To see more of Adam's work, head over to his Facebook page, and don't forget to 'like' and share it if you enjoy it.  Adam is currently based in Berlin.

Gardening Update

Here's a photo of today's harvest (taken by me, not Adam; you can tell by the poor focus and primitive lighting):

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More Thoughts on Macronutrient Trends

I had a brief positive exchange with Gary Taubes about the NuSI post.  He reminded me that there's an artifact (measurement error) in the USDA data on fat consumption in the year 2000 when they changed assessment methods.  Here are the USDA data on macronutrient consumption since 1970, corrected for loss (28.8%) but not corrected for the artifact:

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Nutrition Science Initiative (NuSI)

Some of you may have heard of an ambitious new nutrition research foundation called the Nutrition Science Initiative (NuSI).  In this post, I'll explain what it is, why it matters, and how I feel about it-- from the perspective of an obesity researcher. 

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Calories and Carbohydrate: a Natural Experiment

In the lab, we work hard to design experiments that help us understand the natural world.  But sometimes, nature sets up experiments for us, and all we have to do is collect the data.  These are called "natural experiments", and they have led to profound insights in every field of science.  For example, Alzheimer's disease is usually not considered a genetic disorder.  However, researchers have identified rare cases where AD is inherited in a simple genetic manner.  By identifying the genes involved, and what they do, we were able to increase our understanding of the molecular mechanisms of the disease.

The natural experiment I'll be discussing today began in 1989 with the onset of a major economic crisis in Cuba. This coincided with the loss of the Soviet Union as a trading partner, resulting in a massive economic collapse over the next six years, which gradually recovered by 2000. 

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A Late Summer Harvest

It's been a good year for gardening in Seattle, at least in my garden.  Thanks to great new tools* and Steve Solomon's recipe for homemade fertilizer, my house has been swimming in home-grown vegetables all summer.  I'm fortunate that a friend lets me garden a 300 square foot plot behind her house.  Here's a photo of part of today's harvest; various kale/collards, zucchini, tomatoes and the last of the pole beans:

Perfect for the Eocene diet.  

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Does Calorie Restriction Extend Lifespan in Mammals?

Until about two years ago, the story went something like this: calorie restriction extends lifespan in yeast, worms, flies, and rodents.  Lifespan extension by calorie restriction appears to be biologically universal, therefore it's probably only a matter of time until it's demonstrated in humans as well.  More than 20 years ago, independent teams of researchers set out to demonstrate the phenomenon in macaque monkeys, a primate model closer to humans than any lifespan model previously tested.

Recent findings have caused me to seriously question this narrative.  One of the first challenges was the finding that genetically wild mice (as opposed to inbred laboratory strains) do not live longer when their calorie intake is restricted, despite showing hormonal changes associated with longevity in other strains, although the restricted animals do develop less cancer (1).  One of the biggest blows came in 2009, when researchers published the results of a study that analyzed the effect of calorie restriction on lifespan in 41 different strains of mice, both male and female (2).  They found that calorie restriction extends lifespan in a subset of strains, but actually shortens lifespan in an even larger subset.  Below is a graph of the effect of calorie restriction on lifespan in the 41 strains.  Positive numbers indicate that calorie restriction extended life, while negative numbers indicate that it shortened life:

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SOCIAL MEDIA AND THE MEDICAL PROFESSION

I am a Luddite when it comes to social media, the web-based interactive media such as Facebook and other more professionally oriented ones like Linkedin.  I do have a Facebook page but I rarely use it. I have a blog where I post my poetry http://stephenleeder.blogspot.com.au/but no one ever visits and another blog where I post extended versions of articles like this
http://steve-leeder-better-health.blogspot.com/. And yes, I have Tweeted 30 times!  Basically, I stick to email.

But my youngest son (19) belongs to a generation for whom social media are a principal social communication channel. Recent medical graduates know all about it and how to use it wisely and well. It serves to link doctor to doctor and to some extent patient to doctor.

Social media according toWikipedia includes “web- and mobile-based technologies that are used to turn communication into interactive dialogue among organisations, communities and individuals”.

Today, news travels like lightning via Twitter and Facebook.  "A common thread," says Wikipedia, "running through all definitions of social media is a blending of technology and social interaction for the [rapid] co-creation of value."

Social media are cheap to use.  Anyone can publish on them unlike on the commercial media.  And they are immediate: whereas it may take weeks to get an idea into print, with social media communication is now. You can edit an article easily on social media whereas reprinting to correct an error is a nightmare. 

Are the social media likely to be professionally useful?  My guess is that they will prove to be so.  A group of general practitioners could use social media to discuss how best to manage a group of patients in a local nursing home. But they might get their fingers burnt unless the social medium they were using was fenced off, like a gated village, for their use alone. 

Australian Doctorhas established docs4docs for that purpose.  Take a look at http://just4docs.com.au/index.php/forums/topic/26/medicare-localsand see as an example a series of depressing conversational comments on Medicare Locals

If you are going to use social media for professional purposes please be careful.  A list of questions to ask yourself before you get too deeply into social media were provided in a paper published in the Medical Journal of Australia last year by a working group drawn from the AMA Council of Doctors in Training, NZMA Doctors-in-Training Council, AMSA, and the New Zealand Medical Students’ Association (NZMSA).

A guide from which the MJA paper was drawn can be found at http://ama.com.au/socialmedia.  Here are the questions.

Have you ever Googled yourself? Do you feel comfortable with the results that are shown?

Have you ever:

• Posted information about a patient or person from your workplace on Facebook?

• Added patients as friends on Facebook or MySpace?

• Added people from your workplace as friends?

• Made a public comment online that could be considered offensive?

• Become a member or fan of any group that might be considered racist, sexist, or otherwise derogatory?

• Put up photos or videos of yourself online that you wouldn’t want your patients, employers or people from your workplace to see?

• Felt that friends have posted information online that may result in negative consequences for them? Did you let them know?

• Checked your privacy settings?

So there you have it!  Good luck but take care!

Madonna's "MDNA Show Manifesto" Defends Using Guns on Tour: Do You Agree?

As we speak, Madonna is en route to my city- Philadelphia, to launch the North American leg of her "MDNA World Tour".  In advance of her arrival, she has released a statement to the local Metro defending one of the most controversial parts of her tour...the use of fake firearms in concert.  Here is a portion of that statement:

"It's true there is a lot of violence in the beginning of the show and sometimes the use of fake guns - but they are used as metaphors.  I do not condone violence or the use of guns.  Rather they are symbols of wanting to appear strong and wanting to find a way to stop feelings  that I find hurtful or damaging.   In my case its wanting to stop the lies and hypocrisy of the church,  the intolerance of many narrow minded cultures and societies I have experienced throughout my life and in some cases  the pain I have felt from having my heart broken".

Gun violence is (unfortunately) not a new problem.  However, the topic is quite timely due to increased U.S. media coverage following several mass shootings in the past few weeks- Aurora, CO, Oak Creek, WI, and New York, NY.  The issue of gun violence has reached crisis levels in Philadelphia where Madonna will be performing.  A new open source journalism project called http://guncrisis.org/ "contends that there is an epidemic of homicide by gunfire in Philadelphia and similar cities".  They are seeking solutions.

The solutions being sought by GunCrisis: Philadelphia and others involve taking a public health approach to gun violence.  The recent high profile shootings have produced several well-written pieces about gun violence and what we need to do next:

•  Prompt policy discussions about easy access to ammunition, high-capacity magazines, and assault weapons.
• Use our public health skills to conduct further research into the causes of firearm injuries.
• Examine gun violence as a social disease- one that stems from a society "saturated with guns".

Tell me what you think:

Do you believe that the gun "saturation" goes beyond those in our homes to include those used for entertainment?  E.g., Guns in movies or video games; Madonna's concert props

Is Madonna successful? Does using guns as a metaphorical image help her reach her goals and battle against hypocrisy and intolerance?

In addition to those listed above, what other strategies should we incorporate into a public health approach against gun violence?

AHS11 Talk Posted

After a one-year delay, my talk from the 2011 Ancestral Health Symposium is online with slides synched.  The talk is titled "Obesity: Old Solutions for a New Problem", and it's an overview of some of the research linking food reward to food intake and body fatness.  This is the talk that introduced a fundamentally new idea to the ancestral community: not only does the chemical composition of food matter, but also its sensory qualities-- in fact, the sensory qualities of food are among the primary determinants of food intake.  I didn't come up with the idea of course, I simply translated the research for a more general audience and put my own evolutionary spin on it.

The talk would be a bit different if I were to give it today, as my understanding of the subject has expanded, and my speaking skills have improved.  However, the central message remains as true today as it was a year ago.  You can find the talk here.

The slide synching was done by an extremely generous man named Ben Fury.  As you can see in the video, he did an excellent job.  Without Ben, this video would have remained in internet limbo forever.

Below, I've published a message from Ben explaining the interesting work that he does.  Please contact him if you think it's interesting.

A Message from Ben Fury

I was writing a book on health, fitness and diet in 2009 when my house burned down in the Station Fire, along with 165,000 acres of my beloved Angeles National Forest. Since then, I've had a series of people needing help come through my life, that have upgraded and morphed my talents...

Seniors with chronic pain, falls, brittle bones, and stiff shrunken muscles.
Diabetics with out of control blood sugars, going blind, and having limbs lopped off.
Neurologically challenged people with spastic limbs and foggy brains.
Fat, listless, unhappy people with no idea how they got that way, seeing no way out of the darkness.
Each of them needing help in different ways, but all with an underlying theme of what works to help heal our conditions:

•     Remove flour, sugar, beans, and heavily processed oils from our diet. Eat real food.
•     Get strong.
•     Get flexible.
•     Stop ceding health responsibility to outside forces, and take charge of our own wellness.
•     Only use truly evidence based medicine. Don't just pop the latest pill or get the latest surgery all the other people are doing. Be wary of the disease mongers in both the conventional and alternative camps.
•     Find our "happy thoughts." Use the simple restoratives of sleep, play, and reflection, to let go of pain, find inner peace, and let in joy and purposeful outer direction.

The methods to accomplish these goals are varied, and I have both non-profit and for-profit ventures to share them.
Their websites are currently in development.
The for-profit is BenFury.com
The non-profit is PainRelieversUSA.org , whose mission statement is:

To move beyond pain management...
and learn to live pain free.

Feel free to write to me  at: ben [at] benfury dot com

Ancestral Health Symposium 2012

I recently returned from AHS12 and a little side trip to visit family.  The conference was hosted at Harvard University through the Harvard Food Law Society.  Many thanks to all the organizers who made it happen.  By and large, it went smoothly.

The science as expected ranged from outstanding to mediocre, but I was really encouraged by the presence and enthusiastic participation of a number of quality researchers and clinicians. The basic concept of ancestral health is something almost anyone can get behind: many of our modern health problems are due to a mismatch between the modern environment and what our bodies "expect".  The basic idea is really just common sense, but of course the devil is in the details when you start trying to figure out what exactly our bodies expect, and how best to give it to them.  I think our perspective as a community is moving in the right direction.

Read more »

Lorcaserin: the Latest FDA-approved Obesity Drug

The FDA recently approved a new drug called lorcaserin (brand name Belviq) for the treatment of obesity.  Lorcaserin causes an average of 13 lbs (5.8 kg) of weight loss over a year, compared to 5 lbs (2.2 kg) for placebo (1), which is less than the other recently approved drug Qsymia (formerly Qnexa; topiramate/phentermine).

Learning about obesity drugs is always a good opportunity to gain insight into the mechanisms that underlie the development and reversal of obesity.  If you've been following this blog for a while, you already have a pretty good guess what organ this new drug acts on.  Make your guess and read on!

Read more »

Two Great Quotes About Obesity (technical)

By Dr. Hans-Rudolf Berthoud, from a recent paper, "The Neurobiology of Food Intake in an Obesogenic Environment" (1).  I came across it because it cites my review paper (2).  My perspective on obesity is similar to his.  From the abstract:

The modern lifestyle with its drastic changes in the way we eat and move puts pressure on the homoeostatic system responsible for the regulation of body weight, which has led to an increase in overweight and obesity. The power of food cues targeting susceptible emotions and cognitive brain functions, particularly of children and adolescents, is increasingly exploited by modern neuromarketing tools. Increased intake of energy-dense foods high in fat and sugar is not only adding more energy, but may also corrupt neural functions of brain systems involved in nutrient sensing as well as in hedonic, motivational and cognitive processing.

And a nice one from the conclusions:
Read more »

GOLD MEDAL DREAMING*

LET the Games begin! As the 2012 Olympic Games get underway in London, the spirit of competition and international goodwill that characterises the Olympics offers a rare chance to enjoy and admire excellence in abundance.

It is no surprise that another highly competitive field — health and medical research — holds an event modelled on the Olympic Games. In 2009, Beijing reprised its hosting of the 2008 Olympic Games, with a medical and surgical Olympiad, sponsored by the International Association of Surgeons, Gastroenterologists and Oncologists in collaboration with the Chinese Society of Surgery and the Chinese Medical Association.

Attending doctors competed, using scientific papers as their currency, the best receiving gold medals.

The Greek Embassy in Beijing described how the closing ceremony of the medical Olympics was dedicated to “the Greek culture, its scientific and medical history, and of course, to the renowned Greek physician Hippocrates who was born in the island of Kos in the Aegean in 460 BC and has been considered one of the most outstanding figures in the history of medicine”.

Greece hosted the first international medical Olympiad in 1996 on the island of Kos.

A different style of health-related Olympics was created by American filmmaker Michael Moore, known for his work on a number of satirical documentaries, including Sicko, an exposé of the inequalities and inefficiencies of the American health care system. Before Sicko, Moore created TV Nation: The Health Care Olympics, where Canada, the US and Cuba were matched against each other in three competitive races, involving the care of legs, ankles and feet, respectively.

This Olympic backdrop does raise the question of how much competition is good for health care.

Private enterprise enthusiasts suggest that we need a lot more competition than we currently have to “drive” efficiency. “Drive” is the new best friend of young managers so caution is advised with any rhetoric that uses it.

Competition may push health care towards excellence — and who could dispute that parts of the US health care system are the best in the world for those who can pay. The problem is the huge disparities that occur in quality of care for those who cannot pay.

What we need is a new set of medals for achieving equity, humanity and reasonable efficiency.

In that race Australia would do well, while at the same time winning many prizes for excellence of care much to the amazement of the market fundamentalists.

The irony is, of course, that while “One World One Dream” was the catchphrase for the Beijing Olympics, there is ultimately no way in our unequal world that a universal dream — the fulfilment of the human right to access to basic health care — can persist into wakefulness … not with more than 3 billion people living on less than $2.50 a day.

We must go beyond the Olympics to find the ethical inspiration needed to enable us to address poverty and inequality to achieve that dream.

Gold, indeed.

*Previously published in MJA InSight